EMERGENCY · HAEMORRHAGE
ROTEM · Obstetric
Massive obstetric haemorrhage guided by ROTEM results. On agreement with Consultant Anaesthetist and Obstetrician. Always base treatment upon clinical scenario.
1 ·Initial Steps
Always do this first
Order / Give
4 Units Red Cells
Run
FibTEM and ExTEM
Consider
Tranexamic Acid 1 g (PPH or perioperative)
2 ·CT ExTEM > 100 s?
If CT ExTEM > 100 s AND actively bleeding
Action
Order FFP (give when ready) — run in parallel with waiting for results
Wait 5 minutes for FibTEM and ExTEM results, then find your branch below.
3 ·FibTEM A5 < 7 AND ExTEM A5 < 47
FibTEM A5 < 7 AND ExTEM A5 < 47
Action
Fibrinogen Concentrate 3 g → Recheck ROTEM in 10 minutes
3 ·FibTEM A5 7–12 AND ExTEM A5 < 47
FibTEM A5 7–12 AND ExTEM A5 < 47
Active / High risk bleeding
Fibrinogen Concentrate 3 g → Recheck ROTEM in 10 minutes
Not bleeding
Recheck ROTEM within 1 hour
3 ·FibTEM A5 > 12 AND ExTEM A5 > 47
FibTEM A5 > 12 AND ExTEM A5 > 47
Result
No products required
Platelets
Give Platelets when
Indication
Low ExTEM but normal FibTEM, or if ≥ 10 units of blood
Targets
Treatment Goals
Hb 70–90 g/L
Fibrinogen > 2.0 g/L
Platelets > 50 × 10⁹/L
PT Ratio < 1.5
Temp > 36 °C
Lab Contacts