Background: Post Partum Hemorrhage (PPH) is a common cause of maternal mortality. Whatever the initial etiology of PPH, dilutional coagulopathy sets in all patients. As d-dimer values increased in the third trimester these patients are wrongly diagnosed as DIC. The major coagulation abnormally associated with PPH is acquired fibrinogen deficiency as per recent studies. Coagulation tests are time consuming and ROTEM is emerging as a point of care device in PPH.

Aims: To study correlation between fibrinogen levels and FIBTEM parameters on ROTEM in women delivering after34 weeks of gestation. The secondary objective is to study the utility of FIBTEM and fibrinogen levels in predicting PPH

Methods: 100 pregnant women in third trimester who were admitted for delivery were enrolled. Pre and post delivery (1 hour) /on onset of PPH samples were collected and studied. Tests performed -CBC, PT, APTT, fibrinogen, d-dimer and ROTEM.

Results: 16 out of 100 women suffered from PPH. The reference ranges of fibrinogen, PT, APTT, d-dimer and ROTEM parameters in pregnant women pre delivery and post delivery established. Pre and Post delivery fibrinogen < 2 mg/L was 100% predictive of PPH. Clot amplitude of FIBTEM at 5 minutes -A5 had a positive correlation with fibrinogen levels with r² =0.713. CFT and CT on FIBTEM had a negative correlation with fibrinogen. On the basis of ROC curves fibrinogen < 2.79g/L was found to be the best cut off to predict PPH with 92% accuracy. FIBTEM A5 values < 16.5 mm had 81% predictive accuracy for PPH.

Conclusions: Plasma fibrinogen levels and FIBTEM A5 can be used to predict PPH and to guide blood transfusion in on appropriate manner once PPH occurs. Further studies are required to validate the application of ROTEM in management of PPH.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/utility-of-fibrinogen-levels-and-rotational-thrombo-elastometry-rotem-in-predicting-post-partum-hemorrhage/