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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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1 retracted
Mizutani, A., Okajima, K., Uchiba, M., Isobe, H., Harada, N., Mizutani, S., & Noguchi, T. (2003) · Blood · doi:10.1182/blood-2002-08-2406 · Cited by 125
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Cantwell, R., Clutton-Brock, T. H., COOPER, G. M., Dawson, A. H., Drife, J., Garrod, D., Harper, A., Hulbert, D., Lucas, S. B., McClure, J. H., et al. (2011) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2010.02847.x · Cited by 3,047
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Bremme, K. A. (2003) · Best Practice & Research Clinical Haematology · doi:10.1016/s1521-6926(03)00021-5 · Cited by 871
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CHARBIT, B., MANDELBROT, L., SAMAIN, E., BARON, G., HADDAOUI, B., KEITA, H., SIBONY, O., MAHIEU‐CAPUTO, D., HURTAUD‐ROUX, M. F., HUISSE, M. G., et al. (2007) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2007.02297.x · Cited by 762
Kang, Y. G., Martin, D. J., Márquez, J. M. S., Lewis, J. H., Bontempo, F. A., Shaw, B. W., Starzl, T. E., & WINTER, P. M. (1985) · Anesthesia & Analgesia · doi:10.1213/00000539-198509000-00008 · Cited by 680
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Rourke, C. P., Curry, N. S., Khan, S., TAYLOR, R., RAZA, I., Davenport, R. A., Stanworth, S. J., & Brohi, K. (2012) · Journal of Thrombosis and Haemostasis · doi:10.1111/j.1538-7836.2012.04752.x · Cited by 553
Saving Mothers’ Lives. Reviewing maternal deaths to make motherhood safer: 2006-2008
Wilkinson, H. (2011) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2011.03097.x · Cited by 512
Prevalence and risk factors of severe obstetric haemorrhage
Al‐Zirqi, I., Vangen, S., Forsén, L., & Stray‐Pedersen, B. (2008) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2008.01859.x · Cited by 445
Haemostatic reference intervals in pregnancy
Jørgensen, M., Klajnbard, A., Andersen, M. R., Colov, N. P., Stender, S., & Szecsi, P. B. (2010) · Thrombosis and Haemostasis · doi:10.1160/th09-10-0704 · Cited by 364
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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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