Maher Patrick, Katz Dan, Afzal Omara, Nyamu Sylviah, Richardson Lynne D
Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Eur J Obstet Gynecol Reprod Biol. 2025 Jan;304:36-40. doi: 10.1016/j.ejogrb.2024.11.019. Epub 2024 Nov 19.
Vaginal bleeding in early pregnancy is a common presentation in the Emergency Department (ED), often resulting in pregnancy loss. Hypercoagulability exceeding normal physiological changes may be associated with miscarriage, but conventional clotting tests do not reliably detect this effect. Rotational thromboelastometry (ROTEM), which performs a more comprehensive clotting evaluation, may demonstrate coagulopathic abnormalities contributing to vaginal bleeding and miscarriage in early pregnancy that are not present in normal gestation.
This study aimed to evaluate the relationship between coagulation results from ROTEM testing in patients undergoing active evaluation for possible miscarriage compared to samples taken from asymptomatic patients with healthy pregnancies.
This was a prospective case control study from a single center. Patients with chief complaint of vaginal bleeding in early pregnancy (less than 20 weeks) were recruited from the ED for ROTEM testing. These results were compared to healthy pregnant women presenting for routine prenatal care at our hospital's obstetrical clinic. Crude results were analyzed using t-test for ROTEM measures, and differences were then compared using multiple linear regression, controlling for patient age, race, ethnicity, number of prior pregnancies, and estimated gestational age (EGA) in weeks. ROTEM measurements of interest were the clot formation kinetics using EXTEM, INTEM, and NATEM tracings.
Over the study, 46 patients were recruited from the ED and 51 from the obstetric clinic. Both groups had similar mean ages, and racial and ethnic distribution. ED patients had earlier EGA than OB clinic patients, 7.6 weeks vs. 10.7 weeks, but higher patient age and higher number of prior pregnancies. ROTEM results were not significantly different between groups on univariate analysis except for INTEM CFT and INTEM MCF. After controlling for the patient age and estimated gestational age, no ROTEM result differed between groups.
In pregnant patients presenting to the ED with vaginal bleeding before 20 weeks, ROTEM differences were not different in comparison to healthy pregnant patients at the same gestation stage. This suggests that ROTEM clotting profiles may not be useful in the evaluation of vaginal bleeding within this population.
妊娠早期阴道出血是急诊科常见的症状，常导致妊娠丢失。超过正常生理变化的高凝状态可能与流产有关，但传统的凝血检测无法可靠地检测到这种影响。旋转血栓弹力图（ROTEM）能进行更全面的凝血评估，可能显示出导致妊娠早期阴道出血和流产的凝血病异常，而这些异常在正常妊娠中并不存在。
本研究旨在评估对可能流产进行积极评估的患者与无症状健康妊娠患者的ROTEM检测凝血结果之间的关系。
这是一项来自单一中心的前瞻性病例对照研究。从急诊科招募主诉妊娠早期（小于20周）阴道出血的患者进行ROTEM检测。将这些结果与在我院产科门诊进行常规产前检查的健康孕妇进行比较。使用t检验对ROTEM测量的原始结果进行分析，然后使用多元线性回归比较差异，同时控制患者年龄、种族、民族、既往妊娠次数和以周为单位的估计孕周（EGA）。感兴趣的ROTEM测量指标是使用EXTEM、INTEM和NATEM描记图的凝血形成动力学。
在研究过程中，从急诊科招募了46例患者，从产科门诊招募了51例患者。两组的平均年龄、种族和民族分布相似。急诊科患者的EGA比产科门诊患者更早，分别为7.6周和10.7周，但患者年龄更大且既往妊娠次数更多。单因素分析显示，除INTEM CFT和INTEM MCF外，两组间的ROTEM结果无显著差异。在控制患者年龄和估计孕周后，两组间的ROTEM结果无差异。
在妊娠20周前因阴道出血就诊于急诊科的孕妇中，与相同妊娠阶段的健康孕妇相比ROTEM差异无统计学意义。这表明ROTEM凝血图谱在评估该人群的阴道出血时可能并无用处。
