Viscoelastometry guided fresh frozen plasma infusion for postpartum haemorrhage: OBS2, an observational study

Abstract

ISRCTN46295339 ( http://www.isrctn.com/ISRCTN46295339 ) (accessed July 24, 2017), EudraCT 2012-005511-11 ( https://www.clinicaltrialsregister.eu/ctr-search?query=2011-005511-11 ) (accessed July 24, 2017).

Four years' experience of a ROTEM®‐guided algorithm for treatment of coagulopathy in obstetric haemorrhage

“…Of the 203 women with EBL ≥ 1500 ml plus FibTEM A5 ≤ 12 mm, 187 had an ExTEM A5 < 47 mm. However, only 11 (5%) had an ExTEM CT > 100 s. These 11 women all exhibited severe clotting derangement, with ExTEM CT median (IQR [range]) 249 (136–293 [121–512]) s, FibTEM A5 3 (2–3 ) mm and ExTEM A5 10 (9–18 ) mm. Of these women, eight had placental abruptions of whom seven were associated with intra‐uterine death.…”

“…In addition, observational data from the study by Collins et al. found that withholding FFP in those without evidence of coagulopathy on point‐of‐care testing did not result in clinically significant haemostatic impairment .…”

Managing obstetric haemorrhage: is it time for a more personalised approach?

“…At one of the institutions participating in the Collins et al. study , there were significant reductions in red blood cell and plasma usage, obstetric haemorrhages with blood loss > 2500 ml, and critical care admissions across the whole population during the time of the study. When this study ended in November 2015, there was an increase in large haemorrhages similar to before the study and a local inquiry identified themes such as: the multidisciplinary team not attending the mother's bed‐side quickly; a return to estimating blood loss instead of the more accurate gravimetric assessment; viscoelastic haemostatic assays not being performed early; and delays in obstetric and haemostatic interventions .…”

“…This was demonstrated in the observational arm of a study by Collins et al. which enrolled 605 women experiencing moderate to severe postpartum haemorrhage . Fresh frozen plasma was not administered if FIBTEM A5 > 15 mm or bleeding had stopped.…”

“…Based on recent publications, the most recent British Society of Haematology guidelines on the use of viscoelastic haemostatic assays now differ from previous NICE guidance . By evaluating recent data from obstetric haemorrhage , they now recommend that fibrinogen replacement may improve haemostasis if FIBTEM A5 is < 7 mm, or < 12 mm with ongoing bleeding (Grade 2C). Of equal importance, they recommend that fibrinogen replacement is unlikely to improve clinical haemostasis if FIBTEM A5 is > 12 mm (Grade 2B).…”