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Postpartum Hemorrhage: Preventable Maternal Deaths and the Role of Coagulation Monitoring

Hiroyuki Sumikura

Published 2025 in The journal of obstetrics and gynaecology research

ABSTRACT

Postpartum hemorrhage (PPH) remains the most common cause of maternal death worldwide. Although obstetric bleeding often begins with structural causes such as uterine atony or tissue trauma, delayed hemostasis rapidly leads to consumption and dilution of coagulation factors, culminating in secondary coagulopathy. Effective prevention of maternal death therefore requires both rapid control of bleeding and timely correction of coagulation failure. Traditionally, plasma‐based laboratory assays such as PT, aPTT, and Clauss fibrinogen have served as the diagnostic standard. However, their prolonged turnaround time restricts real‐time applicability. Viscoelastic testing (TEG/ROTEM) has expanded bedside coagulation assessment by visualizing clot formation and fibrinolysis, enabling goal‐directed transfusion therapy, yet still demands time and expertise. Recent advances in point‐of‐care (POC) fibrinogen measurement now permit rapid quantification directly from whole blood, producing results within 2 min and allowing immediate, evidence‐based replacement decisions. Integrating these three modalities—POC measurement of fibrinogen for rapid response, viscoelastic testing for dynamic evaluation, and laboratory testing for standardization—constitutes an optimal, tiered framework for managing obstetric coagulopathy. This multimodal approach accelerates intervention, improves precision, and enhances safety in PPH management. Future directions include the broader dissemination of POC measurement devices, multicenter validation of clinical benefit, and development of digital decision‐support systems for real‐time coagulation monitoring. A structured, data‐driven coagulation strategy may finally render maternal death from PPH a fully preventable event.

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