Clinical Review

Value of TEG in Management of Postpartum Haemorrahge

Presented by Xu Ou
Medical director, AP
4/17/15

Background
The United Nations has identified a 75% reduction of
maternal mortality by 2015 as a millennium development
goal.
Postpartum hemorrhage (PPH) continues to be a leading
cause of maternal mortality globally accounting for 1/3 of
maternal deaths in some regions and was estimated to
be responsible for around 143,000 deaths each year.

Abdul-Kadir R, et al. TRANSFUSION 2014;54:1756-1768.

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Evaluation and management of postpartum hemorrhage:

consensus from an international expert panel

Rezan Abdul-Kadir, Claire McLintock, Anne-Sophie Ducloy, et al

Royal Free Hospital, London, UK
Auckland City Hospital, Auckland, New Zealand
Centre Hospitalier Rgional Universitaire de Lille, Lille, France
TRANSFUSION 2014;54:1756-1768.

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Definition
Persistent (ongoing) PPH is active bleeding >1000 mL
within the 24 hours following birth that continues despite
the use of initial measures including first-line uterotonic
agents and uterine massage.

Abdul-Kadir R, et al. TRANSFUSION 2014;54:1756-1768.

2013 Haemonetics Corp

Main Causes

Solomon et al. Br J Anaesth. 2012;109(6):851-63

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Main Causes

Solomon et al. Br J Anaesth. 2012;109(6):851-63

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Inherited bleeding disorder

von Willebrand disease
Carriers of hemophilia
Rare bleeding disorders (congenital hypofibrinogenemia
FV, FVII, FX, FXI & FXII deficiencies)
Severe inherited platelet function defects (Glanzmann
thrombasthenia, Bernard-Soulier syndrome)

Abdul-Kadir R, et al. TRANSFUSION 2014;54:1756-1768.

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Commercially available clotting factor

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Treatment of PLT function disorders

Mild: such as PLT secretion and activation defects
--Tranexamic acid (TXA; 1 g four times daily until lochia is minimal) is
generally sufficient (Grade 3-I).

Moderate: who are not at risk for fluid retention

--DDAVP (1-2 doses) during the immediate postpartum period can be
used in addition to TXA. PLT transfusion should be available in case of
hemorrhage with recombinant activated FVII (rFVIIa) on standby.

Severe: Glanzmann thrombasthenia and BernardSoulier syndrome)

--TXA with or without rFVIIa is used in cases of uncomplicated vaginal
delivery (Grade 3-I)
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Monitoring of coagulopathy of PPH

Abdul-Kadir R, et al. TRANSFUSION 2014;54:1756-1768.

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Recommendation: coagulation screening

Coagulation screens should be performed as soon as
persistent (ongoing) PPH is declared to guide
subsequent therapy. Standard tests should include PLT
count, prothrombin time, activated partial thromboplastin
time, and fibrinogen concentration. Where available,
POC testing can be performed in addition to standard
tests of coagulation. Coagulation status assessment
should be repeated every 45 to 60 minutes until the
bleeding is controlled and coagulation abnormalities are
corrected.
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Positioning
The consensus confirms the value of TEG as a POC test
in diagnosis of coagulopathy during treatment of PPH
PLT mapping is able to measure the disorder of platelet
dysfunction but it wasnt mentioned in the consensus.
More education is needed to get awareness of the
additional value of TEG test

Abdul-Kadir R, et al. TRANSFUSION 2014;54:1756-1768.

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Questions

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