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You are in a peripheral hospital without onsite laboratory support after hours and you are involved in the care of a young parturient with uterine atony who has now bled over 2litres. Although you have called in someone to do some laboratory testing – you know that these results will be at least 45-90minutes away. How likely is it that this woman has become coagulopathic? What approach should you take in this setting? Should you use empiric coagulation supportive therapy? FFP? Fibrinogen? TXA?
This week we have the audio of a great talk Nolan wrote for the obstetric intensive care symposium held in Adelaide earlier this year, and which he then kindly presented to our department in April.
Pregnancy is a procoagulant state and during haemorrhage obstetric coagulopathy is actually relatively rare. The underlying mechanisms are different to trauma and other patient groups and we should use this knowledge to help us in our use of blood product therapy especially when rapid coagulation testing (eg viscoelastic tests like ROTEM) are not rapidly available.
However there are some exceptions to this rule – beware early onset of coagulopathy in women with abruption, HELLP, and AFE!
Obstetric Intensive Care Symposium Adelaide 2018
If you want to watch the video of this talk with it’s powerpoint slides: