Clinical Study On Monitoring Obstetric Hemorrhage And Predicting The Blood Loss By Use Of Thrombelastography

Objective: To evaluate the value of thrombelastography(TEG)in the monitoring of perioperative coagulation function in maternal with obstetric hemorrhagic diseases,and to discuss whether TEG can predict the bleeding risk and total blood loss in intraoperation.Method: Sixty maternals undergoing elective cesarean section were divided into hemorrhage group(with placental abruption,placenta previa,placenta implantation,HELLP syndrome or preeclampsia)and control group(normal maternals without aforementioned diseases).In the hemorrhage group,blood loss beyond 1000 ml was defined as massive hemorrhage.Hemorrhage group was treated with general anesthesia and the control group was treated with epidural anesthesia.Preoperative and postoperative blood routine,coagulation,TEG were detected.Hemodynamic parameters,blood loss,urine output and fluid intake(crystal,colloid,blood product)in intraoperative were continuously measured.TEG was detected again when intraoperative bleeding was more than 1000 ml.If blood transfusion is required,TEG is detected again after transfusion.Blood loss after the operation was also counted.Results:(1)There were no statistical difference between the two groups in preoperative blood routine,coagulation and TEG parameters.(2)There was no significant difference in the TEG parameters between the hemorrhage maternals and the non-hemorrhage maternals.(3)The correlation between TEG parameters,blood routine and coagulation in the hemorrhage group was as follows: R value was positively correlated with PT,K value was negatively correlated with Plt and Fig,and positively correlated with PT.Angle、MA were positively correlated with RBC,Hb,Hct,Plt,Fig and negatively correlated with PT,APTT.CI value was positively correlated with PT and negatively correlated with Fig.(4)The TEG parameters associated with the amount of bleeding in the massive hemorrhage maternals were K value,Angle,CI value.K value was positively correlated with the amount of bleeding whereas Angle,CI value was negatively correlated.The correlation between K value and blood loss was the strongest(r=0.879,P=0.002);Angle(r=-0.695,P=0.038)was the weaker,CI(r=-0.709,P=0.049)was the weakest.Conclusion:TEG parameters was associated with blood routine 、coagulation in the maternals wether with or without hemorrhagic disease of obstetrics.The preoperative K value,Angle and CI value of the hemorrhage maternals with hemorrhagic disease of obstetrics were significantly related to the ammount of blood loss in cesarean section.