Hemostatic assessment of postpartum hemorrhage cases using sonoclot signature

Background
Postpartum hemorrhage (PPH) (defined as a blood loss of 500 ml or more within 24 h after childbirth) is a significant obstetric complication that poses a serious threat to maternal health and substantial morbidity, including anemia, the need for multiple blood transfusions, organ failure, and hysterectomy worldwide. Despite the established use of preventative interventions, the incidence of PPH is increasing worldwide. This highlights the need for a coordinated approach to prevention, early recognition, and intervention by a multidisciplinary team. The sonoclot device is a viscoelastic hemostatic assay device that offers advantages as a point-of-care tool. It provides a comprehensive picture of clotting function. Rapid identification of clotting problems by sonoclot can guide effective PPH management and prevent serious complications for mothers.


Patients and methods
A case–control study included 90 participants divided into 60 patients with primary PPH admitted to the obstetrics and gynecological Department, in Women’s Health Hospital and 30 healthy controls. The study was carried out in the Clinical Pathology Department, Assiut University Hospitals, in collaboration with the Obstetric and Gynecological Department, Women’s Health Hospital, and was conducted from December 2022 to April 2024.


Results
The results showed abnormal Sonoclot parameters in the PPH group compared with the control group. The PPH group had significantly lower activated clotting time, higher clot rate, and higher Platelet function in comparison to the control group. Both patients with PPH due to coagulopathy, thrombocytopenia, or admitted to the ICU had significantly longer activated clotting time, lower clot rate, and lower platelet function in comparison to other groups, with no differences between the uterine atony group and other obstetric causes group- or in patients without ICU admission.


Conclusion
Sonoclot’s potential for hemostatic assessment in PPH holds significant promise. In this study, it provided rapid, point-of-care results on global coagulation function which correlated well with both the conventional testing methods and the clinical state and course of the patients. Sonoclot analysis can also detect the severity of PPH and predict ICU admission in PPH with high sensitivity and specificity.