Four Years' Experience of a ROTEM-Guided Algorithm for Treatment of Coagulopathy in Obstetric Hemorrhage. Issue 3 (September 2020) - McNamara, H.
Abstract : ( Anaesthesia . 2019;74:984–991) Although many advances have been made in the care of obstetric patients, maternal hemorrhage is still a major contributor to morbidity and mortality. Fibrinogen levels, like most coagulation factors, are increased during normal pregnancy, which contributes to an increased risk of venous thromboembolism. In the setting of obstetric hemorrhage, though, a low fibrinogen level is associated with a greater risk of developing severe postpartum hemorrhage. Until 2012, the standard treatment for obstetric hemorrhage at the investigators' institution was the administration of a standardized shock pack containing fresh frozen plasma, packed red blood cells, and platelets. After July 2012, the transfusion practice was changed and blood therapy was informed by rotational thromboelastometry (ROTEM) coagulation test results. For patients with ongoing hemorrhage, administration of fibrinogen concentrate was a component of the treatment. This observational study examined 4 years of cumulative data on the ROTEM-directed algorithm treatment for patients with obstetric hemorrhage, including assessment of blood product and fibrinogen concentrate usage.