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
