Edinburgh Napier University

  Introduction: major obstetric haemorrhage (MOH) is a
significant cause of maternal morbidity and mortality. Despite a lack of published evidence, thromboelastometry has been recommended for monitoring coagulation in obstetric patientswith MOH.
Methods: all patients with MOH requiring standard laboratory tests (SLT) for suspected coagulopathy were included and a paired ROTEM sample was taken. Indications for blood product transfusion and antifibrinolytic agents were determined by reference to the British Committee for Standards in Haematology and the ROTEM Expert Meeting Working Group algorithm. The sensitivity and specificity of the ROTEM algorithm for the requirement for FFP or platelet transfusion was calculated. Spearman's rank correlation coefficient and ROC curve analysis were applied to identify the ROTEM variables that most accurately guided therapy.
Results: 66 women met inclusion criteria, all with a blood loss >1.5 litres. 93 paired blood samples were analysed by SLT and ROTEM thromboelastometry. 21 pairs of blood samples from nine patients demonstrated coagulopathy requiring treatment. The ROTEM algorithm demonstrated excellent sensitivity (0.88) and specificity (0.96) for the presence of coagulopathy requiring treatment. Sensitivity and specificity for FFP transfusion were 0.76 and 0.96 respectively but for platelet transfusion sensitivity was poor (0.37) with a specificity of 0.97. Correlation between
FIBTEM MCF and fibrinogen levels was strongest (r=0.79, 95% CI 0.65 -0.88, P