title: Coagulopathy and placental abruption: changing management with ROTEM-guided fibrinogen concentrate therapy.
abstract: Placental abruption may cause significant haemorrhage and coagulopathy that can progress rapidly due to simultaneous consumption and depletion of clotting factors. Plasma fibrinogen levels are predictive of further haemorrhage. Rapid detection and treatment of hypofibrinogenaemia is essential in the evolving clinical and haematological situation. The use of near-patient testing of coagulation using rotational thromboelastometry (ROTEM) allows dynamic monitoring of coagulopathy. Following the introduction of fibrinogen concentrate into our unit, a ROTEM-guided algorithm was developed for use in obstetric haemorrhage. We describe four cases of placental abruption, haemorrhage and severe coagulopathy that span the introduction of the algorithm. Three cases were associated with intrauterine death and the fourth with delivery of an extremely premature neonate. Rotational thromboelastometry was used in all cases but methods of fibrinogen replacement differ, illustrating evolving management of the condition in our unit.
authors: Tom Bryson Department of Anaesthesia, Liverpool Women's Hospital, Liverpool, UK. Electronic address: helenmcnamara@doctors.org.uk.
authors: H
authors: H
authors: McNamara
authors: Tom Bryson Department of Anaesthesia, Liverpool Women's Hospital, Liverpool, UK.
authors: S
authors: S
authors: Mallaiah
authors: Tom Bryson Department of Anaesthesia, Liverpool Women's Hospital, Liverpool, UK.
authors: P
authors: P
authors: Barclay
authors: Tom Bryson Department of Anaesthesia, Liverpool Women's Hospital, Liverpool, UK.
authors: C
authors: C
authors: Chevannes
authors: Tom Bryson Department of Anaesthesia, Liverpool Women's Hospital, Liverpool, UK.
authors: A
authors: A
authors: Bhalla
mesh_terms: D000037:Abruptio Placentae / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D000465:Algorithms; D001777:Blood Coagulation / Q000187:drug effects; D001778:Blood Coagulation Disorders / Q000150:complications / Q000188:drug therapy*; D005260:Female; D005340:Fibrinogen / Q000627:therapeutic use*; D006801:Humans; D011247:Pregnancy; D013916:Thrombelastography; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D005340:Fibrinogen
keywords: Coagulopathy; Fibrinogen concentrate; Hypofibrinogenaemia; Placental abruption; Rotational thromboelastometry