Rotational thromboelastometry is a viscoelastomeric, point-of-care method for testing haemostasis in whole blood which can be visualised rapidly, in real time, in the operating theatre. Advantages over traditional coagulation tests relate to the rapid feedback of results and the ability to visualise hyperfibrinolysis. We present a case of suspected amniotic fluid embolism that presented with sudden respiratory arrest associated with haemodynamic compromise during a non-elective caesarean delivery. Soon after the collapse, coagulopathy developed. Rotational thromboelastometry showed hyperfibrinolysis and hypofibrinogenaemia, which allowed targeted coagulation factor replacement therapy and the use of tranexamic acid. Hyperfibrinolysis may be a contributor to the coagulopathy associated with amniotic fluid embolism but has been infrequently reported, perhaps due to limited diagnosis with traditional coagulation tests. Treatment of the coagulopathy associated with a suspected amniotic fluid embolism with antifibrinolytic agents may deserve greater consideration.

译文

:比例血栓弹力测定法是一种粘弹性体的即时检验方法,用于测试全血中的止血效果,可以在手术室中快速实时地进行可视化。相对于传统凝血测试的优势在于结果的快速反馈和可视化超纤维蛋白溶解的能力。我们提出了一例疑似羊水栓塞的病例,该病例在非选择性剖宫产过程中出现突然的呼吸暂停,并伴有血流动力学的损害。崩溃后不久,凝血病就发展了。旋转血栓弹力测定显示高纤蛋白溶解和低纤维蛋白原性贫血,可进行靶向凝血因子替代治疗和使用氨甲环酸。高纤蛋白溶解可能是与羊水栓塞相关的凝血病的病因,但鲜有报道,这可能是由于传统凝血试验的诊断有限所致。与抗纤溶剂一起治疗怀疑与羊水栓塞有关的凝血病可能值得更多考虑。

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