The correlation of Rotational Thromboelastometry (ROTEM) derived parameters with severe obstetric haemorrhage

Abstract

Background Prediction of severe obstetric haemorrhage may facilitate timely interventions and reduce maternal morbidity and mortality. Rotational thromboelastometry (ROTEM) provides point-of-care coagulation parameters that may identify patients at risk of severe haemorrhage. Purpose Our aim was to determine the correlation of ROTEM-derived parameters at early stages of postpartum haemorrhage. Research design Retrospective cohort study. Study Sample Patients who utilised ROTEM during postpartum haemorrhage from 2013 to 2021. Data Collection and Analysis Severe harmorrhage was defined as: (1) decrease in haemogoblin concentration >4g.dL -1 within 48 h; (2) packed red blood cell transfusion of >1000 mL; (3) haemostatic intervention such as angiographic embolisation, arterial ligration, or hysterectomy; or (4) death. ROTEM-derived parameters were collected accordingly. Results Data from 36 patients were analysed, of whom 29 (80.6%) developed severe haemorrhage. FIBTEM A5, A10, and A20 were highly correlated (r > +/−0.7) with severe haemorrhage. There were moderate correlations (r = +/− 0.5 to 0.7) between EXTEM A5, A10, A20, maximum clot firmness, maximum lysis, and lysis index-30 with severe haemorrhage. Conclusions These findings are consistent with prior studies reporting associations between fibrinogen concentration, EXTEM A10, and FIBTEM A10 with severe haemorrhage. In conjunction with these studies, our results support the use of FIBTEM A5 and A10 as early biomarkers to predict progression to severe haemorrhage and facilitate timely implementation of appropriate medical or surgical interventions.