Point-of-Care Thromboelastometry in the Management of Acute Obstetric Hemorrhage

Massive obstetric hemorrhage is the leading cause of maternal morbidity and direct obstetric death in developed countries. It is also the most frequent reason for maternal ICU admission. Mismanagement of maternal hemorrhage is one of the potentially preventable causes of maternal mortality in the USA. Thromboelastometry (TEM)—previously named rotational thromboelastography (ROTEG) or rotational thromboelastometry (ROTEM)—is an established viscoelastic method for hemostasis testing in whole blood. It investigates the interaction of coagulation factors, their inhibitors, anticoagulant drugs, and blood cells (especially platelets) during clotting and subsequent fibrinolysis. The rotational conditions mimic the sluggish flow of blood in veins. Introduction into clinical practice of point-of-care TEM provides prompt bedside analysis of hemostasis. Utilization of point-of-care TEM allows for the transition from one-size-fits-all fixed-ratio resuscitation to a personalized goal-directed transfusion strategy. Such an individualization of treatment for hemorrhage-related coagulopathy will almost certainly lead to improvements in clinical outcome and a reduced cost of care for patients with massive obstetric hemorrhage.