Gerinnungsbeurteilung in unkomplizierten und hypertensiven Schwangerschaften mittels der Thrombelastometrie - Einsatz des ROTEM® in der Geburtshilfe

Abstract

Purpose of the Study: Thrombelastography provides an overall assessment of hemostatic function through the analysis of the viscoelastic properties of whole blood and is useful in managing perioperative coagulopathies. Our study investigated the use of an enhanced method, thrombelastometry with specific coagulation activators (ROTEM®), in obstetrics. We looked for differences between non-pregnant and pregnant women and coagulation changes in hypertensive pregnancies. Patients and Methods: Citrate plasma was collected from 18 healthy non-pregnant pre-menopausal women, 50 women in the 3rd trimester of uncomplicated pregnancies, 14 women with preeclampsia and 8 women suffering from HELLP syndrome. Thrombelastometry was performed with ROTEM® (Pentapharm GmbH, Munich, Germany), using specific activators to evaluate the extrinsic and intrinsic systems. Coagulation time (CT), clot formation time (CFT) and maximal clot firmness (MCF) were determined. Results: Pregnant women showed a significant decrease of CT and CFT in the extrinsic system and an increase of MCF in both systems compared to non-pregnant women. In the preeclamptic group, a tendency toward further coagulation activation with decreased levels of CT and CFT could be observed. Patients with HELLP syndrome showed a significantly prolonged CFT (127s and 102 s) and a decreased MCF (55 mm and 57 mm) in both the extrinsic and the intrinsic system compared with healthy (CFT: 74 s and 60 s; MCF: 66 mm and 68 mm) and preeclamptic (CFT: 65 s and 56 s; MCF: 66 mm and 69 mm) pregnant women. There was a highly significant correlation between CFT and MCF, respectively, and the platelet count. Conclusion: ROTEM® provides a quick, reproducible assessment of hemostatic functions and can be used as a bedside test. We confirmed hypercoagulability during pregnancy. Our results suggest that ROTEM® may be a tool to monitor coagulation changes during hypertensive pregnancies and to detect changes of coagulation activation including the phase of factor consumption with risk of hemorrhagia. Furthermore, in cases of thrombopenia it will be possible to determine the actual state of coagulation before a necessary caesarean section.