The Use of the Maximum Amplitude Parameter in Thromboelastography for Obstetric Anesthesiology: A Retrospective Study Conducted at a University Medical Center

Background and Aims: Thromboelastography (TEG) is a non-invasive, readily available quantitative test used to assess the clotting ability of whole blood. In this study, we aim to explore the indications for utilizing TEG during the peripartum period. Methods: A single-center, retrospective study was conducted, analyzing the electronic medical records of 288 women admitted to the labor and delivery unit, all of whom underwent TEG testing. The study period was five years. Data collected encompassed various hematological parameters; and TEG parameters with a focus on maximum amplitude (MA) were recorded. Furthermore, the diagnoses prompting TEG referral were documented for each participant. Results: All participants were categorized into one of the following six groups: gestational thrombocytopenia (n = 41, 14.24%), immune thrombocytopenic purpura (ITP) (n = 33, 11.46%), preeclampsia (n = 27, 9.38%), preexisting coagulopathy (n = 14, 4.86%), suspected coagulopathy (n = 26, 9.03%), and massive bleeding (n = 147, 51.04%). TEG results indicated that MA values were within the normal range for the majority of participants in each category. Regional anesthesia was performed across all groups, with the following distribution: gestational thrombocytopenia (73.17%), ITP (36.36%), preeclampsia (62.96%), preexisting coagulopathy (64.29%), suspected coagulopathy (53.85%), and massive bleeding (65.46%). Conclusions: We identified two primary reasons for performing TEG during the peripartum period: low platelet count and massive bleeding. TEG, particularly the MA parameter, plays a valuable role in peripartum management, particularly in guiding decisions regarding the suitability of neuraxial anesthesia in the presence of a low platelet count and in directing the administration of blood products in cases of massive bleeding.