Viscoelastic Testing in Obstetrics

Your pager goes off for a postpartum hemorrhage (PPH) on the labor floor. While the patient is hemodynamically stable, the estimated blood loss is almost 2 liters, so you place additional large-bore intravenous access while drawing off a “rainbow set” of labs. You also draw a blood gas and an additional citrated tube of blood for viscoelastic testing so you can begin goal-directed therapy while waiting for the results of your other tests. The blood gas shows a hematocrit of 20, so you begin to transfuse packed red blood cells. Your viscoelastic testing suggests factor and fibrinogen deficiencies, so you begin to transfuse FFP and cryoprecipitate. Meanwhile, your traditional blood tests have only just arrived at the laboratory. This all-too-common scenario demonstrating PPH complicated by disseminated intravascular coagulation illustrates the real-time information that viscoelastic testing can provide to aid in the swift diagnosis and treatment of coagulopathy on the labor...