{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:08:14Z","timestamp":1790359694293,"version":"4.1.0"},"reference-count":33,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2019,4,5]],"date-time":"2019-04-05T00:00:00Z","timestamp":1554422400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    We report four years of observational data from a large UK hospital and tertiary referral unit, following the introduction of a rotational thromboelastometry\u2010guided algorithm for treatment of coagulopathy in major obstetric haemorrhage. Fibrinogen concentrate was used to treat acquired hypofibrinogenaemia as defined by a Fib\n                    <jats:styled-content style=\"fixed-case\">TEM<\/jats:styled-content>\n                    A5 value of &lt;\u00a07\u00a0mm, or 7\u201312\u00a0mm with ongoing or high risk of haemorrhage. Of 32,647 deliveries over 4\u00a0years, 893 (2.7%) women had an estimated blood loss \u2265\u00a01500\u00a0ml. Two\u2010hundred and three (23%) of these had a Fib\n                    <jats:styled-content style=\"fixed-case\">TEM<\/jats:styled-content>\n                    A5 \u2264\u00a012\u00a0mm and 110 received fibrinogen concentrate. We compared clinical outcomes and blood product use with 52 patients who met the same criteria, over a 12\u2010month pre\u2010intervention period during which shock packs were used. In the algorithm group, there was a significant reduction in the number of units (p\u00a0&lt;\u00a00.0001) and total volume (p\u00a0=\u00a00.0007) of blood products transfused, with a reduction in transfusion\u2010associated circulatory overload (p\u00a0=\u00a00.002). Women with placental abruption exhibited more severe coagulopathy and required higher doses of fibrinogen concentrate than women who bled due to other causes. Analysis of rotational thromboelastometry results demonstrated that coagulopathy is not observed in all women who suffer obstetric haemorrhage and cannot be predicted solely by blood loss. Therefore, formulaic treatment with blood products is not justified. When coagulopathy does occur, it appears to be multifactorial and can be severe. Point\u2010of\u2010care testing allows early identification and individualised treatment of coagulopathy. This is supported by the improved outcomes reported.\n                  <\/jats:p>","DOI":"10.1111\/anae.14628","type":"journal-article","created":{"date-parts":[[2019,4,6]],"date-time":"2019-04-06T02:29:37Z","timestamp":1554517777000},"page":"984-991","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":145,"title":["Four years' experience of a ROTEM\n                    <sup>\u00ae<\/sup>\n                    \u2010guided algorithm for treatment of coagulopathy in obstetric haemorrhage"],"prefix":"10.1111","volume":"74","author":[{"given":"H.","family":"McNamara","sequence":"first","affiliation":[{"name":"Liverpool Women's NHS Foundation Trust Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Kenyon","sequence":"additional","affiliation":[{"name":"Liverpool Women's NHS Foundation Trust Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Smith","sequence":"additional","affiliation":[{"name":"Mid Cheshire Hospitals NHS Foundation Trust Crewe UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Mallaiah","sequence":"additional","affiliation":[{"name":"Liverpool Women's NHS Foundation Trust Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Barclay","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Hospital NHS Foundation Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,4,5]]},"reference":[{"key":"e_1_2_6_2_1","volume-title":"Saving Lives, Improving Mothers\u2019 Care \u2013 Lessons Learned to Inform Maternity Care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2013\u201315","author":"Knight 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