Rotational Thromboelastometry (ROTEM) Hemostasis Profile in Pregnant Women with Preeclampsia and Their Offspring: An...

Area of Science:

• Obstetrics and Gynecology
• Hematology
• Neonatology

Background:

• Conventional Coagulation Tests (CCTs) inadequately assess coagulation in preeclampsia (PE), failing to distinguish pathological from normal pregnancy hypercoagulability.
• Rotational Thromboelastometry (ROTEM) offers detailed clot dynamics but is underutilized in PE, especially for neonates.
• Understanding PE's impact on maternal and neonatal hemostasis is crucial for improved clinical management.

Purpose of the Study:

• To identify hemostatic alterations in PE using ROTEM, undetectable by CCTs.
• To assess the impact of maternal PE on neonatal hemostasis at birth.
• To evaluate ROTEM's potential for diagnosing PE-related coagulation disorders.

Main Methods:

• An observational study compared 31 women with PE and 45 controls, analyzing intrapartum maternal blood and neonatal arterial samples within one hour of birth.
• ROTEM assays (INTEM, EXTEM, FIBTEM, APTEM) and CCTs were performed.
• ROC analyses assessed ROTEM's ability to predict maternal thrombocytopenia and transfusion needs.

Main Results:

• Preeclamptic women showed increased clot firmness and formation rates (INTEM, FIBTEM) with evidence of hyperfibrinolysis, not fully captured by CCTs.
• ROTEM parameters (A10, CFT) effectively predicted maternal persistent thrombocytopenia and transfusion requirements.
• Neonates born to mothers with PE exhibited significantly lower clot firmness across all ROTEM assays, indicating neonatal hypocoagulability.

Conclusions:

• ROTEM effectively identified maternal hypercoagulability with hyperfibrinolysis and neonatal hypocoagulability in PE.
• These ROTEM-detected alterations were often missed by conventional coagulation tests.
• Further research is warranted to integrate ROTEM into clinical practice for managing PE-related hemostatic changes in mothers and neonates.