Thromboelastography and peripartum coagulation profiles associated with caesarean section delivery

Area of Science:

• Obstetrics and Gynecology
• Hematology
• Surgical Coagulation

Background:

• Thromboembolic (TE) disease is the leading cause of maternal mortality in the UK.
• Caesarean section significantly increases the risk of TE disease.
• Risk assessment and thromboprophylaxis are crucial for pregnant women undergoing surgery.

Purpose of the Study:

• To evaluate coagulation changes in women undergoing elective caesarean sections using thromboelastography (TEG).
• To compare coagulation profiles between different thromboembolic risk groups.
• To assess the impact of pre-operative fluid restriction and thromboprophylaxis on coagulation.

Main Methods:

• Blood samples were collected from 54 women at multiple time points: antenatal, pre-surgery, immediately post-surgery, 4 hours post-delivery, and 24 hours post-delivery.
• Thromboelastography (TEG) was used to analyze R time (clot initiation) and maximum amplitude (MA) (clot strength).
• Coagulation data were analyzed for high, moderate, and low thromboembolic risk groups.

Main Results:

• Pre-operative fluid restriction and surgery led to a reduced R time, indicating hypercoagulability.
• R time returned to pre-operative levels by 24 hours post-surgery.
• Pre-operatively, high and moderate risk groups showed shorter R times compared to the low risk group.
• After thromboprophylaxis, high and moderate risk groups had similar R times to the low risk group at 24 hours post-surgery.

Conclusions:

• TEG demonstrates transient hypercoagulability following pre-operative fluid restriction and caesarean section.
• Coagulation returns to third-trimester levels by 24 hours post-surgery.
• High and moderate risk women exhibit relative pre-operative hypercoagulability, which normalizes post-operatively with thromboprophylaxis.