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point of care coagulation and pregnancy

L Chow, A Carr, L MacKenzie, A Walker, D Archer, A Lee
BACKGROUND: Dalteparin is often used for prophylaxis or treatment of venous thromboembolism during pregnancy, yet there is no laboratory test to accurately reflect its clinical activity. Thromboelastography is a point-of-care monitor of whole blood coagulation. The aim of this study was to determine if serial doses of dalteparin added in vitro to whole blood samples from term, pregnant women are detectable as changes in thromboelastography parameters. METHODS: Thirty healthy parturients presenting for elective caesarean section were recruited...
September 1, 2016: International Journal of Obstetric Anesthesia
Offer Erez, Salvatore Andrea Mastrolia, Jecko Thachil
Disseminated intravascular coagulation (DIC) is a life-threatening situation that can arise from a variety of obstetrical and nonobstetrical causes. Obstetrical DIC has been associated with a series of pregnancy complications including the following: (1) acute peripartum hemorrhage (uterine atony, cervical and vaginal lacerations, and uterine rupture); (2) placental abruption; (3) preeclampsia/eclampsia/hemolysis, elevated liver enzymes, and low platelet count syndrome; (4) retained stillbirth; (5) septic abortion and intrauterine infection; (6) amniotic fluid embolism; and (7) acute fatty liver of pregnancy...
October 2015: American Journal of Obstetrics and Gynecology
Kathleen M Antony, Roshanak Mansouri, Melanie Arndt, Shiu-Ki Rocky Hui, Purviben Jariwala, Virginia Moreland Mcmullen, Jun Teruya, Kjersti Aagaard
OBJECTIVE: The diagnosis of coagulopathy cannot always be performed at point of care. Thromboelastography (TEG) and the platelet-function analyzer (PFA-100), have emerged as reliable means for coagulation analysis. However, their reliable utility in pregnancy remains to be determined. We sought to establish reference values with concomitant determination of other known coagulation measures in nonlaboring gravidae in an effort to report the mean and variance of multiple testing modalities...
May 2015: American Journal of Perinatology
R E Collis, P W Collins
The haemostatic management of major obstetric haemorrhage remains challenging, and current published guidance relies heavily on experience from the non-pregnant population and expert opinion. In recent years, an interest in the implications of relative hypofibrinogenaemia, point-of-care monitoring of coagulation abnormalities, and the potential to give goal-directed therapy to correct coagulopathies, have created the possibility of significantly challenging and changing guidance. There is evidence that the haemostatic impairment in the pregnant population is different from trauma-induced bleeding, and the type and rate of onset of coagulopathies differ depending on the underlying cause...
January 2015: Anaesthesia
Shunsuke Hyuga, Rie Kato, Toshiyuki Okutomi
Amniotic fluid embolism (AFE) is a disorder with a high mortarity rate, because it often causes sudden respiratory failure, circulatory collapse and disseminated intravascular coagulation (DIC). We present a case of AFE in which an obstetric anesthesiologist promptly initiated resuscitation of a parturient and saved her without any sequelae. Her fetus was diagnosed as intrauterine fetal demise on 25th gestational week and vaginal delivery under epidural analgesia was planned. One hundred and five minutes after induction of labor with prostaglandine E1, sudden tetanic convulsion occurred with a loss of consciousness...
December 2013: Masui. the Japanese Journal of Anesthesiology
N M de Lange, L E van Rheenen-Flach, M D Lancé, L Mooyman, M Woiski, E C van Pampus, M Porath, A C Bolte, L Smits, Y M Henskens, H C Scheepers
BACKGROUND: Post-partum haemorrhage (PPH) causes rapidly developing deficiencies in clotting factors and contributes to substantial maternal morbidity and mortality. Rotational thromboelastometry (ROTEM(®)) is increasingly used as a point of care coagulation monitoring device in patients with massive haemorrhage; however, there are limited data on reference ranges in the peri-partum period. These are required due to the haemostatic changes in pregnancy. METHODS: In a Dutch multi-centre trial, 161 subjects were included; blood samples were obtained during labour (T1) and within 1 h of delivery (T2)...
May 2014: British Journal of Anaesthesia
A J Butwick
No abstract text is available yet for this article.
April 2013: International Journal of Obstetric Anesthesia
S Sharma, J Uprichard, A Moretti, H Boyce, R Szydlo, G Stocks
BACKGROUND: Thromboelastography (TEG®) is a point of care monitor of whole blood coagulation and has previously demonstrated hypercoagulability in both pregnant and obese populations. However, the individual and combined contribution of pregnancy and obesity on coagulation status has not been defined. We carried out a study to assess the effect of both pregnancy and body mass index (BMI) on blood coagulation using laboratory tests of coagulation and thromboelastography. METHODS: This was a prospective study of 96 women divided into four equal groups; non-pregnant lean (NPL) BMI <25kg/m(2), pregnant lean (PL) BMI <25kg/m(2), non-pregnant obese (NPO) BMI >35kg/m(2) and pregnant obese (PO) BMI >35kg/m(2)...
April 2013: International Journal of Obstetric Anesthesia
J S Hill, G Devenie, M Powell
Thrombelastography® is a monitor of coagulation and fibrinolytic status, with point-of-care applications in managing haemorrhaging patients. Advocates have suggested a possible role in managing obstetric haemorrhage. This study aims to develop a pregnancy-specific thrombelastography-guided transfusion algorithm, which could be integrated into the management of postpartum haemorrhage. In this prospective observational study, 57 healthy, term-parturients provided pre-caesarean whole blood specimens for thrombelastography analyses...
November 2012: Anaesthesia and Intensive Care
N F Collins, M Bloor, N J McDonnell
Rotational thromboelastometry is a viscoelastomeric, point-of-care method for testing haemostasis in whole blood which can be visualised rapidly, in real time, in the operating theatre. Advantages over traditional coagulation tests relate to the rapid feedback of results and the ability to visualise hyperfibrinolysis. We present a case of suspected amniotic fluid embolism that presented with sudden respiratory arrest associated with haemodynamic compromise during a non-elective caesarean delivery. Soon after the collapse, coagulopathy developed...
January 2013: International Journal of Obstetric Anesthesia
C Solomon, R E Collis, P W Collins
Postpartum haemorrhage (PPH) is a major risk factor for maternal morbidity and mortality. PPH has numerous causative factors, which makes its occurrence and severity difficult to predict. Underlying haemostatic imbalances such as consumptive and dilutional coagulopathies may develop during PPH, and can exacerbate bleeding and lead to progression to severe PPH. Monitoring coagulation status in patients with PPH may be crucial for effective haemostatic management, goal-directed therapy, and improved outcomes...
December 2012: British Journal of Anaesthesia
Natascha M de Lange, Marcus D Lancé, Reneé de Groot, Erik A M Beckers, Yvonne M Henskens, Hubertina C J Scheepers
Globally, postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality. In the current treatment of severe PPH, first-line therapy includes transfusion of packed cells and fresh-frozen plasma in addition to uterotonic medical management and surgical interventions. In persistent PPH, tranexamic acid, fibrinogen, and coagulation factors are often administered. Secondary coagulopathy due to PPH or its treatment is often underestimated and therefore remains untreated, potentially causing progression to even more severe PPH...
July 2012: Obstetrical & Gynecological Survey
T Binder, B Vavrinková, I Hadacová, I Hrachovinová, P Salaj, M Hruda
OBJECTIVE: To evaluate the course of pregnancy and puerperium in asymptomatic carriers of FV Leiden and FII prothrombin mutation in heterozygous configuration in terms of risk of thrombembolic disease and late pregnancy complications. To evaluate whether global prophylactic LMWH administration already during pregnancy has brought some benefit to these women. TYPE OF STUDY: Prospective study. METHODS: From June 2007 to June 2011, we monitored the incidence of thrombembolic events (TED) and severe late pregnancy complications in 473 asymptomatic carriers of FV Leiden and FII prothrombin mutation in heterozygous configuration...
February 2012: Ceská Gynekologie
S Armstrong, R Fernando, K Ashpole, R Simons, M Columb
BACKGROUND: Assessment of maternal coagulation to determine suitability for neuraxial anaesthesia and management of obstetric haemorrhage remains a challenge. Thromboelastography provides point of care patient assessment of the viscoelastic properties of whole blood clotting and can assist the clinician in haemostatic decision-making. The study aim was to determine the ROTEM® thromboelastometer 95% reference limits for third trimester parturients and to compare these with non-pregnant female controls...
October 2011: International Journal of Obstetric Anesthesia
S Setty, A Reddell, A England, K Gomez, R Kadir
Regional blocks like spinal, epidural and combined spinal epidural (CSE) are relatively contraindicated in individuals with bleeding disorders. Consequently pregnant women with severe factor XI (FXI) deficiency are often denied this option during labour and caesarean section. We describe three women with severe FXI deficiency in whom regional block was performed with low-dose recombinant factor VIIa (rFVIIa) for their operative procedures during delivery. All women achieved haemostasis and had uncomplicated regional block, delivery and surgical procedures...
November 2011: Haemophilia: the Official Journal of the World Federation of Hemophilia
Maha Othman, Bani J Falcón, Rezan Kadir
Pregnancy is a unique situation where significant physiological changes in all maternal organ systems take place. Most of these changes return to normal after delivery. During normal pregnancy the hemostatic balance changes in the direction of hypercoagulability, thus decreasing bleeding complications at time of delivery. The pregnancy-associated hypercoagulability sets a foundation for hemostatic abnormalities during pregnancy and may be associated with pregnancy complications. Assessment of the hemostatic status in pregnancy and its complications can be critical to diagnosis and management not only within the obstetric ward but in trauma, anesthesia, and other situations...
October 2010: Seminars in Thrombosis and Hemostasis
H A Haeberle, D Menzel, K Unertl, B Nohé
The case presented describes the combined onset of heparin-induced thrombocytopenia II (HIT) and post-transfusion purpura (PTP) 5-10 days following exposure to heparin and blood transfusion during aortic dissection repair. On day 4 the platelet count decreased by 40% and D-dimers started to increase again. Despite a low clinical probability for HIT-II at this time (4T score of 3) serological testing was done the next day and yielded a negative test result. Following a transient rise after platelet transfusion another 40% decrease in platelet count occurred on day 8...
December 2011: Der Anaesthesist
A A Hanke, O Elsner, K Görlinger
We report the peri-operative management of a 32-year-old patient suffering from symptomatic hypofibrinogenaemia and factor XIII deficiency scheduled for caesarean section. Starting with an impaired fibrinogen (1.04 g x l(-1)) and factor XIII level (48%), fibrinogen and factor XIII administration was guided by point-of-care rotational thrombelastometry (ROTEM) to achieve normal whole blood coagulation, which allowed uncomplicated spinal anaesthesia and an uneventful surgical procedure. We conclude that rotational thrombelastometry may be suitable to guide administration of coagulation factors in patients with hereditary bleeding disorders and allow otherwise contraindicated neuraxial anaesthesia and surgery to proceed without increased risk of blood loss...
June 2010: Anaesthesia
Daniela Fischerova
Sepsis and/or acute blood loss can be encoutered as an emergency condition in gynaecology, especially in women with ectopic pregnancy/miscarriage, acute pelvic inflammatory disease (PID)/tuboovarian abscesses, post-puerperal sepsis/haemorrhage and even in postoperative scenarios. If underestimated or suboptimally treated, both can lead to an inadequate tissue perfusion (defined as shock) and the development of multi-organ failure. Morbidity and mortality after development of one of the shock syndromes (septic or haemorrhagic) correlates directly with the duration and severity of the malperfusion...
October 2009: Best Practice & Research. Clinical Obstetrics & Gynaecology
Cyril Huissoud, Nicolas Carrabin, Mehdi Benchaib, Oriane Fontaine, Albrice Levrat, Denis Massignon, Sandrine Touzet, René-Charles Rudigoz, Michel Berland
We analysed changes in coagulation during normal pregnancy with a novel point-of-care device based on thrombelastometry (ROTEM). We compared the results obtained with those of standard coagulation tests in 104 patients: 20 non-pregnant women (controls) and 84 women in the first (T1, n = 17), second (T2, n = 9) and third (T3, n = 58) trimesters of pregnancy. We measured the clotting time (CT), the maximum clot firmness (MCF), the early clot amplitude at 5 and 15 minutes (CA(5), CA(15)) and the clot lysis index (CLI(30)) with four tests containing specific reagents...
April 2009: Thrombosis and Haemostasis
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