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Cited by 113Trauma, Hemostasis, Coagulopathy, ResuscitationBlood transfusion and managementMaternal and fetal healthcare

Major obstetric haemorrhage: monitoring with thromboelastography, laboratory analyses or both?

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Karlsson, O., Jeppsson, A., Hellgren, M.·2014·International Journal of Obstetric Anesthesia
DOI 10.1016/j.ijoa.2013.07.003
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Abstract

Background Haemorrhage is a common cause of morbidity and mortality in the obstetric population. The aim of this study was to compare the use of thromboelastography and laboratory analyses to evaluate haemostasis during major obstetric haemorrhage. A secondary aim was to evaluate correlations between the results of thromboelastography, laboratory analyses and estimated blood loss.Methods Forty-five women with major obstetric haemorrhage and 49 women with blood loss <600 mL were included. The following thromboelastography analyses were performed: time to start of clotting (TEG-R), time to 20 mm of clot firmness (TEG-K), rate of clot growth (TEG-Angle), maximum amplitude of clot (TEG-MA) and lysis after 30 min (TEG-LY30). In addition, platelet count, activated partial thromboplastin time, prothrombin time, fibrinogen, antithrombin and D-dimer were measured.Results Thromboelastography variables reflecting clot stability and fibrinolysis were decreased in women with massive obstetric haemorrhage compared to women with normal bleeding, while clot initiation was accelerated. Laboratory analyses also showed impaired haemostasis with the most pronounced differences in platelet count, fibrinogen concentration and antithrombin activity. The strongest correlations existed between fibrinogen and TEG-MA and between estimated blood loss and TEG-MA, fibrinogen and antithrombin, respectively.Conclusions Impaired haemostasis, demonstrated by thromboelastography and laboratory analyses, was found after an estimated blood loss of 2000 mL. Thromboelastography provides faster results than standard laboratory testing which is advantageous in the setting of on-going obstetric haemorrhage. However, laboratory analyses found greater differences in coagulation variables, which correlated better with estimated blood loss.

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  • Point-of-care viscoelastic tests may direct resuscitative efforts to avoid over treatment.

    “Additionally, these point-of-care tests may direct resuscitative efforts to avoid over treatment (89–91).”

    From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [90]

    The Discussion (pp. 5–6) says point-of-care viscoelastic testing might guide appropriate blood-product decisions and provides faster guidance for intervention in major obstetric haemorrhage. It does not state that using these tests avoids overtreatment or show that overtreatment was reduced. (LLM, conf=0.83)

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Authors
Karlsson, O., Jeppsson, A., & Hellgren, M.
Affiliations
Sahlgrenska University Hospital (SE)
Corresponding author
Karlsson, O.
ORCID
Venue
International Journal of Obstetric Anesthesia
Publisher
Elsevier BV
Published
2014-02
Volume
23
Issue
1
Pages
10-17
ISSN
0959-289X (ISSN-L)
DOI
10.1016/j.ijoa.2013.07.003
OpenAlex
W2109264182
Cited by
113
References
42
Citations by year
2026: 5 · 2025: 5 · 2024: 8 · 2023: 10 · 2022: 12 · 2021: 9 · 2020: 8 · 2019: 12 · 2018: 11 · 2017: 13 · 2016: 7 · 2015: 7 · 2014: 5 · 2013: 1
FWCI
5.90
Type
journal article
Language
en
Open access
Locations
  • International Journal of Obstetric Anesthesia (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
  • Health Sciences › Medicine › Biochemistry › Blood transfusion and management
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
Keywords
obstetric hemorrhage, thromboelastography, hemostasis, coagulation monitoring, fibrinogen, antithrombin III, D-dimer, estimated blood loss, clot stability, fibrinolysis, platelet count, activated partial thromboplastin time, prothrombin time
MeSH terms
Adult, Antithrombins, Blood Coagulation, Female, Fibrin Fibrinogen Degradation Products, Fibrinogen, Postpartum Hemorrhage, Hemostasis, Humans, Partial Thromboplastin Time, Platelet Count, Pregnancy, Prospective Studies, Prothrombin Time, Thrombelastography

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