Thromboelastometry (Tem) in Pregnant Women: Basal Tem Profile and Tem Profile after Carbetocin Administration in Women at High Risk for Post-Partum Haemorrhage

Benedetta Zuppani,Valentina Panetta,Carlotta Montagnoli,Maria Elisabetta Romanini,Maria Grazia Frigo,Mario Filippo Segatore,Herbert Valensise,Giovanni Larciprete

doi:10.15344/2394-4986/2014/103

Benedetta Zuppani, Valentina Panetta + Show 6 more

Open Access

https://doi.org/10.15344/2394-4986/2014/103

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Abstract

The aims of this study were to evaluate the thromboelastometry profile in pregnant at risk of post-partum haemorrhage and evaluate changes in thromboelastometry profile after administration of Carbetocin, used as uterotonic drugs in this patients during caesarean section. Twenty-one women undergoing elective caesarean section were consecutively enrolled, with risk factors for primary post-partum haemorrhage. All patients underwent the same combined spinal-epidural (CSE) anaesthesia. A basal thromboelastometry profile was performed. Women according to the study protocol received 500 ml of 0.9% NaCl solution IV and as uterotonic drug a bolus of 100 μg IV of Carbetocin at delivery of the anterior shoulder. Five minutes after uterotonic infusion, a new blood sample was performed for thromboelastometry profile after Carbetocin. Considering the changes in thomboelastometry profile before and after Carbeton, TEM exhibited significantly lower in MCF (in-TEM and ex-TEM) (p<0.01) and in A10 (in-TEM and ex-TEM) (p<0.01). We note also a significantly higher CFT ex-TEM value after Carbetocin (p<0.01).

Highlights

Post-partum haemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide
All TEM parameters (CT, clot formation time (CFT), Maximum Clot Firmness (MCF), A10, maximum lysis (ML)) included in normal range suggested by the manufacturer
A normal pregnancy is associated with major changes in many aspects of haemostasis that create a state of hypercoagulability

Summary

Introduction

Post-partum haemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. The study conducted by the International PPH Collaborative Group, reports an increasing trend in coded PPH between 1991 and 2006 in low income countries, and in Canada, New South Wales and the USA, as a possible result of increased maternal age at childbirth, increased rate of caesarean delivery, increased rate of induction of labor and higher number of multiple pregnancies [1]. Even today almost 500.000 women die for this potentially preventable cause each year [3]. The gravity of the bleeding and the presence of haemorrhagic shock depend on the amount of blood lost (Table 1) [4]

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