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Updated: May 3, 2026

Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization
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Peri-partum reference ranges for ROTEM(R) thromboelastometry.

N M de Lange1, L E van Rheenen-Flach, M D Lancé

  • 1Department of Obstetrics and Gynaecology, Orbis Medical Centre, Sittard, The Netherlands.

British Journal of Anaesthesia
|February 4, 2014
PubMed
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This study establishes reference ranges for Rotational Thromboelastometry (ROTEM®) parameters during labor and delivery. These new ranges aid in managing postpartum hemorrhage (PPH) by providing crucial coagulation data.

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.
Keywords:
blood, coagulationhaemostasispost-partum haemorrhagereference valuesthromboelastography

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  • 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.