Peri-partum reference ranges for ROTEM(R) thromboelastometry.

Area of Science:

• Obstetrics and Gynecology
• Hematology
• Point-of-Care Testing

Background:

• Postpartum hemorrhage (PPH) is a major cause of maternal mortality, linked to rapid clotting factor deficiencies.
• Rotational Thromboelastometry (ROTEM®) is a valuable point-of-care tool for assessing massive hemorrhage.
• Established reference ranges for ROTEM® are lacking for the peri-partum period, despite significant hemostatic changes during pregnancy.

Purpose of the Study:

• To establish reference ranges for ROTEM® parameters (INTEM, EXTEM, FIBTEM, APTEM) in the peri-partum period.
• To assess the comparability of these ranges between labor and immediate postpartum.
• To confirm the correlation between FIBTEM and plasma fibrinogen levels.

Main Methods:

• A multi-center trial involving 161 subjects in the Netherlands.
• Blood samples collected during labor (T1) and within 1 hour postpartum (T2).
• ROTEM® analysis (INTEM, EXTEM, FIBTEM, APTEM) following International Federation of Clinical Chemistry guidelines.

Main Results:

• Reference ranges were determined for key ROTEM® parameters including clotting time (CT), clot formation time (CFT), α-angle, and maximum clot firmness (MCF).
• Ranges were consistent across participating centers and between T1 and T2 sampling points.
• Specific T1 EXTEM ranges: CT 31-63s, CFT 41-120s, MCF 42-78mm; INTEM: CT 109-225s, CFT 40-103s, MCF 63-78mm; FIBTEM: CT 31-79s, MCF 13-45mm; APTEM: CT 33-62s, CFT 42-118s, MCF 61-79mm.

Conclusions:

• Reliable reference values for ROTEM® parameters in the peri-partum period have been established.
• The correlation between FIBTEM and plasma fibrinogen (Clauss method) was confirmed.
• Further investigation is required to define specific thresholds for initiating hemostatic therapy during PPH.