University Hospital of Wales, Cardiff, UK.
Liverpool Women's Hospital NHS Trust, Liverpool, UK.
Int J Obstet Anesth. 2021 May;46:102979. doi: 10.1016/j.ijoa.2021.102979. Epub 2021 Mar 26.
Anticipating obstetric coagulopathy is important when obstetric anaesthetists are involved in the clinical management of women with postpartum haemorrhage. Although the incidence of coagulopathy in women with postpartum haemorrhage is low, significant hypofibrinogenaemia is associated with major haemorrhage-related morbidity and thus early identification and treatment is essential to improve outcomes. Point-of-care viscoelastic haemostatic assays, including thromboelastography and rotational thromboelastometry, provide granular information about alterations in clot formation and hypofibrinogenaemia, allow near-patient interpretation of coagulopathy, and can guide goal-directed treatment. If these assays are not available, anaesthetists should closely monitor the maternal coagulation profile with standard laboratory testing during the active phase of postpartum bleeding in order to rule coagulopathy 'in or out', decide if pro-haemostatic therapies are indicated, and assess the response to haemostatic support.
当产科麻醉师参与产后出血妇女的临床管理时，预测产科凝血障碍很重要。尽管产后出血妇女发生凝血障碍的发生率较低，但明显的纤维蛋白原减少与大出血相关的发病率显著相关，因此早期识别和治疗对于改善结局至关重要。即时检测的粘弹性止血检测，包括血栓弹力图和旋转血栓弹力计，提供了关于凝血块形成和纤维蛋白原减少的详细信息，允许在床旁解读凝血障碍，并可以指导靶向治疗。如果这些检测不可用，麻醉师应在产后出血的活跃期期间通过标准实验室检测密切监测产妇的凝血谱，以确定凝血障碍“存在或不存在”，决定是否需要促凝治疗，并评估对止血支持的反应。
