[227-POS]: Thromboelastography (TEG((R))) and rotational thromboelastometry (ROTEM((R))) in pregnancy: A systematic review

Abstract

OBJECTIVES: To evaluate the current position of thromboelastography (TEG) and rotational thromboelastometry (ROTEM) in clinical obstetric practice. METHODS: A search of the literature was performed on the following databases PubMed MEDLINE, EMBASE and the Cochrane Database of Systematic reviews. All articles published after 1990 until February 2013 and written in English, German, French, Spanish, Italian and Dutch concerning human pregnancies were eligible for inclusion. Eligible papers were subdivided in normal and complicated pregnancy outcomes and processed. RESULTS: 287 articles were found, of which 60 are included in the review. All studies with TEG/ROTEM performed in uncomplicated pregnancies, found significant changes towards a hypercoagulable state, especially in the third trimester. Hypercoagulability was found to persist till at least 3 weeks postpartum. In postpartum hemorrhage FIBTEM-ROTEM correlated well with the measured fibrinogen levels. Although, in severe preeclampsia with low platelets (<100.000/mm(3)) or in HELLP-syndrome changes in TEG/ROTEM associated with hypocoagulability are described, most studies were not able to show any significant differences between healthy pregnant women and women with mild preeclampsia. Miscarriage is associated with hypercoagulable changes in TEG/ROTEM compared to healthy non-pregnant and pregnant women. 26 case reports concerning women with specific coagulation disorders were identified and TEG/ROTEM was used for guiding therapeutic decision making. CONCLUSIONS: In individual women with coagulation disorders TEG/ROTEM can be useful to provide complementary information for "decision-making" and "therapy-guidance". The use of TEG((R)) or ROTEM((R))-analysis in the general obstetric practice, is at this time not recommended. Further research with standardized processing of data is most promising for bedside monitoring and interventions of postpartum hemorrhage. DISCLOSURES: A.C. Bolte: None. F.J. Hermans: None. L.E. Van Rheenen-Flach: None.