When does obstetric coagulopathy occur and how do I manage it?. (May 2021) - Collis, R.E.
Highlights: Overall incidence of coagulopathy in postpartum haemorrhage is rare. Hypofibrinogenaemia is most common and associated with the most severe bleeding. Point-of-care viscoelastic haemostatic assays (POC-VHA) allow bedside monitoring. Fibrinogen should be first line treatment if VHA shows hypofibrinogenaemia. Directed treatment of hypofibrinogenaemia using POC-VHA may improve outcomes. Abstract: Anticipating obstetric coagulopathy is important when obstetric anaesthetists are involved in the clinical management of women with postpartum haemorrhage. Although the incidence of coagulopathy in women with postpartum haemorrhage is low, significant hypofibrinogenaemia is associated with major haemorrhage-related morbidity and thus early identification and treatment is essential to improve outcomes. Point-of-care viscoelastic haemostatic assays, including thromboelastography and rotational thromboelastometry, provide granular information about alterations in clot formation and hypofibrinogenaemia, allow near-patient interpretation of coagulopathy, and can guide goal-directed treatment. If these assays are not available, anaesthetists should closely monitor the maternal coagulation profile with standard laboratory testing during the active phase of postpartum bleeding in order to rule coagulopathy 'in or out', decide if pro-haemostatic therapies are indicated, and assess the response to haemostatic support.