Point-of-care visco-elastic testing for postpartum haemorrhage: A narrative review

Area of Science:

• Obstetrics
• Hematology
• Critical Care Medicine

Background:

• Postpartum hemorrhage (PPH) is a major global cause of maternal mortality.
• Acute obstetric coagulopathy (AOC) is a distinct coagulopathy in PPH, necessitating timely intervention.
• Visco-elastic hemostatic assays (VHAs) offer potential for guiding PPH treatment.

Purpose of the Study:

• To review the evidence on using VHAs to guide PPH treatment.
• To explore the roles of fibrinogen and tranexamic acid (TXA) in PPH management.
• To assess the benefits and limitations of VHAs in PPH.

Main Methods:

• Narrative review of current evidence on VHAs, fibrinogen, and TXA in PPH.
• Analysis of prospective and retrospective cohort studies on VHA effectiveness.
• Examination of guidelines and trial data for TXA use.

Main Results:

• VHAs show potential in reducing transfusions and complications in PPH, though results vary.
• Fibrinogen replacement is essential for PPH management and can be guided by VHAs.
• Prompt administration of TXA is recommended for PPH, but prophylactic use lacks proven benefit in most scenarios.

Conclusions:

• Women with PPH may benefit from VHAs for improved outcomes.
• Fibrinogen concentrate is preferred over cryoprecipitate for PPH management.
• TXA is a cornerstone of PPH treatment, administered promptly upon diagnosis.