{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T20:03:37Z","timestamp":1785873817471,"version":"3.56.0"},"reference-count":49,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T00:00:00Z","timestamp":1756166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Conventional Coagulation Tests (CCTs) fail to accurately reflect Preeclampsia\u2019s (PE\u2019s) coagulation status, disease progression, and hemostatic alterations. They do not differentiate between the normal hypercoagulability of healthy pregnancies and the pathological hypercoagulability associated with PE. Rotational Thromboelastometry (ROTEM) analyzes clot dynamics from initiation through amplification and propagation to termination and fibrinolysis. However, their application in PE, particularly in neonates born to women with PE, is limited. We aimed to identify the hemostatic alterations in pregnant women with PE using ROTEMs that remain undetected by CCTs and to assess PE\u2019s impact on neonatal hemostasis at birth. Methods: This was a single-center observational study (March 2022\u2013March 2024) including 31 women with PE (34 newborns) and 45 pregnancies without PE (47 newborns). Maternal blood was collected intrapartum before placental delivery. Neonatal arterial samples were obtained within the first hour of life before vitamin K administration. ROTEM (Intrinsic (INTEM), Extrinsic (EXTEM), Fibrinogen (FIBTEM), Aprotinin (APTEM)), and CCTs were performed. Subgroup analyses considered PE severity and onset. ROC analyses examined discrimination for persistent maternal thrombocytopenia within 7 days of delivery and association with maternal platelet transfusion. Results: In preeclamptic women, the INTEM and FIBTEM assays were more affected, with higher Actual Clot Firmness (ACF) (p = 0.03, p = 0.04, respectively) and a higher Clot Formation Rate (CFR) (p = 0.03, p = 0.02, respectively). Hyperfibrinolysis was present (CT-APTEM &lt; CT-EXTEM, MCF-APTEM &gt; MCF-EXTEM). Clot Formation Time CFT-EXTEM was an indicator of maternal platelet transfusion (AUC = 0.81). Across EXTEM, INTEM, and APTEM, A10 (Amplitude at 10 min) and CFT showed good discrimination capability for maternal persistent thrombocytopenia within 7 days of delivery (AUCs 0.82\u20130.95). Neonates of women with PE presented lower ACF across all assays (INTEM p = 0.003; EXTEM p = 0.001; FIBTEM p = 0.01; APTEM p &lt; 0.001), consistent across severity\/onset subgroups. Conclusions: In this cohort, ROTEM identified maternal hypercoagulability with hyperfibrinolysis and neonatal hypocoagulability during the first hour of life. Several alterations were not reflected in CCTs. Further prospective studies should evaluate the role and clinical utility of combining ROTEM with CCTs for hemostatic monitoring in women with PE and their neonates.<\/jats:p>","DOI":"10.3390\/diagnostics15172156","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T14:18:49Z","timestamp":1756217929000},"page":"2156","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Rotational Thromboelastometry (ROTEM) Hemostasis Profile in Pregnant Women with Preeclampsia and Their Offspring: An Observational Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9578-7111","authenticated-orcid":false,"given":"Christos-Georgios","family":"Kontovazainitis","sequence":"first","affiliation":[{"name":"2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Papageorgiou University Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitra","family":"Gialamprinou","sequence":"additional","affiliation":[{"name":"2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Papageorgiou University Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Fleva","sequence":"additional","affiliation":[{"name":"Immunology and Histocompatibility Department, Papageorgiou University Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodoros","family":"Theodoridis","sequence":"additional","affiliation":[{"name":"1st Department of Obstetrics and Gynecology, Papageorgiou University Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5570-9514","authenticated-orcid":false,"given":"Ilias","family":"Chatziioannidis","sequence":"additional","affiliation":[{"name":"1st Neonatal Department and Neonatal Intensive Care Unit (NICU), Ippokrateio University Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Mitsiakou","sequence":"additional","affiliation":[{"name":"2nd Department of Paediatrics, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anastasia","family":"Banti","sequence":"additional","affiliation":[{"name":"Haematology Department, Papageorgiou University Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elissavet","family":"Diamanti","sequence":"additional","affiliation":[{"name":"2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Papageorgiou University Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9796-1614","authenticated-orcid":false,"given":"Georgios","family":"Mitsiakos","sequence":"additional","affiliation":[{"name":"2nd Neonatal Department and Neonatal Intensive Care Unit (NICU), Papageorgiou University Hospital, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Kenny, L.C., McCrae, K.R., and Cunningham, F.G. (2015). Platelets, coagulation, and the liver. Chesley\u2019s Hypertensive Disorders in Pregnancy, Elsevier. [4th ed.].","DOI":"10.1016\/B978-0-12-407866-6.00017-1"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1055\/s-0030-1270336","article-title":"Hemostasis in Pre-Eclampsia","volume":"37","author":"Higgins","year":"2011","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Cohen, H., and O\u2019Brien, P. (2015). Hemostatic Changes in Normal Pregnancy. Disorders of Thrombosis and Hemostasis in Pregnancy, Springer International Publishing.","DOI":"10.1007\/978-3-319-15120-5"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1055\/s-0042-1760332","article-title":"Hemostasis in the Pregnant Woman, the Placenta, the Fetus, and the Newborn Infant","volume":"49","author":"Warren","year":"2023","journal-title":"Semin. Thromb. Hemost."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Kontovazainitis, C.-G., Gialamprinou, D., Theodoridis, T., and Mitsiakos, G. (2024). Hemostasis in Pre-Eclamptic Women and Their Offspring: Current Knowledge and Hemostasis Assessment with Viscoelastic Tests. Diagnostics, 14.","DOI":"10.3390\/diagnostics14030347"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Committee on Practice Bulletin (2020). Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet. Gynecol., 135, e237\u2013e260.","DOI":"10.1097\/AOG.0000000000003891"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1161\/HYPERTENSIONAHA.108.117358","article-title":"Early and Late Preeclampsia: Two Different Maternal Hemodynamic States in the Latent Phase of the Disease","volume":"52","author":"Valensise","year":"2008","journal-title":"Hypertension"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1515\/biol-2019-0037","article-title":"The diagnostic efficacy of thrombelastography (TEG) in patients with preeclampsia and its association with blood coagulation","volume":"14","author":"Lidan","year":"2019","journal-title":"Open Life Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1002\/ijgo.12785","article-title":"The ability of thromboelastography parameters to predict severe pre-eclampsia when measured during early pregnancy","volume":"145","author":"Wang","year":"2019","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1097\/MBC.0000000000000759","article-title":"Thromboelastographic analysis of haemostasis in preeclamptic and normotensive pregnant women","volume":"29","author":"Murray","year":"2018","journal-title":"Blood Coagul. Fibrinolysis"},{"key":"ref_11","first-page":"1793","article-title":"Whole blood thromboelastometry profiles in women with preeclampsia","volume":"53","author":"Spiezia","year":"2015","journal-title":"Clin. Chem. Lab. Med. CCLM"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1093\/bja\/aet480","article-title":"Peri-partum reference ranges for ROTEM\u00ae thromboelastometry","volume":"112","author":"Mooyman","year":"2014","journal-title":"Br. J. Anaesth."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1093\/bja\/77.2.157","article-title":"Thrombelastography changes in pre-eclampsia and eclampsia","volume":"77","author":"Orlikowski","year":"1996","journal-title":"Br. J. Anaesth."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1007\/s13224-016-0906-y","article-title":"Role of Thromboelastography Versus Coagulation Screen as a Safety Predictor in Pre-eclampsia\/Eclampsia Patients Undergoing Lower-Segment Caesarean Section in Regional Anaesthesia","volume":"66","author":"Ahmad","year":"2016","journal-title":"J. Obstet. Gynecol. India"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.bpa.2022.02.004","article-title":"Latest advances in postpartum hemorrhage management","volume":"36","author":"Kumaraswami","year":"2022","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/s13049-024-01263-5","article-title":"Thromboelastography as an early prediction method for hypofibrinogenemia in emergency department patients with primary postpartum hemorrhage","volume":"32","author":"Kim","year":"2024","journal-title":"Scand. J. Trauma Resusc. Emerg. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1177\/00031348241309563","article-title":"What, When, and Why: Viscoelastic Hemostatic Assays and Their Uses in Trauma Resuscitation","volume":"91","author":"Burkhart","year":"2025","journal-title":"Am. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1002\/ajh.23599","article-title":"TEG and ROTEM: Technology and clinical applications","volume":"89","author":"Whiting","year":"2014","journal-title":"Am. J. Hematol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1111\/jth.14882","article-title":"Systematic review of viscoelastic testing (TEG\/ROTEM) in obstetrics and recommendations from the women\u2019s SSC of the ISTH","volume":"18","author":"Amgalan","year":"2020","journal-title":"J. Thromb. Haemost."},{"key":"ref_20","unstructured":"(2022, August 18). NICE Guideline Hypertension in Pregnancy: Diagnosis and Management. Available online: https:\/\/www.nice.org.uk\/guidance\/ng133\/resources\/hypertension-in-pregnancy-diagnosis-and-management-pdf-66141717671365."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1111\/aogs.13846","article-title":"Validation of the 34-week gestation as definition of late onset preeclampsia: Testing different cutoffs from 30 to 37 weeks on a population-based cohort of 1700 preeclamptics","volume":"99","author":"Robillard","year":"2020","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"214365","DOI":"10.1155\/2011\/214365","article-title":"Maternal Preeclampsia and Neonatal Outcomes","volume":"2011","author":"Backes","year":"2011","journal-title":"J. Pregnancy"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Committee on Practice Bulletin (2019). ACOG Practice Bulletin No. 203: Chronic Hypertension in Pregnancy. Obstet. Gynecol., 133, e26\u2013e50.","DOI":"10.1097\/AOG.0000000000003020"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1515\/jpm-2023-0444","article-title":"Coagulation assessment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infected pregnant women and their offspring by using rotational thromboelastometry (ROTEM)","volume":"52","author":"Mitsiakos","year":"2024","journal-title":"J. Perinat. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"100100","DOI":"10.1016\/j.rpth.2023.100100","article-title":"Sepsis-induced coagulopathy in preterm neonates with Gram-positive sepsis presents with hypercoagulation and reduced platelet activation compared with healthy preterm neonates","volume":"7","author":"Gialamprinou","year":"2023","journal-title":"Res. Pract. Thromb. Haemost."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1097\/00000542-199902000-00009","article-title":"Assessment of Changes in Coagulation in Parturients with Preeclampsia Using Thromboelastography","volume":"90","author":"Sharma","year":"1999","journal-title":"Anesthesiology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e23623","DOI":"10.1002\/jcla.23623","article-title":"Thromboelastography (TEG) in normal pregnancy and its diagnostic efficacy in patients with gestational hypertension, gestational diabetes mellitus, or preeclampsia","volume":"35","author":"Xie","year":"2021","journal-title":"J. Clin. Lab. Anal."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1016\/S0002-9378(96)70045-5","article-title":"Evidence of endothelial activation and endothelial activators in cord blood of infants of preeclamptic women","volume":"175","author":"Davidge","year":"1996","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"345","DOI":"10.3109\/08977190903184670","article-title":"Fetal and maternal angiogenic\/anti-angiogenic factors in normal and preeclamptic pregnancy","volume":"27","author":"Catarino","year":"2009","journal-title":"Growth Factors"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"462","DOI":"10.12891\/ceog1864.2015","article-title":"Detecting coagulability status by thromboelastography in women with the history of preeclampsia and inherited thrombophilia","volume":"42","author":"Bulbul","year":"2015","journal-title":"Clin. Exp. Obstet. Gynecol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"104297","DOI":"10.1016\/j.ijoa.2024.104297","article-title":"Platelet aggregation and thromboelastometry monitoring in women with preeclampsia: A prospective observational study","volume":"61","author":"Andersson","year":"2025","journal-title":"Int. J. Obstet. Anesth."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1080\/08998280.2023.2217534","article-title":"Baseline rotational thromboelastometry (ROTEM) values in a healthy, diverse obstetric population and parameter changes by pregnancy-induced comorbidities","volume":"36","author":"Fiol","year":"2023","journal-title":"Bayl. Univ. Med. Cent. Proc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1203\/00006450-199803000-00007","article-title":"Fetuses from Preeclamptic Mothers Show Reduced Hepatic Erythropoiesis","volume":"43","author":"Stallmach","year":"1998","journal-title":"Pediatr. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1182\/blood.V88.3.900.900","article-title":"Evolution of blood coagulation activators and inhibitors in the healthy human fetus","volume":"88","author":"Delahousse","year":"1996","journal-title":"Blood"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1097\/01.mbc.0000164425.67674.90","article-title":"The effect of pre-eclampsia on the levels of coagulation and fibrinolysis factors in umbilical cord blood of newborns","volume":"16","author":"Zanardo","year":"2005","journal-title":"Blood Coagul. Fibrinolysis"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1161\/01.RES.0000152391.45273.A2","article-title":"Fetal Liver-Sparing Cardiovascular Adaptations Linked to Mother\u2019s Slimness and Diet","volume":"96","author":"Haugen","year":"2005","journal-title":"Circ. Res."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Karapati, E., Valsami, S., Sokou, R., Pouliakis, A., Tsaousi, M., Sulaj, A., Iliodromiti, Z., Iacovidou, N., and Boutsikou, T. (2024). Hemostatic Profile of Intrauterine Growth-Restricted Neonates: Assessment with the Use of NATEM Assay in Cord Blood Samples. Diagnostics, 14.","DOI":"10.3390\/diagnostics14020178"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.thromres.2008.08.008","article-title":"Haemostatic profile of full-term, healthy, small for gestational age neonates","volume":"124","author":"Mitsiakos","year":"2009","journal-title":"Thromb. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"425","DOI":"10.23736\/S2724-5276.23.07214-2","article-title":"Neonatal hemostasis and the use of thromboelastography\/rotational thromboelastometry in the neonatal period","volume":"76","author":"Katsaras","year":"2024","journal-title":"Minerva Pediatr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"3455","DOI":"10.1007\/s00431-021-04154-4","article-title":"The use of thromboelastography (TEG) and rotational thromboelastometry (ROTEM) in neonates: A systematic review","volume":"180","author":"Katsaras","year":"2021","journal-title":"Eur. J. Pediatr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e30131","DOI":"10.1002\/pbc.30131","article-title":"Thrombocytopenia and neonatal outcomes among extremely premature infants exposed to maternal hypertension","volume":"70","author":"Delaney","year":"2023","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1055\/s-2007-999970","article-title":"Effects of Preeclampsia on Maternal and Cord Blood Clotting Activity","volume":"2","author":"Lox","year":"1985","journal-title":"Am. J. Perinatol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e42","DOI":"10.1055\/s-0035-1565923","article-title":"Neonatal Thrombocytopenia as a Consequence of Maternal Preeclampsia","volume":"06","author":"Kalagiri","year":"2015","journal-title":"Am. J. Perinatol. Rep."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Bayoumi, M.A.A., Ali, A.A.H., Hamad, S.G., Ali, A.A.M., Elmalik, E.E., Elkalaf, M.M.I.R., Moustafa, B.A.A., Shaltout, D.A.D.A., Chandra, P., and Langtree, L.J. (2020). Effect of Maternal Preeclampsia on Hematological Profile of Newborns in Qatar. BioMed Res. Int., 2020.","DOI":"10.1155\/2020\/7953289"},{"key":"ref_45","first-page":"162","article-title":"Absent umbilical artery end-diastolic velocity in growth-restricted fetuses: A risk factor for neonatal thrombocytopenia","volume":"96","author":"Baschat","year":"2000","journal-title":"Obstet. Gynecol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1080\/14767058.2017.1401996","article-title":"How does preeclampsia affect neonates? Highlights in the disease\u2019s immunity","volume":"32","author":"Marins","year":"2019","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1177\/107602960501100415","article-title":"Coagulation and Fibrinolysis in Preeclampsia and Neonates","volume":"11","author":"Tanjung","year":"2005","journal-title":"Clin. Appl. Thromb."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/S0049-3848(00)00267-X","article-title":"The Effect of Pre-eclampsia on Coagulation and Fibrinolytic Activation in the Neonate","volume":"99","author":"Higgins","year":"2000","journal-title":"Thromb. Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1067\/mob.2002.126280","article-title":"Levels of plasminogen activators and their inhibitors in maternal and umbilical cord plasma in severe preeclampsia","volume":"187","author":"Roes","year":"2002","journal-title":"Am. J. Obstet. Gynecol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/17\/2156\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:33:10Z","timestamp":1760034790000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/17\/2156"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,26]]},"references-count":49,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["diagnostics15172156"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15172156","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,26]]}}}