Four years' experience of a ROTEM ® ‐guided algorithm for treatment of coagulopathy in obstetric haemorrhage
Abstract
We report four years of observational data from a large UK hospital and tertiary referral unit, following the introduction of a rotational thromboelastometry-guided algorithm for treatment of coagulopathy in major obstetric haemorrhage. Fibrinogen concentrate was used to treat acquired hypofibrinogenaemia as defined by a FibTEM A5 value of < 7 mm, or 7-12 mm with ongoing or high risk of haemorrhage. Of 32,647 deliveries over 4 years, 893 (2.7%) women had an estimated blood loss ≥ 1500 ml. Two-hundred and three (23%) of these had a FibTEM A5 ≤ 12 mm and 110 received fibrinogen concentrate. We compared clinical outcomes and blood product use with 52 patients who met the same criteria, over a 12-month pre-intervention period during which shock packs were used. In the algorithm group, there was a significant reduction in the number of units (p < 0.0001) and total volume (p = 0.0007) of blood products transfused, with a reduction in transfusion-associated circulatory overload (p = 0.002). Women with placental abruption exhibited more severe coagulopathy and required higher doses of fibrinogen concentrate than women who bled due to other causes. Analysis of rotational thromboelastometry results demonstrated that coagulopathy is not observed in all women who suffer obstetric haemorrhage and cannot be predicted solely by blood loss. Therefore, formulaic treatment with blood products is not justified. When coagulopathy does occur, it appears to be multifactorial and can be severe. Point-of-care testing allows early identification and individualised treatment of coagulopathy. This is supported by the improved outcomes reported.
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Compared to other causes of obstetrical hemorrhage, pregnant people with significant abruption experience greater decreases in platelets, require more platelet transfusions, and have more acquired hypofibrinogenemia.
“Compared to other causes of obstetrical hemorrhage, pregnant people with significant abruption experience greater decreases in platelets, require more platelet transfusions, and have more acquired hypofibrinogenemia (95–97).”
From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [95]
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- Authors
- McNamara, H., Kenyon, C., Smith, R., Mallaiah, S., & Barclay, P.
- Affiliations
- Liverpool Womens NHS Foundation Trust (GB)
- Mid Cheshire Hospitals NHS Foundation Trust (GB)
- Chelsea and Westminster Hospital NHS Foundation Trust (GB)
- Corresponding author
- McNamara, H.
- ORCID
- Venue
- Anaesthesia
- Publisher
- Wiley
- Published
- 2019-04-05
- Volume
- 74
- Issue
- 8
- Pages
- 984-991
- ISSN
- 0003-2409 (ISSN-L)
- 1365-2044
- OpenAlex
- W2932734781
- Cited by
- 154
- References
- 25
- Citations by year
- 2026: 11 · 2025: 18 · 2024: 15 · 2023: 22 · 2022: 32 · 2021: 26 · 2020: 23 · 2019: 6 · 2013: 1
- FWCI
- 13.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Anaesthesia (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Biochemistry › Blood transfusion and management
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
- Keywords
- obstetric hemorrhage, coagulopathy, rotational thromboelastometry, fibrinogen concentrate, blood product transfusion, transfusion-associated circulatory overload, placental abruption, point-of-care coagulation testing, treatment algorithm
- MeSH terms
- Algorithms, Blood Coagulation Disorders, Female, Fibrinogen, Postpartum Hemorrhage, Humans, Pregnancy, Prospective Studies, Thrombelastography
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