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Am J Perinatol 2024; 41(07): 915-923
DOI: 10.1055/a-1788-5025
Original Article

Viscoelastic Testing in an Obstetric Population at High Risk of Hemorrhage

Stephen M. Graves 
1   Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
,
Lauren Montemorano
2   Department of Obstetrics and Gynecology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
,
Kara M. Rood
1   Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
,
Maged M. Costantine 
1   Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
,
Kasey Fiorini
3   Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio
,
Michael Cackovic
1   Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
› Author Affiliations Funding The project was funded by the Department of Obstetrics and Gynecology at the Ohio State University. The ROTEM delta analyzer device was borrowed from Instrumentation Laboratory for the conduct of this work.
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Abstract

Introduction Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic test used in trauma for goal-directed transfusion. However, there are limited data on baseline ROTEM parameters in the U.S. obstetric population. Obtaining baseline parameters is a first step in implementing a goal-directed massive transfusion protocol in obstetric hemorrhage.

Objective Our study aimed to establish pre- and postdelivery baseline parameters in a high-risk obstetric population and determine their association with postpartum hemorrhage (PPH).

Study Design Prospective observational study of patients ≥34 weeks' gestation, at high risk of PPH, admitted for delivery. INTEM, EXTEM, FIBTEM, and APTEM assays were performed at the time of admission to labor and delivery and then 2 hours after delivery. Primary outcome was pre- and postdelivery ROTEM parameters among women without PPH. A sample size of 60 women was needed for >90% power to detect at least 50% correlation between pre- and postdelivery assuming a loss of 10% of participants to follow-up.

Results Of 60 women in the study, 10 (17%) had PPH. Baseline characteristics were not different between those with or without PPH. Pre- and postdelivery ROTEM parameters were not significantly different except for APTEM. None of the patients who had PPH, compared with 4 (10%) of those who did not, had shortened clotting time and higher maximum clot firmness in postdelivery APTEM compared with EXTEM, a pattern suggestive of hyperfibrinolysis (p = 0.4).

Conclusion In this study, we describe baseline ROTEM parameters in women at high risk of PPH. The majority of patients did not have a ROTEM pattern that is suggestive of hyperfibrinolysis, for which tranexamic acid is thought to be beneficial. Based on our findings, previously established obstetric transfusion thresholds for goal-directed massive transfusion protocols are likely valid for the majority of the obstetric population regardless of the presence of comorbidities or pregnancy complications.

Key Points

  • ROTEM parameters do not vary significantly before and after delivery.

  • Most patients did not have a hyperfibrinolysis pattern, for which tranexamic acid is thought to be beneficial.

  • Previous goal-directed obstetric transfusion thresholds are likely valid in most populations.

Keywords

postpartum hemorrhage - viscoelastic testing - ROTEM - maternal mortality

Clinical Trial

Clinical Trial Registered at ClinicalTrials.gov, ID#: NCT04409015, https://clinicaltrials.gov/ct2/show/NCT04409015.




Publication History

Received: 15 November 2021

Accepted: 17 February 2022

Accepted Manuscript online:
04 March 2022

Article published online:
27 May 2022

© 2022. Thieme. All rights reserved.

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