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Thromboelastography obstetric

Olga Meltem Akay
Hemostasis is a complex dynamic process involving bleeding and thrombosis as two end-points. Conventional coagulation tests which are measured in plasma examine only isolated portions of the coagulation cascade, thereby giving no information on important interactions essential to the clinical evaluation of hemostatic function. Thromboelastography (TEG), originally described in 1948 has improved over the decades and become a valuable tool of coagulation testing because of the limitations of standard coagulation tests...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
Daniel Katz, Joshua Hamburger, Dorian Batt, Jeffrey Zahn, Yaakov Beilin
Agreement between estimated fibrinogen concentration via thromboelastography and traditional assays is not established in the parturient. We therefore recruited 56 parturients and performed Clauss and functional fibrinogen level (FLEV) tests. Mean difference of measurements was 36.8 mg/dL (95% CI, 21.8-51.9) with a standard deviation of 52.8 mg/dL. Calculated limits of agreement were 140.2 mg/dL (95% CI, 166.3-114.6) and -66.6 mg/dL (95% CI, -40.8 to -92.5), within the maximum allowable difference of 165 mg/dL...
February 23, 2018: Anesthesia and Analgesia
Rachel Collis, Emilia Guasch
Major obstetric haemorrhage is a leading cause of maternal mortality. A prescriptive approach to early recognition and management is critical to improving outcomes. Uterine atony is the primary cause of post-partum haemorrhage. First-line prevention and treatment include the administration of uterine tonic agents; other conservative measures include uterine cavity tamponade and uterine compression sutures. Interventional radiology procedures have been used for both prophylaxis and treatment, but a hysterectomy may be necessary if conservative measures fail...
March 2017: Best Practice & Research. Clinical Anaesthesiology
Liang Shen, Sheida Tabaie, Natalia Ivascu
Hemorrhage is a major contributor to morbidity and mortality during the perioperative period. Current methods of diagnosing coagulopathy have various limitations including long laboratory runtimes, lack of information on specific abnormalities of the coagulation cascade, lack of in vivo applicability, and lack of ability to guide the transfusion of blood products. Viscoelastic testing offers a promising solution to many of these problems. The two most-studied systems, thromboelastography (TEG) and rotational thromboelastometry (ROTEM), offer similar graphical and numerical representations of the initiation, formation, and lysis of clot...
April 2017: Journal of Thoracic Disease
Asrar Ahmad, Monica Kohli, Anita Malik, Megha Kohli, Jaishri Bogra, Haider Abbas, Rajni Gupta, B B Kushwaha
PURPOSE: In this study, we aimed to correlate thromboelastography (TEG) variables versus conventional coagulation profile in all patients presenting with pre-eclampsia/eclampsia and to see whether TEG would be helpful for evaluating coagulation in parturients before regional anaesthesia. MATERIALS AND METHODS: This was a prospective study on 100 pre-eclampsia/eclampsia patients undergoing lower-segment caesarean section under regional anaesthesia. Two blood samples were collected...
October 2016: Journal of Obstetrics and Gynaecology of India
A Le Gouez, F J Mercier
Major obstetric hemorrhage is a challenge for anesthesiologists because it remains responsible for over 10% of maternal deaths in high-income countries. A standardized multidisciplinary management, described in locally validated protocols and based on international guidelines is mandatory to prevent these deaths. The first difficulty relies on the systematic underestimation of the bleeding. Collection bags must be used to facilitate the diagnosis and therefore rapid management. The etiologies in antenatal or postpartum must be well-known in order to be treated adequately...
November 2016: Transfusion Clinique et Biologique: Journal de la Société Française de Transfusion Sanguine
Eric A Gehrie, Ian Baine, Garrett S Booth
OBJECTIVES: In obstetrics, the decision to transfuse blood components has historically been driven by traditional laboratory testing in combination with direct observation of bleeding. The adjunctive use of viscoelastic testing, including thromboelastometry and thromboelastography, has gained increasing acceptance in the clinical domain. METHODS: We performed a review of the published medical literature by searching the PUBMED database for keywords "viscoelastic" and "obstetric," as well as "viscoelastic" and "postpartum hemorrhage...
August 2016: American Journal of Clinical Pathology
A Ioscovich, D Shatalin, A J Butwick, Y Ginosar, S Orbach-Zinger, C F Weiniger
BACKGROUND: Anesthesia practices for placenta previa (PP) and accreta (PA) impact hemorrhage management and other supportive strategies. We conducted a survey to assess reported management of PP and PA in all Israeli labor and delivery units. METHODS: After Institutional Review Board waiver, we surveyed all 26 Israeli hospitals with a labor and delivery unit by directly contacting the representatives of obstetric anesthesiology services in every department (unit director or department chair)...
April 2016: Acta Anaesthesiologica Scandinavica
Jingyi Zhou, Yu Xin, Qiulan Ding, Linlin Jiang, Yaopeng Chen, Jing Dai, Yeling Lu, Xi Wu, Qian Liang, Hongli Wang, Xuefeng Wang
Congenital (hypo)dysfibrinogenemia patients may have obstetric complications during their pregnancies. This study aimed to evaluate thromboelastography (TEG) as a potential tool for assessing the tendency for obstetric complications in those patients in a non-pregnant state. A total of 22 female subjects with congenital (hypo)dysfibrinogenemia were recruited. Nine subjects had histories of obstetric complications and the other 13 subjects had at least one uneventful pregnancy without obstetric complications as yet...
February 2016: Clinical and Experimental Pharmacology & Physiology
Alexander J Butwick, Lawrence T Goodnough
PURPOSE OF REVIEW: Major obstetric hemorrhage is a leading cause of maternal morbidity and mortality. We will review transfusion strategies and the value of monitoring the maternal coagulation profile during severe obstetric hemorrhage. RECENT FINDINGS: Epidemiologic studies indicate that rates of severe postpartum hemorrhage (PPH) in well resourced countries are increasing. Despite these increases, rates of transfusion in obstetrics are low (0.9-2.3%), and investigators have questioned whether a predelivery 'type and screen' is cost-effective for all obstetric patients...
June 2015: Current Opinion in Anaesthesiology
Antoinette C Bolte, Frederik J Hermans, Leonie E Van Rheenen-Flach
OBJECTIVES: To evaluate the current position of thromboelastography (TEG) and rotational thromboelastometry (ROTEM) in clinical obstetric practice. METHODS: A search of the literature was performed on the following databases PubMed MEDLINE, EMBASE and the Cochrane Database of Systematic reviews. All articles published after 1990 until February 2013 and written in English, German, French, Spanish, Italian and Dutch concerning human pregnancies were eligible for inclusion...
January 2015: Pregnancy Hypertension
Jeffrey Huang, Nicholas McKenna, Noah Babins
No consensus exists on when it is safe to administer neuraxial blockade in a patient with a low platelet count. It has been suggested that thromboelastography (TEG) may be useful in assessing platelet function in parturients with thrombocytopenia. The purpose of the study was to analyze the incidence of neurologic complications, if any, related to regional anesthesia in parturients with a platelet count less than 100,000 mm-3 and especially those with less than 80,000 mm3 and normal TEG values. The data were prospectively collected during a 3-year period...
April 2014: AANA Journal
O Karlsson, A Jeppsson, M Hellgren
BACKGROUND: Haemorrhage is a common cause of morbidity and mortality in the obstetric population. The aim of this study was to compare the use of thromboelastography and laboratory analyses to evaluate haemostasis during major obstetric haemorrhage. A secondary aim was to evaluate correlations between the results of thromboelastography, laboratory analyses and estimated blood loss. METHODS: Forty-five women with major obstetric haemorrhage and 49 women with blood loss <600 mL were included...
February 2014: International Journal of Obstetric Anesthesia
A Fassoulaki, C Staikou
BACKGROUND: Pregnancy and puerperium are associated with a hypercoagulable state. The aim of the study was to assess the impact of spinal anaesthesia on coagulation using thromboelastography in healthy term pregnant women undergoing elective caesarean delivery. METHODS: Thromboelastography was performed on 60 women undergoing elective caesarean delivery under spinal anaesthesia. As spinal anaesthesia has different effects on upper and lower extremity vasculature, venous blood samples were collected from both hand and foot, before and one hour after spinal injection...
January 2013: International Journal of Obstetric Anesthesia
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
Ove Karlsson, Tommy Sporrong, Andreas Hillarp, Anders Jeppsson, Margareta Hellgren
BACKGROUND: Hemostatic disorders are common in obstetric complications. Thromboelastography (TEG®) simultaneously measures coagulation and fibrinolysis within 10 to 20 minutes. Our primary aim in this prospective longitudinal study was to obtain knowledge about physiological changes in TEG® variables during normal pregnancy and 8 weeks postpartum. The secondary aims were to compare TEG® variables during pregnancy with TEG® variables 8 weeks postpartum and gestational weeks 10 to 15 and to correlate TEG® variables to standard laboratory analyses...
October 2012: Anesthesia and Analgesia
Anne Juul Wikkelsoe, Arash Afshari, Jakob Stensballe, Jens Langhoff-Roos, Charlotte Albrechtsen, Kim Ekelund, Gabriele Hanke, Heidi Fosgrau Sharif, Anja U Mitchell, Jens Svare, Ane Troelstrup, Lars Møller Pedersen, Jeannet Lauenborg, Mette Gøttge Madsen, Birgit Bødker, Ann M Møller
BACKGROUND: Postpartum haemorrhage (PPH) remains a leading cause of maternal mortality worldwide. In Denmark 2% of parturients receive blood transfusion. During the course of bleeding fibrinogen (coagulation factor I) may be depleted and fall to critically low levels, impairing haemostasis and thus worsening the ongoing bleeding. A plasma level of fibrinogen below 2 g/L in the early phase of postpartum haemorrhage is associated with subsequent development of severe haemorrhage. Use of fibrinogen concentrate allows high-dose substitution without the need for blood type crossmatch...
July 17, 2012: Trials
Melissa E B Bauer, Samuel T Bauer, Amir B Rabbani, Jill M Mhyre
A 31-year-old woman at 32 weeks' gestation presented with an ST segment elevation myocardial infarction with subsequent bare metal stent placement. A multidisciplinary team coordinated the delivery plan, including anticoagulation and delivery mode. Because the patient was at high risk for stent thrombosis, clopidogrel was discontinued after 4 weeks and bridged with eptifibatide for 7 days. Eptifibatide was stopped for induction of labor. Twelve hours after eptifibatide was discontinued, hemostatic function was assessed with thromboelastography before initiating neuraxial analgesia...
September 2012: Anesthesia and Analgesia
Bani J Falcón, Tiziana Cotechini, Shannyn K Macdonald-Goodfellow, Maha Othman, Charles H Graham
Spontaneous pregnancy loss is often associated with aberrant maternal inflammation and systemic coagulopathies. However, the role of inflammation in the development of obstetric coagulopathies is poorly understood. Further, questions remain as to whether systemic coagulopathies are linked to placental haemostatic alterations, and whether these local alterations contribute to a negative foetal outcome. Using a model of spontaneous foetal loss in which pregnant rats are given a single injection of bacterial lipopolysaccharide (LPS), we characterised the systemic maternal coagulation status following LPS administration using thromboelastography (TEG), a global haemostatic assay that measures the kinetics of clot formation...
March 2012: Thrombosis and Haemostasis
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
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