Abstract
During pregnancy and puerperium, there are pronounced hemostatic changes characterized
by increased coagulability and decreased fibrinolysis. In addition, hemostasis can
change dramatically during obstetric complications. Several reports have described
substandard management of hemostatic defects in this setting and state the need for
guidelines and better care. Point-of-care devices can assess hemostatic status and
are especially suitable in perioperative settings. Using point-of-care devices, no
time is required for transportation, allowing faster availability of results and providing
potential for better care of the patient. This article will demonstrate the use of
a viscoelastic method in six different patients; five with impaired hemostasis, and
where the use of viscoelastic method contributes or should have contributed to better
care. The cases represent patients with normal delivery; postpartum hemorrhage (PPH);
PPH with low fibrinogen; placental abruption; preeclampsia with hemolysis, elevated
liver enzymes, low platelet count syndrome; and finally, one patient with sepsis.
This article also shows the need for good practices and good supervision to implement
the devices in patient care.
Keywords
obstetric - point-of-care - viscoelastic method - thromboelastography - thromboelastometry
- hemostatic complication - postpartum hemorrhage - DIC - fibrinogen
