Thromboelastometry during Labor and after Delivery

Gabriele Tola, Silvia Sirparo, Luca Ruggeri, Giorgio Capogna

Department of Anesthesiology, Città di Roma Hospital, Rome, Italy..

DOI: 10.4236/ojanes.2013.34050                

Abstract

The normal values of thromboelastometry (MonoTEM-A^?, Framar Hemologix) in pregnancy have not been determined. The aim of this study was to establish the reference ranges for the thromboelastometer in healthy pregnant women during labor and after delivery. After ethical institutional approval and informed consent, we collected blood samples for analysis from 95 healthy labouring women and 40 volunteers (non pregnant women, control group). A sample of 360 μL of whole native blood was tested using the MonoTEM-A^? equipment and analyzed within 4 min, at 37℃. We recorded: R = time to initial fibrin formation; K = time to initial clot formation; Alpha Angle = acceleration of clot formation and MA = strength of the blood clot. When compared to the control group, R and K values were lower in women during labor and after the delivery. The Alpha angle and MA values were higher in the laboring women and in the same women after delivery as compared to the control group. Our study determined the reference ranges for the MonoTEM-A^? in pregnancy during labor and immediately after the delivery. Data obtained from thromboelastometry confirm the hypercoagulability status in pregnancy and the puerperium. MonoTEM-A^? thromboelastometry may be a very useful tool to assess the clotting activity in this patient setting.

Keywords

Pregnancy; Labor; Thromboelastometry

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	D. Wozniak and B. Adamik, “Thromboelastography,” Anestezjologia Intensywna Terapia, Vol. 43, No. 4, 2011, pp. 244-247.
[2]	R. J. Luddington, “Thromboelastography/Thromboelastometry,” Clinical & Laboratory Haematology, Vol. 27, No. 1, 2005, pp. 81-90. doi:10.1111/j.1365-2257.2005.00681.x
[3]	H. Gorton and G. Lyons, “Is It Time to Invest in a Thromboelastograph?” International Journal of Obstetric Anesthesia, Vol. 8, No. 3, 1999, pp. 171-178. doi:10.1016/S0959-289X(99)80133-2
[4]	G. Rajpal, J. M. Pomerantz, M. V. Ragni, J. H. Waters and M. C. Vallejo, “The Use of Thromboelastography for the Peripartum Management of a Patient with Platelet Storage Pool Disorder?” International Journal of Obstetric Anesthesia, Vol. 20, No. 2, 2011, pp. 173-177. doi:10.1016/j.ijoa.2010.09.014
[5]	S. K. Sharma and J. Philip, “The Effect of Anesthetic Techniques on Blood Coagulability in Parturients as Measured by Thromboelastography,” Anesthesia & Analgesia, Vol. 85, No. 1, 1997, pp. 82-86.
[6]	E. Cuvillon, M. Bonnetty, J. P. Favereau, P. Grandchamp and N. Nathan, “Epidural Analgesia in a Pregnant Woman with Essential Thrombocythaemia,” Annales Françaises d’Anesthésie et de Réanimation, Vol. 22, No. 5, 2003, pp. 453-456. doi:10.1016/S0750-7658(03)00091-1
[7]	S. K. Sharma, J. Philip, C. W. Whitten, U. B. Padakandla and D. F. Landers, “Assessment of Changes in Coagulation in Parturients with Preeclampsia Using Thromboelastography,” Anesthesiology, Vol. 90, No. 2, 1999, pp. 385-390. doi:10.1097/00000542-199902000-00009
[8]	S. K. Backe and G. R. Lyons, “High-Dose Tinzaparin in Pregnancy and the Need for Urgent Delivery,” British Journal of Anaesthesia, Vol. 89, No. 2, 2002, pp. 331-334. doi:10.1093/bja/aef189
[9]	J. R. Davies, R. Fernando and S. P. Hallworth, “Hemostatic Function in Healthy Pregnant and Preeclamptic Women: An Assessment Using the Platelet Function Analyzer (PFA-100) and Thromboelastograph,” Anesthesia & Analgesia, Vol. 104, No. 2, 2007, pp. 416-420. doi:10.1213/01.ane.0000253510.00213.05
[10]	A. A. Hanke, O. Elsner and K. Görlinger, “Spinal Anaesthesia and Caesarean Section in a Patient with Hypofibrinogenaemia and Factor XIII Deficiency,” Anaesthesia, Vol. 65, No. 6, 2010, pp. 641-645. doi:10.1111/j.1365-2044.2010.06324.x
[11]	S. K. Sharma, R. L. Vera, W. C. Stegall and C. W. Whitten, “Management of a Postpartum Coagulopathy Using Thrombelastography,” Journal of Clinical Anesthesia, Vol. 9, No. 3, 1997, pp. 243-247. doi:10.1016/S0952-8180(97)00026-3
[12]	A. Butwick and S. Harter, “An in Vitro Investigation of the Coagulation Effects of Exogenous Oxytocin Using Thromboelastography in Healthy Parturients,” Anesthesia & Analgesia, Vol. 113, No. 2, 2011, pp. 323-326. doi:10.1213/ANE.0b013e3182222a82
[13]	C. A. Wong, S. Liu and R. Glassenberg, “Comparison of Thrombelastography with Common Coagulation Tests in Preeclamptic and Healthy Parturients,” Regional Anesthesia, Vol. 20, No. 6, 1995, pp. 521-527.
[14]	F. M. Miall, P. S. Deol, T. A. Barnes, K. Dampier, C. C. Watson, C. A. Oppenheimer, et al., “Coagulation Status and Complications of Pregnancy,” Thrombosis Research, Vol. 115, No. 6, 2005, pp. 461-467. doi:10.1016/j.thromres.2004.09.019
[15]	O. Karlsson, T. Sporrong, A. Hillarp, A. Jeppsson and M. Hellgren, “Prospective Longitudinal Study of Thromboelastography and Standard Hemostatic Laboratory Tests in Healthy Women during Normal Pregnancy,” Anesthesia & Analgesia, Vol. 115, No. 4, 2012, pp. 890-898. doi:10.1213/ANE.0b013e3182652a33
[16]	B. Macafee, J. P. Campbell, K. Ashpole, M. Cox, F. Matthey, L. Acton and S. M. Yentis, “Reference Ranges for Thromboelastography (TEG) and Traditional Coagulation Tests in Term Parturients Undergoing Caesarean Section under Spinal Anaesthesia,” Anaesthesia, Vol. 67, 2012, No. 10, pp. 741-747. doi:10.1111/j.1365-2044.2012.07101.x
[17]	F. Polak, I. Kolnikova, M. Lips, A. Parizek, J. Blaha and M. Stritesky, “New Recommendations for Thromboelastography Reference Ranges for Pregnant Women,” Thrombosis Research, Vol. 128, No. 1, 2011, pp. 14-17. doi:10.1016/j.thromres.2011.04.007
[18]	S. Armstrong, R. Fernando, K. Ashpole, R. Simons and M. Columb, “Assessment of Coagulation in the Obstetric Population Using ROTEM® Thromboelastometry,” International Journal of Obstetric Anesthesia, Vol. 20, No. 4, 2011, pp. 293-298. doi:10.1016/j.ijoa.2011.05.004
[19]	S. K. Sharma, J. Philip and J. Wiley, “Thromboelastographic Changes in Healthy Parturients and Postpartum Women,” Anesthesia & Analgesia, Vol. 85, No. 1, 1997, pp. 94-98.
[20]	G. Della Rocca, T. Dogareschi, T. Cecconet, S. Buttera, A. Spasiano, P. Nadbath, et al., “Coagulation Assessment in Normal Pragnancy: Thrombelastography with Citrated Non Activated Samples,” Minerva Anestesiologica, Vol. 67, No. 7, 2012, pp. 741-747.
[21]	C. Huissoud, N. Carrabin, M. Benchaib, O. Fontaine, A. Levrat, D. Massignon, et al., “Coagulation Assessment in Normal Pregnancy,” Journal of Thrombosis and Haemostasis, Vol. 101, No. 4, 2009, pp. 755-761.
[22]	A. Butwick and B. Carvalho, “The Effect of Colloid and Crystalloid Preloading on Thromboelastography Prior to Cesarean Delivery,” Canadian Journal of Anesthesia, Vol. 54, No. 3, 2007, pp. 190-195. doi:10.1007/BF03022639
[23]	G. Turker, T. Yilmazlar, E. B. Mogol, A. Gurbet, S. Dizman and H. Gunay, “The Effects of Colloid Pre-Loading on Thromboelastography Prior to Caesarean Delivery: Hydroxyethyl Starch 130/0.4 versus Succinylated Gelatin,” Journal of International Medical Research, Vol. 39, No. 1, 2011, pp. 143-149. doi:10.1177/147323001103900115
[24]	P. L. Steer, B. E. Finley and L. A. Blumenthal, “Abruptio Placentae and Disseminated Intravascular Coagulation: Use of Thrombelastography and Sonoclot Analysis,” International Journal of Obstetric Anesthesia, Vol. 3, No. 4, 1994, pp. 229-233. doi:10.1016/0959-289X(94)90074-4
[25]	S. C. L. Koh, et al., “Thrombelastography in Normal Subjects and in Various Clinical States,” Journal of Medical Laboratory Science, Vol. 7, No. 1, 1993, pp. 29-34.