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///2018 Abstract Details
2018 Abstract Details2019-08-02T15:57:01-05:00

Goal directed transfusion and coagulation management of a major obstetric hemorrhage and DIC; a case report

Abstract Number: T1C-3
Abstract Type: Case Report/Case Series

Anjum Anwar MD1 ; Oscar Alam MD2; Richard Tennant MD3; Fouzia Khalid FCPS4; Igor Ianov MD5

Objective:

To describe the effect of point of care testing (POCT) using thromboelastogram (TEG) on maternal coagulation monitoring and transfusion strategy in a major obstetric hemorrhage.

Introduction:

Evidence has shown that hemostatic impairment in the pregnant population is different from trauma-induced bleeding, and the type and rate of onset of coagulopathies differ depending on the underlying cause (1). Therefore use of POCT like TEG or thromboelastometry (ROTEM) can be very helpful in establishing hemostasis and reducing transfusion requirements.

We describe a case report where coagulopathy following a massive obstetric hemorrhage was managed successfully by using POCT, TEG.

Case Report:

A 30 year old G3P2002 at 39 weeks presented in labor and received an epidural for analgesia. After laboring for two hours she became hemodynamically unstable and was taken for an emergency C-section. General anesthesia using rapid sequence technique and invasive BP monitoring was administered. Fluid resuscitation and vasopressors were initiated.

On exploration, she was found to have placental abruption along with cervico vaginal lacerations. The intraoperative blood loss was estimated to be 9900 ml. She showed clinical signs of DIC and with assessment of hemostasis by TEG as well as traditional coagulation studies. TEG revealed coagulation factor deficiencies, decreased clot strength, and platelets dysfunction with a prolonged R, decreased K and decreased MA respectively. The coagulation profile at the same time showed APTT 144, PT 49.8, INR 5.5 and fibrinogen less than 60. The patient received 6 units of PRBCs, 3 units of cryoprecipitate and 1 unit of platelets. The platelet count was 75,000 prior to transfusion but the decision was made to transfuse based on platelet dysfunction as supported by TEG. Following administration of blood products her APTT improved to 37, PT to 18, INR to 1.5 and fibrinogen to 357. This was also supported by improvement in TEG results and further transfusion of products was held. She started to become hemodynamically stable and was weaned off vasopressors. She was transferred to ICU for further care.

Conclusion:

POCTs like TEG can be very helpful in assessment of hemostasis and in detection and goal directed management of coagulopathy secondary to hemmorhage.

Reference:

Collis RE, Collins PW. Haemostatic management of obstetric haemorrhage. Anaesthesia. 2015 Jan 1;70(s1):78.



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