Clinical value of early viscoelastometric point-of-care testing during postpartum hemorrhage for the prediction of severity of bleeding: A multicenter prospective cohort study in the Netherlands

Paul I. Ramler, Ada Gillissen, Dacia D.C.A. Henriquez, Camila Caram-Deelder, Alexander A. Markovski, Moniek P.M. de Maat, Johannes J. Duvekot, Jeroen C.J. Eikenboom, Kitty W.M. Bloemenkamp, Jan M.M. van Lith, Thomas van den Akker, Johanna G. van der Bom*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

8 Citations (Scopus)

Abstract

Introduction: To evaluate rotational fibrin-based thromboelastometry (ROTEM® FIBTEM) with amplitude of clot firmness at 5 min (A5) as an early point-of-care parameter for predicting progression to severe postpartum hemorrhage, and compare its predictive value with that of fibrinogen. Material and methods: Prospective cohort study in the Netherlands including women with 800–1500 ml of blood loss within 24 h following birth. Blood loss was quantitatively measured by weighing blood-soaked items and using a fluid collector bag in the operating room. Both FIBTEM A5 values and fibrinogen concentrations (Clauss method) were measured between 800 and 1500 ml of blood loss. Predictive accuracy of both biomarkers for the progression to severe postpartum hemorrhage was measured by area under the receiver operating curves (AUC). Severe postpartum hemorrhage was defined as a composite endpoint of (1) total blood loss >2000 ml, (2) transfusion of ≥4 packed cells, and/or (3) need for an invasive intervention to cease bleeding. Results: Of the 391 women included, 72 (18%) developed severe postpartum hemorrhage. Median (IQR) volume of blood loss at blood sampling was 1100 ml (1000–1300) with a median (interquartile range [IQR]) fibrinogen concentration of 3.9 g/L (3.4–4.6) and FIBTEM A5 value of 17 mm (13–20). The AUC for progression to severe postpartum hemorrhage was 0.53 (95% confidence interval [CI] 0.46–0.61) for FIBTEM A5 and 0.58 (95% CI 0.50–0.65) for fibrinogen. Positive predictive values for progression to severe postpartum hemorrhage for FIBTEM A5 ≤12 mm was 22.5% (95% CI 14–33) and 50% (95% CI 25–75) for fibrinogen ≤2 g/L. Conclusions: The predictive value of FIBTEM A5 compared to fibrinogen concentrations measured between 800 and 1500 ml of blood loss following childbirth was poor to discriminate between women with and without progression towards severe postpartum hemorrhage.

Original languageEnglish
Pages (from-to)1656-1664
Number of pages9
JournalActa Obstetricia et Gynecologica Scandinavica
Volume100
Issue number9
DOIs
Publication statusPublished - 1 Sep 2021

Bibliographical note

Funding Information:
The TeMpOH-2?study was supported by an internal grant from Sanquin Research (PPOC 13-029). Tem International GmbH (Munich, Germany) provided the Leiden University Medical Center with a ROTEM? device on the basis of a loan agreement without additional charge. The other two hospitals already owned ROTEM? devices that were made available for this study. Reagents used in the ROTEM? devices were paid by the study without discount. The authors thank research technician D. Priem-Visser, research nurses C. Kolster-Bijdevaate, M.?S. Bourgonje-Verhart, C.?E. Bleeker-Taborh, E. Roos-van Milligen, R.?J. M. Berkhout, E. Sucu, E. C. Willems of Brilman-Tuinhof de Mode, M. Stigter-Dekker, N.?C.?W. van Rijn and J. van Rhee, medical students M. van de Sande, R. H. Wouters and L. S. Smits, and clinical midwives of the Leiden University Medical Center, Erasmus Medical Center Rotterdam and Isala Zwolle for their contributions to the TeMpOH-2 study.

Funding Information:
The TeMpOH‐2 study was supported by an internal grant from Sanquin Research (PPOC 13‐029). Tem International GmbH (Munich, Germany) provided the Leiden University Medical Center with a ROTEM® device on the basis of a loan agreement without additional charge. The other two hospitals already owned ROTEM® devices that were made available for this study. Reagents used in the ROTEM® devices were paid by the study without discount.

Publisher Copyright:
© 2021 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG)

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