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Prediction of Platelet Function Using Viscoelastic Test (ROTEM® Sigma) in Obstetric Anesthesia.

29 mei 2026 bijgewerkt door: Nicolas Brogly

Prediction of Platelet Function Using Viscoelastic Test (ROTEM® Sigma) in Obstetric Anesthesia: an Prospective Observational Study

This prospective observational, non-interventional, single-center study aims to evaluate whether the viscoelastic parameter PLTEM, derived from ROTEM® sigma testing (EXTEM-A5 minus FIBTEM-A5), can accurately estimate platelet count in obstetric patients with thrombocytopenia and/or severe postpartum hemorrhage.

The study will include pregnant women older than 18 years managed during labor and delivery at the Hospital General Universitario Gregorio Marañón, Madrid (Spain).

The primary objective is to validate the clinical usefulness of PLTEM as a rapid point-of-care tool to support clinical decision-making regarding neuraxial anesthesia and transfusion management in obstetric emergencies.

Studie Overzicht

Toestand

Werving

Conditie

Interventie / Behandeling

Gedetailleerde beschrijving

Obstetric hemorrhage remains the leading cause of maternal mortality worldwide. In Spain, recent studies estimate an incidence between 2% and 5%. The main causes include uterine atony, genital tract trauma, retained placental tissue, and coagulation disorders. Early recognition and management of coagulation abnormalities are essential to reduce maternal morbidity and mortality.

Viscoelastic testing using rotational thromboelastometry (ROTEM® sigma) provides dynamic real-time assessment of coagulation and has become increasingly integrated into obstetric hemorrhage management algorithms. Platelet function plays a major role in clot formation, and impairment of platelet quantity or function may influence transfusion strategies and the safety of neuraxial anesthesia techniques.

The PLTEM parameter (Platelet contribution to clot firmness) estimates platelet contribution to clot strength and is calculated as the difference between EXTEM-A5 and FIBTEM-A5. In other clinical settings, PLTEM-derived measurements have demonstrated the ability to estimate platelet count with good accuracy. However, evidence validating its utility in obstetric patients remains limited.

The hypothesis of this study is that PLTEM may provide a reliable and rapid estimation of platelet count in urgent obstetric settings, thereby optimizing clinical decision-making, facilitating safer neuraxial anesthesia management, and improving transfusion practices.

This is a prospective, observational, non-interventional, single-center study conducted at the Hospital General Universitario Gregorio Marañón, Madrid (Spain). The study population will include pregnant women older than 18 years attended during labor and delivery who present with thrombocytopenia of any etiology and/or develop postpartum hemorrhage greater than 1,500 mL. Patients who decline participation will be excluded.

Clinical and laboratory data will be collected as part of routine care during the intrapartum and immediate postpartum periods. Variables recorded will include demographic characteristics, conventional laboratory parameters, ROTEM® variables, neuraxial anesthesia procedures, quantification of hemorrhage, transfusion requirements, need for reintervention, and maternal complications.

The primary objective is to validate the clinical usefulness of PLTEM in the obstetric setting and assess its correlation with conventional platelet count measurements. Secondary objectives include evaluation of additional ROTEM® parameters associated with coagulation abnormalities, assessment of transfusion requirements and hemorrhagic outcomes, and exploration of the relationship between thrombocytopenia, fibrinogen levels, and other factors contributing to obstetric coagulopathy.

The estimated minimum sample size is 85 patients, adjusted for an anticipated 20% loss rate. Statistical analyses will be performed using SPSS version 29.0. The study period will extend from protocol approval until completion of recruitment, with an anticipated completion date of December 2026.

Studietype

Observationeel

Inschrijving (Geschat)

85

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studiecontact

Studie Contact Back-up

Studie Locaties

  • Spanje
      • Madrid, Spanje, 28007
        • Werving
        • Hospital General Universitario Gregorio Marañón
        • Contact:

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

  • Volwassen
  • Oudere volwassene

Accepteert gezonde vrijwilligers

Nee

Bemonsteringsmethode

Kanssteekproef

Studie Bevolking

Cohort of consecutive consenting patients with suspicion and/or confirmed thrombocytopenia admitted in the labor ward, the obstetric operating room or the obstetric post anaesthetic care unit for delivery in a tertiary university hospital in Madrid-Spain for a period of 1 year.

Beschrijving

Inclusion criteria:

  • Parturients with a suspicion or confirmed thrombocytopenia before delivery (platelet count < 120x10^9/L),
  • Parturients with severe postpartum haemorrhage (blood loss >1500 mL) with a suspicion of thrombocytopenia.

Exclusion criteria:

  • parturient age under 18 years;
  • refusal to participate

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

Cohorten en interventies

Groep / Cohort
Interventie / Behandeling
Obstetric Patients with confirmed or suspicion of thrombocytopenia

The study will include all the consecutive consenting parturients admitted to our maternal unit in the inclusion period with the following inclusion and exclusion criteria.

Inclusion criteria: Parturients with a suspicion or confirmed thrombocytopenia before delivery (platelet count < 120x10^9/L), Parturients with severe postpartum haemorrhage (blood loss >1500 mL) with a suspicion of thrombocytopenia.

Exclusion criteria: parturient age under 18 years; refusal to participate
Ander: Geen interventie: Observationele cohort
Geen interventie: observationele studie

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
To evaluate the correlation between PLTEM value and platelet count on hemogram
Tijdsspanne: At admission to the labour ward in case of thrombocytopenia inferior to 120,000 /mm^3 platelets in the third trimester of pregnancy, or at diagnosis of a severe Post-Partum Hemorrhage > 1,500 mL, until 24 hours after delivery or cesarean delivery.
A blood sample will be extracted in patients at risk or with confirmed thrombcytopenia. A simultaneous platelet count (standard biological test) and ROTEM sigma viscoelastic test will be performed. The correlation between PLTEM5 (EXTEM A5 - FIBTEM A5), PLTEM10 (EXTEM A10 - FIBTEM A10) and platelet count will be determined.
At admission to the labour ward in case of thrombocytopenia inferior to 120,000 /mm^3 platelets in the third trimester of pregnancy, or at diagnosis of a severe Post-Partum Hemorrhage > 1,500 mL, until 24 hours after delivery or cesarean delivery.

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Relationship between ROTEM® parameters, thrombocytopenia, and fibrinogen levels
Tijdsspanne: From admission to the labour ward or from diagnosis of severe postpartum hemorrhage (>1,500 mL), through 24 hours postpartum.
To assess the correlation between ROTEM® sigma-derived parameters (FIBTEM, EXTEM, and INTEM) and standard coagulation assays, including: Clauss fibrinogen, prothrombin time (PT), and activated partial thromboplastin time (aPTT), in obstetric patients with thrombocytopenia and/or postpartum hemorrhage ≥1,500 mL, with the aim of characterizing the coagulopathy profile in these scenarios, with particular attention to hypofibrinogenemia and platelet function.
From admission to the labour ward or from diagnosis of severe postpartum hemorrhage (>1,500 mL), through 24 hours postpartum.
PLTEM threshold for safe neuraxial anesthesia in thrombocytopenic obstetric patients
Tijdsspanne: At admission to the labour ward.
To assess whether a specific PLTEM threshold can be determined with ROTEM® sigma to identify obstetric patients above the established safety platelet count threshold for neuroaxial anesthesia (≥ 70 × 10⁹/L) in a clinically useful timeframe compared to conventional laboratory test.
At admission to the labour ward.

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Sponsor

Nicolas Brogly

Publicaties en nuttige links

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Algemene publicaties

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start (Werkelijk)

1 mei 2026

Primaire voltooiing (Geschat)

1 mei 2027

Studie voltooiing (Geschat)

1 mei 2027

Studieregistratiedata

Eerst ingediend

28 april 2026

Eerst ingediend dat voldeed aan de QC-criteria

29 mei 2026

Eerst geplaatst (Werkelijk)

1 juni 2026

Updates van studierecords

Laatste update geplaatst (Werkelijk)

1 juni 2026

Laatste update ingediend die voldeed aan QC-criteria

29 mei 2026

Laatst geverifieerd

1 mei 2026

Meer informatie

Termen gerelateerd aan deze studie

Trefwoorden

Aanvullende relevante MeSH-voorwaarden

Andere studie-ID-nummers

  • ROTEMPLAQ

Plan Individuele Deelnemersgegevens (IPD)

Bent u van plan om gegevens van individuele deelnemers (IPD) te delen?

NEE

Beschrijving IPD-plan

This was not considered in the design of the research.

Informatie over medicijnen en apparaten, studiedocumenten

Bestudeert een door de Amerikaanse FDA gereguleerd geneesmiddel

Nee

Bestudeert een door de Amerikaanse FDA gereguleerd apparaatproduct

Nee

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