{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T04:13:05Z","timestamp":1774584785876,"version":"3.50.1"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","issue":"07","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:p>\n            Introduction\u2003Rotational thromboelastometry (ROTEM) is a point-of-care viscoelastic test used in trauma for goal-directed transfusion. However, there are limited data on baseline ROTEM parameters in the U.S. obstetric population. Obtaining baseline parameters is a first step in implementing a goal-directed massive transfusion protocol in obstetric hemorrhage.<\/jats:p><jats:p>\n            Objective\u2003Our study aimed to establish pre- and postdelivery baseline parameters in a high-risk obstetric population and determine their association with postpartum hemorrhage (PPH).<\/jats:p><jats:p>\n            Study Design\u2003Prospective observational study of patients \u226534 weeks' gestation, at high risk of PPH, admitted for delivery. INTEM, EXTEM, FIBTEM, and APTEM assays were performed at the time of admission to labor and delivery and then 2\u2009hours after delivery. Primary outcome was pre- and postdelivery ROTEM parameters among women without PPH. A sample size of 60 women was needed for &gt;90% power to detect at least 50% correlation between pre- and postdelivery assuming a loss of 10% of participants to follow-up.<\/jats:p><jats:p>\n            Results\u2003Of 60 women in the study, 10 (17%) had PPH. Baseline characteristics were not different between those with or without PPH. Pre- and postdelivery ROTEM parameters were not significantly different except for APTEM. None of the patients who had PPH, compared with 4 (10%) of those who did not, had shortened clotting time and higher maximum clot firmness in postdelivery APTEM compared with EXTEM, a pattern suggestive of hyperfibrinolysis (p\u2009=\u20090.4).<\/jats:p><jats:p>\n            Conclusion\u2003In this study, we describe baseline ROTEM parameters in women at high risk of PPH. The majority of patients did not have a ROTEM pattern that is suggestive of hyperfibrinolysis, for which tranexamic acid is thought to be beneficial. Based on our findings, previously established obstetric transfusion thresholds for goal-directed massive transfusion protocols are likely valid for the majority of the obstetric population regardless of the presence of comorbidities or pregnancy complications.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-1788-5025","type":"journal-article","created":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T07:18:57Z","timestamp":1646637537000},"page":"915-923","source":"Crossref","is-referenced-by-count":3,"title":["Viscoelastic Testing in an Obstetric Population at High Risk of Hemorrhage"],"prefix":"10.1055","volume":"41","clinical-trial-number":[{"clinical-trial-number":"nct04409015","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2723-0650","authenticated-orcid":false,"given":"Stephen M.","family":"Graves","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren","family":"Montemorano","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, University of Wisconsin Hospital and Clinics, Madison, Wisconsin"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kara M.","family":"Rood","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4076-469X","authenticated-orcid":false,"given":"Maged M.","family":"Costantine","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kasey","family":"Fiorini","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Cackovic","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2022,5,27]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1097\/ACO.0000000000000180","article-title":"Transfusion and coagulation management in major obstetric hemorrhage","volume":"28","author":"A J Butwick","year":"2015","journal-title":"Curr Opin 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