Characterising the Coagulopathy of Obstetric Haemorrhage - (OBS Plus)
Research type
Research Study
Full title
Characterising the Coagulopathy of Obstetric Haemorrhage - (OBS Plus)
IRAS ID
209425
Contact name
Lucy Jane de Lloyd
Contact email
Sponsor organisation
Cardiff and Vale UHB
Duration of Study in the UK
1 years, 6 months, 30 days
Research summary
"Research Summary"
Some women have increased bleeding at the time of child birth and bleeding may be made worse if the blood becomes too thin(does not make clots properly). There is a lot of information about how major trauma can make the blood too thin and how this should be treated, but there is very little information about how bleeding at the time of childbirth can make the blood too thin. Also, it is very likely that specific causes of bleeding may have different effects on how the blood becomes thin. Because there is so little information about how the blood makes clots during bleeding at the time of childbirth, women are usually treated in the same way as people who have had major trauma and this may not be the best treatment.
We suspect that:
1. The abnormal blood clotting associated with bleeding around the time of childbirth is different from that due to bleeding following trauma in non-pregnant adults.
2. The initial blood clotting abnormality and how it changes differs according the cause of the bleeding.The main aim of this study is to describe the abnormalities of clotting associated with different causes of bleeding at the time of childbirth and how these abnormalities change as bleeding progresses. We will also look at what effect treatment designed to improve the blood's ability to clot has on the blood clotting system to see whether it is working as expected.
"Summary of Results"
The OBS plus study set out to describe in detail the blood clotting system, during bleeding during or after childbirth. The study recruited 518 women with severe bleeding at the time of childbirth, and their blood clotting system during the bleeding was investigated in the study.
Blood clotting at the time of childbirth is important to investigate because when the blood clotting system not working well, and is unable to make a healthy blood clot, the bleeding can become very severe and dangerous.
This study was done because not much is known about the blood clotting system in bleeding in childbirth, or how best to treat it.The study found that of the 518 women with severe bleeding, in most women (about 95%) the clotting system was healthy and able to form a healthy blood clot, but in around 1 in 20 women (5%) the blood clotting system was not healthy and able to form a healthy blood clot.
The study found that the reasons for the blood clotting system not working well could be described in 2 ways:
1) Blood loss is very severe, and this leads to the blood clotting system running out of blood clotting factors which means it cannot function well. This happens because clotting factors are lost in a predictable way that is directly related to the amount of bleeding.
2) Blood clotting factors are destroyed in an unpredictable way. This may happen early during bleeding, or even before bleeding is recognised. This cause of bleeding appears to be different from any other known cause of an unhealthy blood clotting system.This work is important because it shows that blood clotting problems during bleeding in childbirth can be unpredictable and severe. The recommendation from this study is that more work needs to be done to understand the blood clotting system during bleeding in childbirth, together with investigation into the best way to treat it, so we can make sure women who bleed at the time of childbirth get the best treatment to limit harms from bleeding and keep them as safe as possible.
REC name
Wales REC 7
REC reference
16/WA/0282
Date of REC Opinion
26 Sep 2016
REC opinion
Favourable Opinion