Coagulation Assessment in Gynecologic Patients

Initial Evaluation and Testing

Prothrombin Time (PT) and Activated Partial Thromboplastin Time (aPTT) should be collected to evaluate the extrinsic/common and intrinsic/common coagulation pathways during active hemorrhage, as recommended by the American College of Obstetricians and Gynecologists 1
Fibrinogen level measurement is crucial as it's the first coagulation factor to reach critically low levels during major bleeding, according to the American College of Obstetricians and Gynecologists 1
Complete blood count (CBC) should be collected to assess anemia, monitor hemoglobin/hematocrit, and evaluate platelet count, as suggested by the American College of Obstetricians and Gynecologists 1

Viscoelastic testing (ROTEM/TEG) can rapidly detect hemostatic changes during ongoing hemorrhage, though it has limitations, as noted by the International Society on Thrombosis and Haemostasis 2, 3
ROTEM FIBTEM A5 is superior to Clauss fibrinogen in predicting transfusion needs and is available more quickly, according to the International Society on Thrombosis and Haemostasis 2, 3

Pregnancy is a hypercoagulable state with shortened clotting times and increased maximum clot firmness that persists up to 3 weeks postpartum, as observed by the International Society on Thrombosis and Haemostasis 2, 3, 5
Normal ranges for pregnant women must be used when interpreting coagulation tests, as aPTT is generally shortened due to elevated Factor VIII, as noted by the International Society on Thrombosis and Haemostasis 6

Never rely solely on conventional coagulation tests (PT/aPTT) during active hemorrhage as they may not correlate with clinical bleeding, as warned by the American College of Obstetricians and Gynecologists 1
Do not delay treatment while waiting for laboratory results in severe bleeding—initiate resuscitation immediately, as recommended by the American College of Obstetricians and Gynecologists 1
Avoid underestimating blood loss with visual assessment alone; quantitative measurement techniques are more reliable, as suggested by the American College of Obstetricians and Gynecologists 1
Traditional coagulation tests were not designed to monitor coagulopathy during active hemorrhage and may not reflect the dynamic clinical situation, as noted by the American College of Obstetricians and Gynecologists 1