Rotational Thromboelastometry Reference Range during Pregnancy, Labor and Postpartum Period

Abstract

Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) have become increasingly popular for urgent assessment of the hemostasis system. Accordingly, TEG and ROTEM algorithms and their corresponding cut-off values are not interchangeable. ROTEM provides fast results (including validated early clot firmness parameters [A5 and A10]), that are easy to use, and the graphical display of the results is easy to interpret. ROTEM manufacturer, Tem Innovations GmbH (Munich, Germany), mentions in the user manual that the manufacturer has not set any strict reference values for INTEM, EXTEM, FIBTEM, APTEM, and NATEM in any patient population (including pregnant women) and that these values are highly variable in healthy subjects. To date, no systematic review assessing ROTEM parameters in pregnant, parturient, and postpartum women is available. With the increasing usage of ROTEM, we conducted this systematic review and meta-analysis to determine the reference values of ROTEM parameters in pregnant, parturient, and postpartum women compared with non-pregnant population.

A Case Report of Rotational Thromboelastometry-Assisted Decision Analysis for Two Pregnant Patients With Platelet Storage Pool Disorder

“…ROTEM analysis at 28 weeks of gestation demonstrated normal values aside from a slightly prolonged extrinsically-activated test with tissue factor (EXTEM) clotting time of 76 seconds, with normal values during pregnancy between 31 and 67 seconds (Table 1). 8 PT, PTT, and platelet count were within normal limits. Given her hematologic history, abnormal ROTEM evaluation, and patient preference for an unmedicated delivery, it was decided to avoid neuraxial labor analgesia.…”

Efficacy of rotational thromboelastometry for diagnosis and correction of coagulopathy in massive postpartum hemorrhage: a cohort retrospective multi-center DiPTEM study

“…До внедрения РОТЭМ в обоих центрах оценка и принятие решения о необ ходимости применения препаратов и трансфузионных сред, влияющих на систему гемостаза, основывались, как правило, на 4 стандартных тестах коагулограммы: АЧТВ, МНО, уровень фибриногена и тромбоцитов. Учитывая длительное время ожидания, необходимое Нес мотря на исходное состояние гиперкоагуляции и гиперфибриногенемии у беременных и рожениц [15], большая роль при интенсивной терапии ПРК отводит ся уровню фибриногена в плазме крови, который не обходимо поддерживать выше 2 г/л [16][17][18][19]. Важный факт -это наличие корреляции между уровнем фибри ногена по Клаусу (2,0 г/л) и показателем А5 FIBTEM (12 мм) [20], который позволяет использовать РОТЭМ в качестве ран ней диагностики гипофибриногене мии [21].…”