(176) Clinical Outcomes with the use of Thromboelastography in Postpartum Hemorrhage

Thursday, January 30, 2025

10:30 AM – 12:30 PM

Coauthor(s)

AK

Aarti Kumar, MD

New York University
New York, New York, United States

Submitting Author and Presenting Author(s)

Dominique Noriega, MD (she/her/hers)

Resident
New York University
New York, NY, United States

Coauthor(s)

CD

Claudia G. Durbin, BA

New York University
New York, New York, United States
MH

Madison S. House, BS

Medical Student
New York University Grossman, School of Medicine
New York, New York, United States
AR

Ashley S. Roman, MD, MPH

MFM Division Director
NYU Langone Health
New York, New York, United States
Meghana A. Limaye, MD

MFM Fellow
NYU Langone Health
New York, New York, United States

Objective: Thromboelastography (TEG) is a viscoelastic test which has been shown to improve outcomes in postpartum hemorrhage (PPH) by rapidly guiding resuscitation. We incorporated TEG into our hemorrhage response protocol (HRP), an algorithm facilitating swift response to PPH, in a pilot study at our high-volume academic medical center. We evaluated the impact of TEG utilization on maternal outcomes and transfusion rate.

Study Design: We conducted a retrospective study of patients with PPH, defined as quantitative blood loss (QBL) >900cc for vaginal delivery or QBL >1500cc for cesarean delivery. The composite (primary) outcome of maternal morbidity included ICU admission, DIC, UAE, surgical intervention including hysterectomy, and/or administration of >3 units of any blood products. Secondary outcomes included number and type of products transfused. Outcomes were compared before (pre-TEG) and after (post-TEG) incorporation of TEG. Analysis was performed with Chi Square, Fisher’s Exact, Mann Whitney U, T-tests, and relative risk. Outcomes were also analyzed by QBL category, mode of delivery, and stages of PPH.

Results: 271 post-TEG and 131 pre-TEG cases were analyzed. Demographics were similar in pre and post TEG groups (Table 1). 5.3% of pre-TEG and 7.4% of post-TEG cases met the composite outcome (p=0.44). Overall more pRBCs were transfused post-TEG (p=0.05) with no significant difference in non-RBC transfusion (p=0.29). Subgroup analyses are shown in Table 2. Cases with stage 3 hemorrhage received more pRBCs post-TEG (p=0.03) with no significant difference in non-RBC transfusion. Of cases with QBL >3L, significantly more non-RBC products were given post-TEG (p=0.01).

Conclusion: Overall, inclusion of TEG in an HRP protocol was associated with unchanged rates of composite maternal morbidity. Future studies should investigate TEG as well as the optimal cohort of patients who could benefit from TEG for guided resuscitation of PPH.