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Major obstetric haemorrhage: monitoring with thromboelastography, laboratory analyses or both?
Open accessAbstract
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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“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]
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“This hemodynamic collapse in AFE is caused by thromboplastin-mediated massive capillary leak, disseminated intravascular coagulation (DIC), renal failure, and potential cardiorespiratory collapse [16,20,31,32].”
BackgroundBlood management in post-partum haemorrhage, including point of care coagulation tests
Belete, M., Gerrans, E., & Keskar, M. (2021) · Signa Vitae · doi:10.22514/sv.2021.030 · Cited by 2
“This study used a TEG reagent that is designed to look at the intrinsic clotting pathway rather than isolate fibrinogen contribution to clot formation [42].”
Schram, M., Uys, F., Purcell-Jones, J., & Pfister, C. (2025) · International Journal of Obstetric Anesthesia · doi:10.1016/j.ijoa.2025.104342 · Cited by 1
Doyle, G. S., Theodore, A. A., & Hansen, J. N. (2017) · Trauma Surgery & Acute Care Open · doi:10.1136/tsaco-2016-000049 · Cited by 1
Lie, S. A., & Mok, M. U. S. (2017) · Proceedings of Singapore Healthcare · doi:10.1177/2010105817698160 · Cited by 1
Acquired Bleeding Disorders in Pregnancy: Obstetric Hemorrhage
Ponnampalam, S., Wilson, S., & Khalil, A. A. (2015) · Springer eBooks · doi:10.1007/978-3-319-15120-5_14 · Cited by 1
Огляд рекомендацій з інтенсивної терапії гострої масивної крововтрати в акушерстві
Sedynkin, V. A., & Кlygunenko, O. М. (2017) · EMERGENCY MEDICINE · doi:10.22141/2224-0586.5.84.2017.109359 · Cited by 1
Geburtshilfliche Anästhesie: Altbewährtes, Kontroversen und neue Perspektiven – Teil 2
Kranke, P., Annecke, T., Bremerich, D. H., Chappell, D., Girard, T., Gogarten, W., Hanß, R., Kaufner, L., Neuhaus, S., Ninke, T., et al. (2017) · AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie · doi:10.1055/s-0043-116682 · Cited by 1
“Kliniken, denen eine Point-of-Care-Gerinnungsanalyse zur Verfügung steht, sollten diese auch zur gezielten Substitution von Gerinnungsfaktoren bei anhaltender PPH einsetzen, da Untersuchungen zeigen konnten, dass Gerinnungsprodukte gezielter und in geringerem Umfang erforderlich werden, wenn eine engmaschige Therapiek…”
Fibrinolysis disorders in obstetric and gynecologic practice
Fedorenko, V. A., & Melnikov, A. P. (2022) · Russian Bulletin of Obstetrician-Gynecologist · doi:10.17116/rosakush20222206118 · Cited by 1
Tranexamic acid for obstetric hemorrhage: Prophylaxis, treatment, both, neither?
Smith, C. T., Arnolds, D. E., & Lim, G. (2021) · Anaesthesia Critical Care & Pain Medicine · doi:10.1016/j.accpm.2021.100953 · Cited by 1
Disseminated Intravascular Coagulation
Burn, M. S., Hosier, H., Hossain, N., & Paidas, M. J. (2024) · doi:10.1002/9781119820260.ch31 · Cited by 1
Fox, K. A. (2016) · Springer eBooks · doi:10.1007/978-3-319-30726-8_9
Roullet, S., de Maistre, E., Ickx, B., Blais, N., Susen, S., Faraoni, D., Garrigue, D., Bonhomme, F., Godiér, A., Lasne, D., et al. (2018) · Anesthésie & Réanimation · doi:10.1016/j.anrea.2018.01.005
The management of undiagnosed placenta percreta at caesarean section
Silva, S. D. (2018) · Journal of Perioperative Practice · doi:10.1177/1750458918755962
Geburtshilfliche Anästhesie Teil 2: Etablierte Standards und neue Perspektiven
Kranke, P., Annecke, T., Bremerich, D. H., Chappell, D., Girard, T., Gogarten, W., Hanß, R., Kaufner, L., Neuhaus, S., Ninke, T., et al. (2018) · Frauenheilkunde up2date · doi:10.1055/a-0592-4594
“Kliniken, denen eine Point-of-Care-Gerinnungsanalyse zur Verfügung steht, sollten diese auch zur gezielten Substitution von Gerinnungsfaktoren bei anhaltender PPH einsetzen, da Untersuchungen zeigen konnten, dass Gerinnungsprodukte gezielter und in geringerem Umfang erforderlich werden, wenn eine engmaschige Therapiek…”
BackgroundBlood Component Therapy and Massive Transfusion
Hui, S. R., Aagaard, K. M., & Teruya, J. (2018) · doi:10.1002/9781119129400.ch36
Endovascular Balloon Occlusion in Obstetrical Hemorrhage
Fox, K. A. (2019) · Hot topics in acute care surgery and trauma · doi:10.1007/978-3-030-25341-7_11
Point-of-Care Tests in for Blood Coagulation in the Perioperative Period
Leavitt, S. A., Missouri, S., Patel, D. J., & Scher, C. (2021) · Springer eBooks · doi:10.1007/978-3-030-59295-0_21
Dynamic Modelling of Obstetric Patient Coagulation from Kaolin-Activated Thromboelastogram Data
Fitzmaurice, K. P., Pressly, M. A., Clermont, G., Waters, J. H., & Parker, R. S. (2020) · IFAC-PapersOnLine · doi:10.1016/j.ifacol.2020.12.656
“2% of all pregnancy-related deaths between 2003 and 2011 (Kuriya et al. (2016)).”
BackgroundSchol, P. B. B., de Lange, N. M., Smits, L. J. M., Henskens, Y., & Scheepers, H. C. J. (2021) · Thrombosis Research · doi:10.1016/j.thromres.2021.09.015
Shariffuddin, I. I. (2014) · Springer eBooks · doi:10.1007/978-3-319-10386-0_24
Fox, K. A. (2021) · Springer eBooks · doi:10.1007/978-3-030-56338-7_12
Suemitsu, C., Fudaba, M., Kitada, K., Kurihara, Y., Tahara, M., Hamuro, A., Misugi, T., Nakano, A., Koyama, M., & Tachibana, D. (2022) · Healthcare · doi:10.3390/healthcare10102060
“Based upon their observation that Angle and MA significantly decreased, they reported that impaired hemostasis was observed in cases with a blood loss of more than 2000 mL [23].”
BackgroundThromboelastography (TEG): Point of Care Test of Hemostasis for Emergency Postpartum Hemorrhage
Dambruoso, P., Raimondo, P., Viti, D. D., Malvası, A., & Brizzi, A. (2023) · Springer eBooks · doi:10.1007/978-3-031-10067-3_44
Pathologie der Plazentarperiode:Antepartuale und Peripartuale Hämorrhagie
Schlembach, D., Mörtl, M., Brezinka, C., & Henrich, W. (2023) · Springer Reference Medizin · doi:10.1007/978-3-662-44369-9_40-2
Metadata
- Authors
- Karlsson, O., Jeppsson, A., & Hellgren, M.
- Affiliations
- Sahlgrenska University Hospital (SE)
- Corresponding author
- Karlsson, O.
- Venue
- International Journal of Obstetric Anesthesia
- Publisher
- Elsevier BV
- Published
- 2014-02
- Volume
- 23
- Issue
- 1
- Pages
- 10-17
- ISSN
- 0959-289X (ISSN-L)
- 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
- FWCI
- 5.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- 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 › Hematology › 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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