Point-of-care viscoelastic testing improves the outcome of pregnancies complicated by severe postpartum hemorrhage Denis Snegovskikh, M.D., Dmitri Souza,

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Presentation transcript:

Point-of-care viscoelastic testing improves the outcome of pregnancies complicated by severe postpartum hemorrhage Denis Snegovskikh, M.D., Dmitri Souza, M.D.,Ph.D., Zachary Walton, M.D., Ph.D., Feng Dai, Ph.D., Rachel Rachler, Angelique Garay, Victoria V. Snegovskikh, M.D., Ferne R. Braveman, M.D., Errol R. Norwitz, M.D., Ph.D. Journal of Clinical Anesthesia Volume 44, Pages 50-56 (February 2018) DOI: 10.1016/j.jclinane.2017.10.003 Copyright © 2017 Terms and Conditions

Fig. 1 Diagrammatic Representation of a TEMogram. CT, clotting time; CTF, clot formation time; A10, amplitude at 10min; MCF, maximum clot firmness; ML, maximum lysis of the clot. Journal of Clinical Anesthesia 2018 44, 50-56DOI: (10.1016/j.jclinane.2017.10.003) Copyright © 2017 Terms and Conditions

Fig. 2 A representative TEMogram of a healthy primigravida at term. The black dotted line represents normal results. Higher-than-normal amplitude of the EXTEM and FIBTEM graphs (A20 and MCF) are evident. This is a normal finding at term given that pregnancy is a hypercoagulable state. Journal of Clinical Anesthesia 2018 44, 50-56DOI: (10.1016/j.jclinane.2017.10.003) Copyright © 2017 Terms and Conditions

Fig. 3 A TEMogram from a patient experiencing massive intrapartum obstetric hemorrhage. A 32-year-old gravida 3, para 2 was admitted at 37weeks of gestation for repeat cesarean delivery and puerperal hysterectomy. Her past medical history is remarkable for morbid obesity, two prior cesarean deliveries, and suspected placenta accreta (possible percreta) on imaging. Her preoperative hemoglobin was 9.7g/dL, hematocrit 28.2%, and platelet count 270,000/μL; prothrombin time/International Normalized Ratio and partial thromboplastin time were normal, and fibrinogen was 499mg/dL. Placenta percreta was confirmed at the time of surgery. Puerperal hysterectomy was performed with an estimated blood loss of 3.5L. This patient received 5L of crystalloids and 1 unit of PRBC (for hematocrit of 19%) during 3-hour-surgery. No FFP, cryoprecipitate or platelets were given. There were no signs of dilutional/consumptive coagulopathy. Her postoperative hematocrit was 22%. The black line represents the preoperative TEMogram (hematocrit 28.2%), red line is the TEMogram after 2h of surgery (hematocrit 19%), and colored fields are the postoperative TEMogram (hematocrit 22%). Minimal (not clinically significant) changes in the results of rotational thromboelastography allowed the surgical team to proceed without further blood product transfusions. Journal of Clinical Anesthesia 2018 44, 50-56DOI: (10.1016/j.jclinane.2017.10.003) Copyright © 2017 Terms and Conditions