Download PDF
Semin Thromb Hemost 2023; 49(02): 145-161
DOI: 10.1055/s-0042-1757895
Review Article

The Role of Thromboelastography during the Management of Postpartum Hemorrhage: Background, Evidence, and Practical Application

Rachel Collis
1   Department of Anaesthetics, University Hospital of Wales, Cardiff, United Kingdom
,
Sarah Bell
1   Department of Anaesthetics, University Hospital of Wales, Cardiff, United Kingdom
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Postpartum hemorrhage (PPH) is a common cause of significant maternal morbidity and mortality that can be associated with coagulopathy, especially hypofibrinogenemia. There is interest in point-of-care viscoelastic hemostatic assays (POC-VHA) in PPH because prompt knowledge of coagulation status can aid diagnosis, identify cases of severe coagulopathy, and allow ongoing monitoring during rapid bleeding. The incidence of coagulopathy in most cases of PPH is low because of the procoagulant state of pregnancy, including raised fibrinogen levels of around 4 to 6 g/L. A Clauss fibrinogen of >2 g/L or POC-VHA equivalent has been found to be adequate for hemostasis during PPH. POC-VHA has been used successfully to diagnose hypofibrinogenemia (Clauss fibrinogen of ≤2 g/L) and guide fibrinogen treatment which has reduced bleed size and complications of massive transfusion. There are uncertainties about the use of POC-VHA to direct fresh frozen plasma and platelet administration during PPH. Several POC-VHA algorithms have been used successfully incorporated in the management of many thousands of PPHs and clinicians report that they are easy to use, interpret, and aid decision making. Due to the relative cost of POC-VHA and lack of definitive data on improving outcomes, these devices have not been universally adopted during PPH.

Keywords

postpartum hemorrhage - thromboelastography - obstetric coagulopathy - fibrinogen replacement


Publication History

Article published online:
01 November 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Prevention and Management of Postpartum Haemorrhage. Prevention and management of postpartum haemorrhage: Green-top Guideline No. 52. BJOG 2017; 124 (05) e106-e149
    Google Scholar
  • 2 Escobar MF, Nassar AH, Theron G. et al; FIGO Safe Motherhood and Newborn Health Committee. FIGO recommendations on the management of postpartum hemorrhage 2022. Int J Gynaecol Obstet 2022; 157 (Suppl 1): 3-50
    CrossrefPubMedGoogle Scholar
  • 3 Marr L, Lennox C, McFadyen AK. Quantifying severe maternal morbidity in Scotland: a continuous audit since 2003. Curr Opin Anaesthesiol 2014; 27 (03) 275-281
    CrossrefPubMedGoogle Scholar
  • 4 Say L, Chou D, Gemmill A. et al. Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health 2014; 2 (06) e323-e333
    CrossrefPubMedGoogle Scholar
  • 5 Thurn L, Wikman A, Westgren M, Lindqvist PG. Massive blood transfusion in relation to delivery: incidence, trends and risk factors: a population-based cohort study. BJOG 2019; 126 (13) 1577-1586
    CrossrefPubMedGoogle Scholar
  • 6 Knight M, Callaghan WM, Berg C. et al. Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group. BMC Pregnancy Childbirth 2009; 9: 55
    CrossrefPubMedGoogle Scholar
  • 7 Sentilhes L, Vayssière C, Deneux-Tharaux C. et al. Postpartum hemorrhage: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF): in collaboration with the French Society of Anesthesiology and Intensive Care (SFAR). Eur J Obstet Gynecol Reprod Biol 2016; 198: 12-21
    CrossrefPubMedGoogle Scholar
  • 8 Obstetrics Subgroup, Chinese Society of Obstetrics and Gynecology, Chinese Medical Association; Obstetrics Subgroup Chinese Society of Obstetrics and Gynecology Chinese Medical Association. Guideline of prevention and treatment about postpartum hemorrhage (2014) [in Chinese]. Zhonghua Fu Chan Ke Za Zhi 2014; 49 (09) 641-646
    PubMedGoogle Scholar
  • 9 Shaylor R, Weiniger CF, Austin N. et al. National and international guidelines for patient blood management in obstetrics: a qualitative review. Anesth Analg 2017; 124 (01) 216-232
    CrossrefPubMedGoogle Scholar
  • 10 Committee on Practice Bulletins-Obstetrics. Practice Bulletin No. 183: postpartum hemorrhage. Obstet Gynecol 2017; 130 (04) e168-e186
    Google Scholar
  • 11 Green L, Knight M, Seeney F. et al. The haematological features and transfusion management of women who required massive transfusion for major obstetric haemorrhage in the UK: a population based study. Br J Haematol 2016; 172 (04) 616-624
    CrossrefPubMedGoogle Scholar
  • 12 Green L, Knight M, Seeney FM. et al. The epidemiology and outcomes of women with postpartum haemorrhage requiring massive transfusion with eight or more units of red cells: a national cross-sectional study. BJOG 2016; 123 (13) 2164-2170
    CrossrefPubMedGoogle Scholar
  • 13 Ramler PI, van den Akker T, Henriquez DDCA. et al; TeMpOH-1 study group. Women receiving massive transfusion due to postpartum hemorrhage: a comparison over time between two nationwide cohort studies. Acta Obstet Gynecol Scand 2019; 98 (06) 795-804
    CrossrefPubMedGoogle Scholar
  • 14 Lasica M, Sparrow RL, Tacey M, Pollock WE, Wood EM, McQuilten ZK. members of the Australian and New Zealand Massive Transfusion Registry Steering Committee. Haematological features, transfusion management and outcomes of massive obstetric haemorrhage: findings from the Australian and New Zealand Massive Transfusion Registry. Br J Haematol 2020; 190 (04) 618-628
    CrossrefPubMedGoogle Scholar
  • 15 Espinoza J, Romero R, Mee Kim Y. et al. Normal and abnormal transformation of the spiral arteries during pregnancy. J Perinat Med 2006; 34 (06) 447-458
    CrossrefPubMedGoogle Scholar
  • 16 Pijnenborg R, Vercruysse L, Hanssens M. The uterine spiral arteries in human pregnancy: facts and controversies. Placenta 2006; 27 (9–10): 939-958
    CrossrefPubMedGoogle Scholar
  • 17 Oyelese Y, Ananth CV. Postpartum hemorrhage: epidemiology, risk factors, and causes. Clin Obstet Gynecol 2010; 53 (01) 147-156
    CrossrefPubMedGoogle Scholar
  • 18 Knight M, Bunch K, Tuffnell D. et al. Lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2016–18. MBRRACE-UK: mothers and babies: reducing risk through audits and confidential enquiries across the UK; 2020. Accessed November 26, 2021, at: https://www.npeu.ox.ac.uk/mbrrace-uk#mbrrace-uk-saving-lives-improving-mothers-care-2020-lessons-to-inform-maternity-care-from-the-uk-and-ireland-confidential-enquiries-in-maternal-death-and-morbidity-2016-18
    PubMedGoogle Scholar
  • 19 Calvert C, Thomas SL, Ronsmans C, Wagner KS, Adler AJ, Filippi V. Identifying regional variation in the prevalence of postpartum haemorrhage: a systematic review and meta-analysis. PLoS One 2012; 7 (07) e41114
    CrossrefPubMedGoogle Scholar
  • 20 Hancock A, Weeks AD, Lavender DT. Is accurate and reliable blood loss estimation the ‘crucial step’ in early detection of postpartum haemorrhage: an integrative review of the literature. BMC Pregnancy Childbirth 2015; 15 (01) 230
    CrossrefPubMedGoogle Scholar
  • 21 ACOG. Quantitative blood loss in obstetric hemorrhage. Accessed April 19, 2022, at: https://www.acog.org/en/clinical/clinical-guidance/committee-opinion/articles/2019/12/quantitative-blood-loss-in-obstetric-hemorrhage
    PubMedGoogle Scholar
  • 22 Bell SF, Watkins A, John M. et al. Incidence of postpartum haemorrhage defined by quantitative blood loss measurement: a national cohort. BMC Pregnancy Childbirth 2020; 20 (01) 271
    CrossrefPubMedGoogle Scholar
  • 23 van der Nelson H, O'Brien S, Burnard S. et al. Intramuscular oxytocin versus Syntometrine® versus carbetocin for prevention of primary postpartum haemorrhage after vaginal birth: a randomised double-blinded clinical trial of effectiveness, side effects and quality of life. BJOG 2021; 128 (07) 1236-1246
    Google Scholar
  • 24 Katz D, Beilin Y. Disorders of coagulation in pregnancy. Br J Anaesth 2015; 115 (Suppl 2): ii75-ii88
    CrossrefPubMedGoogle Scholar
  • 25 Cui C, Yang S, Zhang J. et al. Trimester-specific coagulation and anticoagulation reference intervals for healthy pregnancy. Thromb Res 2017; 156: 82-86
    CrossrefPubMedGoogle Scholar
  • 26 Reese JA, Peck JD, Deschamps DR. et al. Platelet counts during pregnancy. N Engl J Med 2018; 379 (01) 32-43
    CrossrefPubMedGoogle Scholar
  • 27 de Lange NM, van Rheenen-Flach LE, Lancé MD. et al. Peri-partum reference ranges for ROTEM(R) thromboelastometry. Br J Anaesth 2014; 112 (05) 852-859
    Google Scholar
  • 28 Karlsson O, Sporrong T, Hillarp A, Jeppsson A, Hellgren M. Prospective longitudinal study of thromboelastography and standard hemostatic laboratory tests in healthy women during normal pregnancy. Anesth Analg 2012; 115 (04) 890-898
    Google Scholar
  • 29 Charbit B, Mandelbrot L, Samain E. et al; PPH Study Group. The decrease of fibrinogen is an early predictor of the severity of postpartum hemorrhage. J Thromb Haemost 2007; 5 (02) 266-273
    CrossrefPubMedGoogle Scholar
  • 30 Cortet M, Deneux-Tharaux C, Dupont C. et al. Association between fibrinogen level and severity of postpartum haemorrhage: secondary analysis of a prospective trial. Br J Anaesth 2012; 108 (06) 984-989
    CrossrefPubMedGoogle Scholar
  • 31 Gayat E, Resche-Rigon M, Morel O. et al. Predictive factors of advanced interventional procedures in a multicentre severe postpartum haemorrhage study. Intensive Care Med 2011; 37 (11) 1816-1825
    CrossrefPubMedGoogle Scholar
  • 32 Poujade O, Zappa M, Letendre I, Ceccaldi PF, Vilgrain V, Luton D. Predictive factors for failure of pelvic arterial embolization for postpartum hemorrhage. Int J Gynaecol Obstet 2012; 117 (02) 119-123
    CrossrefPubMedGoogle Scholar
  • 33 de Lloyd L, Bovington R, Kaye A. et al. Standard haemostatic tests following major obstetric haemorrhage. Int J Obstet Anesth 2011; 20 (02) 135-141
    CrossrefPubMedGoogle Scholar
  • 34 Wang L, Matsunaga S, Mikami Y, Takai Y, Terui K, Seki H. Pre-delivery fibrinogen predicts adverse maternal or neonatal outcomes in patients with placental abruption. J Obstet Gynaecol Res 2016; 42 (07) 796-802
    CrossrefPubMedGoogle Scholar
  • 35 Wikkelsø AJ, Edwards HM, Afshari A. et al; FIB-PPH trial group. Pre-emptive treatment with fibrinogen concentrate for postpartum haemorrhage: randomized controlled trial. Br J Anaesth 2015; 114 (04) 623-633
    Google Scholar
  • 36 Collins PW, Lilley G, Bruynseels D. et al. Fibrin-based clot formation as an early and rapid biomarker for progression of postpartum hemorrhage: a prospective study. Blood 2014; 124 (11) 1727-1736
    Google Scholar
  • 37 Bell SF, Rayment R, Collins PW, Collis RE. The use of fibrinogen concentrate to correct hypofibrinogenaemia rapidly during obstetric haemorrhage. Int J Obstet Anesth 2010; 19 (02) 218-223
    CrossrefPubMedGoogle Scholar
  • 38 Seto S, Itakura A, Okagaki R, Suzuki M, Ishihara O. An algorithm for the management of coagulopathy from postpartum hemorrhage, using fibrinogen concentrate as first-line therapy. Int J Obstet Anesth 2017; 32: 11-16
    CrossrefPubMedGoogle Scholar
  • 39 Ducloy-Bouthors AS, Mercier FJ, Grouin JM. et al; FIDEL working group. Early and systematic administration of fibrinogen concentrate in postpartum haemorrhage following vaginal delivery: the FIDEL randomised controlled trial. BJOG 2021; 128 (11) 1814-1823
    CrossrefPubMedGoogle Scholar
  • 40 Collins PW, Cannings-John R, Bruynseels D. et al. Viscoelastometric-guided early fibrinogen concentrate replacement during postpartum haemorrhage: OBS2, a double-blind randomized controlled trial. Br J Anaesth 2017; 119 (03) 411-421
    Google Scholar
  • 41 Mallaiah S, Barclay P, Harrod I, Chevannes C, Bhalla A. Introduction of an algorithm for ROTEM-guided fibrinogen concentrate administration in major obstetric haemorrhage. Anaesthesia 2015; 70 (02) 166-175
    CrossrefPubMedGoogle Scholar
  • 42 McNamara H, Kenyon C, Smith R, Mallaiah S, Barclay P. Four years' experience of a ROTEM® -guided algorithm for treatment of coagulopathy in obstetric haemorrhage. Anaesthesia 2019; 74 (08) 984-991
    CrossrefPubMedGoogle Scholar
  • 43 Holcomb JB, Tilley BC, Baraniuk S. et al; PROPPR Study Group. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA 2015; 313 (05) 471-482
    CrossrefPubMedGoogle Scholar
  • 44 Pasquier P, Gayat E, Rackelboom T. et al. An observational study of the fresh frozen plasma: red blood cell ratio in postpartum hemorrhage. Anesth Analg 2013; 116 (01) 155-161
    CrossrefPubMedGoogle Scholar
  • 45 Henriquez DDCA, Caram-Deelder C, le Cessie S. et al; TeMpOH-1 Research Group. Association of timing of plasma transfusion with adverse maternal outcomes in women with persistent postpartum hemorrhage. JAMA Netw Open 2019; 2 (11) e1915628
    CrossrefPubMedGoogle Scholar
  • 46 Green L, Daru J, Gonzalez Carreras FJ. et al. Early cryoprecipitate transfusion versus standard care in severe postpartum haemorrhage: a pilot cluster-randomised trial. Anaesthesia 2022; 77 (02) 175-184
    CrossrefPubMedGoogle Scholar
  • 47 Gillissen A, van den Akker T, Caram-Deelder C. et al; TeMpOH-1 Study Group. Coagulation parameters during the course of severe postpartum hemorrhage: a nationwide retrospective cohort study. Blood Adv 2018; 2 (19) 2433-2442
    CrossrefPubMedGoogle Scholar
  • 48 Deleu F, Deneux-Tharaux C, Chiesa-Dubruille C, Seco A, Bonnet MP. EPIMOMS study group (see Appendix). A population-based analysis of French transfusion practices for women experiencing severe postpartum hemorrhage. Int J Obstet Anesth 2020; 42: 11-19
    CrossrefPubMedGoogle Scholar
  • 49 Bell SF, Collis RE, Bailey C. et al. The incidence, aetiology, and coagulation management of massive postpartum haemorrhage: a two-year national prospective cohort study. Int J Obstet Anesth 2021; 47: 102983
    CrossrefPubMedGoogle Scholar
  • 50 Henriquez DDCA, Bloemenkamp KWM, Loeff RM. et al; TeMpOH-1 study group. Fluid resuscitation during persistent postpartum haemorrhage and maternal outcome: A nationwide cohort study. Eur J Obstet Gynecol Reprod Biol 2019; 235: 49-56
    CrossrefPubMedGoogle Scholar
  • 51 Gillissen A, van den Akker T, Caram-Deelder C. et al; TeMpOH-1 study group. Association between fluid management and dilutional coagulopathy in severe postpartum haemorrhage: a nationwide retrospective cohort study. BMC Pregnancy Childbirth 2018; 18 (01) 398
    Google Scholar
  • 52 Bell SF, Roberts TCD, Freyer Martins Pereira J. et al. The sensitivity and specificity of rotational thromboelastometry (ROTEM) to detect coagulopathy during moderate and severe postpartum haemorrhage: a prospective observational study. Int J Obstet Anesth 2022; 49: 103238
    CrossrefPubMedGoogle Scholar
  • 53 Bell SF, Collis RE, Collins PW. Comparison of haematological indices and transfusion management in severe and massive postpartum haemorrhage: analysis of a two-year national prospective observational study. Int J Obstet Anesth 2022; 50: 103547
    CrossrefPubMedGoogle Scholar
  • 54 Silver RM. Abnormal placentation: placenta previa, vasa previa, and placenta accreta. Obstet Gynecol 2015; 126 (03) 654-668
    CrossrefPubMedGoogle Scholar
  • 55 Butwick A, Lyell D, Goodnough L. How do I manage severe postpartum hemorrhage?. Transfusion 2020; 60 (05) 897-907
    CrossrefPubMedGoogle Scholar
  • 56 Ananth CV, Lavery JA, Vintzileos AM. et al. Severe placental abruption: clinical definition and associations with maternal complications. Am J Obstet Gynecol 2016; 214 (02) 272.e1-272.e9
    CrossrefPubMedGoogle Scholar
  • 57 Tikkanen M. Placental abruption: epidemiology, risk factors and consequences. Acta Obstet Gynecol Scand 2011; 90 (02) 140-149
    CrossrefPubMedGoogle Scholar
  • 58 McNamara H, Mallaiah S, Barclay P, Chevannes C, Bhalla A. Coagulopathy and placental abruption: changing management with ROTEM-guided fibrinogen concentrate therapy. Int J Obstet Anesth 2015; 24 (02) 174-179
    CrossrefPubMedGoogle Scholar
  • 59 Frati P, Foldes-Papp Z, Zaami S, Busardo FP. Amniotic fluid embolism: what level of scientific evidence can be drawn? A systematic review. Curr Pharm Biotechnol 2014; 14 (14) 1157-1162
    CrossrefPubMedGoogle Scholar
  • 60 Fitzpatrick KE, Tuffnell D, Kurinczuk JJ, Knight M. Incidence, risk factors, management and outcomes of amniotic-fluid embolism: a population-based cohort and nested case-control study. BJOG 2016; 123 (01) 100-109
    CrossrefPubMedGoogle Scholar
  • 61 Hasegawa A, Murakoshi T, Otsuki Y, Torii Y. Clinical course of disseminated intravascular coagulopathy-type amniotic fluid embolism: a report of three cases. J Obstet Gynaecol Res 2016; 42 (12) 1881-1885
    CrossrefPubMedGoogle Scholar
  • 62 Fudaba M, Tachibana D, Misugi T, Nakano A, Koyama M. Excessive fibrinolysis detected with thromboelastography in a case of amniotic fluid embolism: fibrinolysis may precede coagulopathy. J Thromb Thrombolysis 2021; 51 (03) 818-820
    CrossrefPubMedGoogle Scholar
  • 63 Schröder L, Hellmund A, Gembruch U, Merz WM. Amniotic fluid embolism-associated coagulopathy: a single-center observational study. Arch Gynecol Obstet 2020; 301 (04) 923-929
    CrossrefPubMedGoogle Scholar
  • 64 Oda T, Tamura N, Ide R. et al. Consumptive coagulopathy involving amniotic fluid embolism: the importance of earlier assessments for interventions in critical care. Crit Care Med 2020; 48 (12) e1251-e1259
    CrossrefPubMedGoogle Scholar
  • 65 Loughran JA, Kitchen TL, Sindhakar S, Ashraf M, Awad M, Kealaher EJ. Rotational thromboelastometry (ROTEM®)-guided diagnosis and management of amniotic fluid embolism. Int J Obstet Anesth 2019; 38: 127-130
    CrossrefPubMedGoogle Scholar
  • 66 Matsunaga S, Masuko H, Takai Y, Kanayama N, Seki H. Fibrinogen may aid in the early differentiation between amniotic fluid embolism and postpartum haemorrhage: a retrospective chart review. Sci Rep 2021; 11 (01) 8379
    CrossrefPubMedGoogle Scholar
  • 67 Lidan H, Jianbo W, Liqin G, Jifen H, Lin L, Xiuyan W. The diagnostic efficacy of thrombelastography (TEG) in patients with preeclampsia and its association with blood coagulation. Open Life Sci 2019; 14: 335-341
    CrossrefPubMedGoogle Scholar
  • 68 Spiezia L, Bogana G, Campello E. et al. Whole blood thromboelastometry profiles in women with preeclampsia. Clin Chem Lab Med 2015; 53 (11) 1793-1798
    CrossrefPubMedGoogle Scholar
  • 69 Crochemore T, de Toledo Piza FM, Silva E, Corrêa TD. Thromboelastometry-guided hemostatic therapy: an efficacious approach to manage bleeding risk in acute fatty liver of pregnancy: a case report. J Med Case Reports 2015; 9: 202
    CrossrefPubMedGoogle Scholar
  • 70 Adelborg K, Larsen JB, Hvas AM. Disseminated intravascular coagulation: epidemiology, biomarkers, and management. Br J Haematol 2021; 192 (05) 803-818
    CrossrefPubMedGoogle Scholar
  • 71 Gillissen A, van den Akker T, Caram-Deelder C. et al. Comparison of thromboelastometry by ROTEM® Delta and ROTEM® Sigma in women with postpartum haemorrhage. Scand J Clin Lab Invest 2019; 79 (1–2): 32-38
    CrossrefPubMedGoogle Scholar
  • 72 Roberts TCD, De Lloyd L, Bell SF. et al. Utility of viscoelastography with TEG 6s to direct management of haemostasis during obstetric haemorrhage: a prospective observational study. Int J Obstet Anesth 2021; 47: 103192
    CrossrefPubMedGoogle Scholar
  • 73 Bell SF, Collis RE, Pallmann P. et al. Reduction in massive postpartum haemorrhage and red blood cell transfusion during a national quality improvement project, Obstetric Bleeding Strategy for Wales, OBS Cymru: an observational study. BMC Pregnancy Childbirth 2021; 21 (01) 377
    CrossrefPubMedGoogle Scholar
  • 74 Frigo MG, Agostini V, Brizzi A, Ragusa A, Svelato A. Practical approach to transfusion management of post-partum haemorrhage. Transfus Med 2021; 31 (01) 11-15
    CrossrefPubMedGoogle Scholar
  • 75 Pavord S, Maybury H. How I treat postpartum hemorrhage. Blood 2015; 125 (18) 2759-2770
    CrossrefPubMedGoogle Scholar
  • 76 Toffaletti JG, Buckner KA. Use of earlier-reported rotational thromboelastometry parameters to evaluate clotting status, fibrinogen, and platelet activities in postpartum hemorrhage compared to surgery and intensive care patients. Anesth Analg 2019; 128 (03) 414-423
    CrossrefPubMedGoogle Scholar
  • 77 Rigouzzo A, Louvet N, Favier R. et al. Assessment of coagulation by thromboelastography during ongoing postpartum hemorrhage: a retrospective cohort analysis. Anesth Analg 2020; 130 (02) 416-425
    CrossrefPubMedGoogle Scholar
  • 78 Collins PW, Solomon C, Sutor K. et al. Theoretical modelling of fibrinogen supplementation with therapeutic plasma, cryoprecipitate, or fibrinogen concentrate. Br J Anaesth 2014; 113 (04) 585-595
    CrossrefPubMedGoogle Scholar
  • 79 McDonnell NJ, Browning R. How to replace fibrinogen in postpartum haemorrhage situations? (Hint: Don't use FFP!). Int J Obstet Anesth 2018; 33: 4-7
    CrossrefPubMedGoogle Scholar
  • 80 Collins PW, Cannings-John R, Bruynseels D. et al; OBS2 study collaborators. Viscoelastometry guided fresh frozen plasma infusion for postpartum haemorrhage: OBS2, an observational study. Br J Anaesth 2017; 119 (03) 422-434
    CrossrefPubMedGoogle Scholar
  • 81 WOMAN Trial Collaborators. Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial. Lancet 2017; 389 (10084): 2105-2116
    Google Scholar
  • 82 Ducloy-Bouthors AS, Duhamel A, Kipnis E. et al. Postpartum haemorrhage related early increase in D-dimers is inhibited by tranexamic acid: haemostasis parameters of a randomized controlled open labelled trial. Br J Anaesth 2016; 116 (05) 641-648
    CrossrefPubMedGoogle Scholar
  • 83 Li C, Gong Y, Dong L, Xie B, Dai Z. Is prophylactic tranexamic acid administration effective and safe for postpartum hemorrhage prevention?: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96 (01) e5653
    CrossrefPubMedGoogle Scholar
  • 84 Sentilhes L, Sénat MV, Le Lous M. et al; Groupe de Recherche en Obstétrique et Gynécologie. Tranexamic acid for the prevention of blood loss after cesarean delivery. N Engl J Med 2021; 384 (17) 1623-1634
    CrossrefPubMedGoogle Scholar
  • 85 Sentilhes L, Winer N, Azria E. et al; Groupe de Recherche en Obstétrique et Gynécologie. Tranexamic Acid for the prevention of blood loss after vaginal delivery. N Engl J Med 2018; 379 (08) 731-742
    Google Scholar
  • 86 Dias JD, Shafizadeh E, Leiriao J, Hartmann J. Global coagulation assays to measure in vitro fibrinolysis. Thromb Update 2021; 4: 100052
    CrossrefPubMedGoogle Scholar
  • 87 Roberts I, Shakur H, Fawole B. et al. Haematological and fibrinolytic status of Nigerian women with post-partum haemorrhage. BMC Pregnancy Childbirth 2018; 18 (01) 143
    CrossrefPubMedGoogle Scholar
  • 88 Shields LE, Wiesner S, Fulton J, Pelletreau B. Comprehensive maternal hemorrhage protocols reduce the use of blood products and improve patient safety. Am J Obstet Gynecol 2015; 212 (03) 272-280
    CrossrefPubMedGoogle Scholar
  • 89 Snegovskikh D, Souza D, Walton Z. et al. Point-of-care viscoelastic testing improves the outcome of pregnancies complicated by severe postpartum hemorrhage. J Clin Anesth 2018; 44: 50-56
    CrossrefPubMedGoogle Scholar
  • 90 Ries JJ, Jeker L, Neuhaus M, Vogt DR, Girard T, Hoesli I. Implementation of the D-A-CH postpartum haemorrhage algorithm after severe postpartum bleeding accelerates clinical management: a retrospective case series. Eur J Obstet Gynecol Reprod Biol 2020; 247: 225-231
    CrossrefPubMedGoogle Scholar
  • 91 Tsang YS, Kurniawan AR, Tomasek O. et al. Effects of rotational thromboelastometry-guided transfusion management in patients undergoing surgical intervention for postpartum hemorrhage: an observational study. Transfusion 2021; 61 (10) 2898-2905
    CrossrefPubMedGoogle Scholar
  • 92 Collins PW, Bell SF, de Lloyd L, Collis RE. Management of postpartum haemorrhage: from research into practice, a narrative review of the literature and the Cardiff experience. Int J Obstet Anesth 2019; 37: 106-117
    Google Scholar
  • 93 Bell SF, Kitchen T, John M. et al. Designing and implementing an all Wales postpartum haemorrhage quality improvement project: OBS Cymru (the Obstetric Bleeding Strategy for Wales). BMJ Open Qual 2020; 9 (02) e000854
    CrossrefPubMedGoogle Scholar
  • 94 WHO. WHO recommendations for the prevention and treatment of postpartum haemorrhage. Accessed April 19, 2022, at: https://www.who.int/publications-detail-redirect/9789241548502
    PubMedGoogle Scholar
  • 95 Görlinger K, Pérez-Ferrer A, Dirkmann D. et al. The role of evidence-based algorithms for rotational thromboelastometry-guided bleeding management. Korean J Anesthesiol 2019; 72 (04) 297-322
    CrossrefPubMedGoogle Scholar
  • 96 Anne EJ. Postpartum haemorrhage - prevention and management. Published Online. 2019. Accessed October 12, 2022 at: https://www.seslhd.health.nsw.gov.au/sites/default/files/documents/pphpreventmanage19.pdf
    PubMedGoogle Scholar