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When does obstetric coagulopathy occur and how do I manage it?
R E Collis1, C Kenyon2, T C D Roberts1
1University Hospital of Wales, Cardiff, UK.
International Journal of Obstetric Anesthesia
|April 28, 2021
Summary
Early identification of obstetric coagulopathy in postpartum hemorrhage is crucial. Point-of-care viscoelastic assays or standard lab monitoring can guide timely treatment to improve maternal outcomes.
Area of Science:
- Obstetrics
- Anesthesiology
- Hematology
Background:
- Postpartum hemorrhage (PPH) can lead to obstetric coagulopathy.
- While rare, significant hypofibrinogenemia in PPH is linked to severe maternal morbidity.
- Early detection and management of coagulopathy are vital for improved patient outcomes.
Purpose of the Study:
- To highlight the importance of anticipating and managing obstetric coagulopathy in PPH.
- To discuss the role of point-of-care viscoelastic assays and standard laboratory testing in guiding treatment.
Main Methods:
- Utilizing point-of-care viscoelastic hemostatic assays (e.g., thromboelastography, rotational thromboelastometry) for near-patient assessment.
- Employing standard laboratory coagulation profiles for monitoring when point-of-care assays are unavailable.
Main Results:
- Viscoelastic assays offer detailed insights into clot formation and hypofibrinogenemia.
- These assays facilitate goal-directed treatment strategies for PPH-related coagulopathy.
- Standard lab tests can effectively monitor coagulation status and guide pro-hemostatic therapy decisions.
Conclusions:
- Prompt recognition and management of obstetric coagulopathy are essential in PPH.
- Viscoelastic assays provide rapid, granular data for guiding treatment.
- Standard laboratory monitoring serves as a viable alternative for assessing and managing coagulopathy in PPH.
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