Abstract Number: PB2537
Meeting: ISTH 2020 Congress
Background: ROTEM is a point of care testing (POCT) that offers a therapeutic approach to postpartum hemorrhage (PPH), this test is not considered a standard of care for this complication. Normal references ranges are different in pregnant women reflecting a hypercoagulable state. Recently the Women Health SSC of the ISTH published the current evidence of these POCT not only in PPH but in other risk conditions in pregnancy (bleeding, hypercoagulability and/or thrombosis).
Aims: To evaluate the use of ROTEM in obstetrics in a single high complexity hospital.(Retropective. May 2018-July 2019).
Methods: ROTEM was indicated during delivery in eight pregnancies: Group A (PPH): 2 patients with placenta acreta; 2 uterus hypotonia (1 with hypovolemic shock);1 cesarean section that needed to be reoperated. Group B (other risk conditions): 1 severe idiopathic pulmonary hypertension (IPH) medicated with prostanoids and unfractionated heparin (UFH); 1 antiphospholipid syndrome (APS) with acute venous thrombosis (VT) near delivery, with thrombocytopenia and UFH; 1 twin pregnancy with thrombocytopenia.
ROTEM R sigma: standard panel comprises EXTEM, FIBTEM and INTEM; ADPTEM was used in the patient with prostanoids and HEPTEM in 1 patient with UFH.
Results: Group A: normal results, allowing to distinguish between surgical and coagulopathic bleeding. Group B: the ADPTEM in IPH detect an abnormal platelet aggregation and platelet transfusion was indicated; in the twin pregnancy with thrombocytopenia (70.000 mm3 ) tests were normal and useful to define spinal anesthesia .The patient with APS and VT with UFH the HEPTEM (use to detect residual heparin) was normal and cesarean section was performed without complications, an hypercoagulable state was detected too.
Conclusions: Most women with PPH have no coagulopathy, where the value of ROTEM base management is to avoid unnecessary transfusion that can increase the basal hypercoagulable state (Group A). Other potential areas for use in obstetrics (Group B) need further investigation.
To cite this abstract in AMA style:Grand B, Gonzalez Alcantara M, Estevez D, Voto L. Rotational Thromboelastometry (ROTEM) in Obstetric Population [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/rotational-thromboelastometry-rotem-in-obstetric-population/. Accessed December 8, 2021.
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