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Samimi Sadeh S, Behseresht A, Khayatian S. Analyzing The Role of Rotational Thromboelastometry (ROTEM) in Postpartum Hemorrhage Management, Accounting the Importance of Time and Target. SJMR 2021; 6 (1) :9-17
URL: http://saremjrm.com/article-1-208-en.html

Postpartum hemorrhage (PPH) is the most significant cause of mothers' postpartum mortality. Its causes are generally explained as a mnemonic of 4Ts, which include: Tone, Tissue, Trauma, Thrombin. It is of extreme importance to perform timely interventions of both surgical and medical treatments to control PPH, also precise and rapid monitoring of maternal coagulopathies plays a critical role in the treatment process. ROTEM usage as an accurate and rapid tool for coagulation assessment on the maternal bedside is progressing worldwide. This study reviews the most up-to-date papers in this field and has summarized the role of rotational thromboelastometry (ROTEM) to treat PPH effectively and with the least adverse outcomes. At first, we explain the causes of PPH, physiological changes in the coagulation system at term pregnancy (including a significant increase in blood fibrinogen levels) and then we explain the application of ROTEM and its output data on medical practice. We also discuss normal values of ROTEM parameters in term pregnancy and compare the normal parameter ranges with the normal non-pregnant population. Ultimately, the way of approaching the ROTEM output parameters, particularly the FIBTEM A5, has been mentioned as a rapid diagnostic output of ROTEM in most PPH-related coagulopathies. Moreover, we demonstrate the costs and benefits of treatment with fibrinogen concentrate and blood products based on the ROTEM output results. It appears that ROTEM has shown a promising view in the field of obstetrics and gynecology surgeries (especially in the management of PPH) and contrives early therapeutic interventions in parallel with reducing the administration of blood products and their adverse outcomes (TACO, TRALI, …) in mothers, therefore maternal mortality and morbidity due to PPH can be reduced more than before by ROTEM-guidance becoming widespread.