[Show abstract][Hide abstract] ABSTRACT: This prospective, observational study investigated the utility of Fibtem® A5 and Clauss fibrinogen as predictors of progression of postpartum haemorrhage (PPH). A consecutive cohort of 356 women experiencing 1000-1500 mL PPH was recruited. Fibtem and fibrinogen were measured and subsequent transfusions, invasive procedures and bleed volume recorded. Women progressing to 8 units of blood products (red blood cells (RBC) + fresh frozen plasma (FFP) + platelets) had a median interquartile range fibrinogen and Fibtem A5 of 2.1 (1.8-3.4) g/L and 12 (7-17) mm, respectively compared to 3.9 (3.2-4.5) and 19 (17-23) for those not progressing. On multivariate analysis, Fibtem was an independent predictor for progression to bleeds >2500 mL (95% confidence interval (CI)) 0.85 (0.77-0.95). ROC AUC (95% CI) for progression to RBC transfusion was 0.67 (0.60-0.74) for fibrinogen and 0.61 (0.54-0.68) for Fibtem, progression to >2500 mL was 0.71 (0.61-0.81) and 0.75 (0.66-0.85) for fibrinogen and Fibtem, respectively. Fibtem A5 less than 10 mm was associated with more prolonged bleeds, median (95% CI) 127 (44-210) compared with 65 (59-71) minutes (P=0.018) and longer stay in high dependency 23.5 (18.4-28.5) compared with 10.8 (9.7-11.8) hours. Fibtem is a rapidly available early biomarker for progression of PPH.
[Show abstract][Hide abstract] ABSTRACT: Background
We set out to validate the accuracy of gravimetric quantification of blood loss during simulated major postpartum haemorrhage and to evaluate the technique in a consecutive cohort of women experiencing major postpartum haemorrhage. The study took part in a large UK delivery suite over a one year period. All women who experienced major postpartum haemorrhage were eligible for inclusion.
For the validation exercise, in a simulated postpartum haemorrhage scenario using known volumes of artificial blood, the accuracy of gravimetric measurement was compared with visual estimation made by delivery suite staff. In the clinical observation study, the blood volume lost during postpartum haemorrhage was measured gravimetrically according to our routine institutional protocol and was correlated with fall in haemoglobin. The main outcome measure was the accuracy of gravimetric measurement of blood loss.
Validation exercise: The mean percentage error of gravimetrically measured blood volume was 4.0 ± 2.7% compared to visually estimated blood volume with a mean percentage error of 34.7 ± 32.1%. Clinical observation study: 356 out of 6187 deliveries were identified as having major postpartum haemorrhage. The correlation coefficient between measured blood loss and corrected fall in haemoglobin for all patients was 0.77; correlation was stronger (0.80) for postpartum haemorrhage >1500 mL, and similar during routine and out-of-hours working.
The accuracy of the gravimetric method was confirmed in simulated postpartum haemorrhage. The clinical study shows that gravimetric measurement of blood loss is correlated with the fall in haemoglobin in postpartum haemorrhage where blood loss exceeds 1500 mL. The method is simple to perform, requires only basic equipment, and can be taught and used by all maternity services during major postpartum haemorrhage.
No preview · Article · Jul 2014 · International Journal of Obstetric Anesthesia
[Show abstract][Hide abstract] ABSTRACT: Postpartum haemorrhage is an important cause of maternal morbidity and mortality. It is associated with haemostatic impairment which may exacerbate bleeding.
All deliveries over a 3-year period in a large UK unit were reviewed and cases of haemorrhage of 1500 mL or more identified. Laboratory records were reviewed and the lowest value for haemoglobin, platelet count and fibrinogen, and longest value for prothrombin time and activated partial thromboplastin time within 24h of delivery were recorded.
Of 18,501 deliveries there were 456 bleeds of 1500 mL or more (2.5%). Fibrinogen levels correlated best with blood loss (r -0.48 P<0.01) and fell progressively as volume increased. Activated partial thromboplastin time was less sensitive (r 0.4 P<0.01) to increasing blood loss. Prothrombin time did not correlate with blood loss (r 0.01). Activated partial thromboplastin time and prothrombin time remained within the normal range in most women despite large bleeds. Similar results were observed in women who received four or more units of red blood cells. Haemoglobin level was adequately maintained irrespective of blood loss. Based on UK national guidelines only 13 of 456 (3%) women should have received fresh frozen plasma, although it was given to 45; despite this, fibrinogen levels below the pregnancy-related normal range were observed in most cases.
Fibrinogen level was the parameter that best correlated with increasing volume of haemorrhage and was the most useful marker of developing haemostatic impairment. Guidelines for fresh frozen plasma use in major postpartum haemorrhage were rarely followed and should be reviewed.
No preview · Article · Mar 2011 · International journal of obstetric anesthesia