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• W2979393463 abstract "Complications of pregnancy, including miscarriage, occur in up to 20% of pregnancies and are frequently diagnosed in the ED. Known risk factors include advanced maternal age, history of vaginal bleeding, and presence of coagulopathy. Rotational thromboelastometry (ROTEM), which performs a comprehensive clotting evaluation, demonstrates hypercoagulable changes during pregnancy, and it is associated with recurrent miscarriages when tested in non-pregnant patients. The utility of ROTEM testing during early pregnancy for prediction of adverse outcomes later in gestation is unknown. This study will test the association of ROTEM results during early pregnancy with later complications in the ED and obstetric (OB) clinic settings. This was a prospective cohort study from a single center. Patients in early pregnancy (less than 20 weeks) were recruited for ROTEM testing equally from two groups, including patients in the ED being evaluated for vaginal bleeding complaint and healthy OB clinic patients at a first prenatal visit. All patients were followed to ascertain pregnancy outcomes at term, including complications and delivery dates. Crude results were analyzed using t-test for ROTEM measures, and effects were then compared using multiple logistic regression, controlling for patient age, estimated gestational age (EGA) in weeks, and recruitment site. ROTEM measurements of interest were the clot formation kinetics using EXTEM and INTEM tracings. Of 69 total patients, adverse outcomes including miscarriage, preterm labor, preeclampsia, or intrauterine growth restriction occurred in 31 patients (44.9%). Adverse outcomes were more common in ED patients than OB clinic patients (83% vs. 25%, p<0.001). EGA was lower in patients with adverse outcomes (7.8 +/- 3.1 vs. 10.9 +/- 3.8 weeks, p<0.01), but this difference became nonsignificant when controlling for site of enrollment. Age, number of prior pregnancies, parity, race, and ethnicity were not associated with adverse pregnancy outcomes. ROTEM results for INTEM or EXTEM values did not differ on crude analysis based on adverse pregnancy outcomes. After controlling for EGA and location of enrollment, ROTEM results remained similar between groups. In early pregnancy before 20 weeks, ROTEM clotting profiles were not predictive of adverse pregnancy outcomes. Adverse outcomes were highly associated with presentation for vaginal bleeding to the ED in this period. This suggests that testing clotting profiles using ROTEM may not be useful in predicting adverse pregnancy outcomes when added to existing clinical history." @default.
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• W2979393463 date "2019-10-01" @default.
• W2979393463 modified "2023-10-17" @default.
• W2979393463 title "47 Clotting Differences Using ROTEM Testing for Early Prediction of Adverse Pregnancy Outcomes" @default.
• W2979393463 doi "https://doi.org/10.1016/j.annemergmed.2019.08.050" @default.
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