Coagulation abnormalities and bleeding in pregnancy: an anesthesiologist's perspective

Area of Science:

• Obstetrics and Gynecology
• Anesthesiology
• Hematology

Background:

• Pregnancy induces a hypercoagulable state due to increased procoagulant and decreased anticoagulant activities.
• Standard coagulation tests (PT, aPTT) lack accuracy in assessing pregnant women's coagulation status.
• Regional anesthesia carries a risk of hematoma, necessitating assessment of platelet function and anticoagulant effects.

Purpose of the Study:

• To highlight the limitations of standard coagulation tests in pregnancy.
• To advocate for advanced hemostasis assessment methods.
• To provide guidance on managing postpartum hemorrhage (PPH).

Main Methods:

• Review of current literature on coagulation changes during pregnancy and PPH management.
• Comparison of standard coagulation tests with thromboelastography and rotational thromboelastometry.
• Analysis of transfusion strategies and pharmacotherapy for PPH.

Main Results:

• Thromboelastography and rotational thromboelastometry can replace standard tests for evaluating coagulation in pregnancy.
• Platelet count, function, and anticoagulant effects are crucial for regional anesthesia safety.
• Intravenous tranexamic acid is recommended for immediate PPH management; pre-emptive fibrinogen is ineffective.

Conclusions:

• Anesthesiologists must monitor for PPH and use advanced coagulation assessments.
• Optimal transfusion ratios for massive PPH require further study.
• Prompt administration of tranexamic acid and fibrinogen (if <2 g/L) is critical for PPH treatment.