Point-of-care coagulation testing for obstetric hemorrhage

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide. Multiple etiologies exist for PPH, both surgical and nonsurgical. One such nonsurgical etiology is either an underlying or a developing hemostatic impairment, which may also exacerbate bleeding due to other causes. Specific causes of coagulopathy in massive obstetric bleeding include hyperfibrinolysis, dilutional coagulopathy due to volume resuscitation, or consumptive coagulopathy. Though central laboratory coagulation studies are reliable and accurate, they may take too long to result (especially at a busy tertiary center, >60min), while the coagulation in patients with PPH may be dynamic and unstable. In this chapter, we will introduce the concept of point-of-care coagulation testing including viscoelastic tests and provide clinicians with timely data to guide blood product transfusion.