Résumé
Background: post-partum hemorrhage (PPH) is one of the leading causes of maternal morbimortality worldwide. Fibrinogen has a major role in coagulation and its decrease during the early phase of PPH is associated with an increased risk of severe PPH. The Quantra® Qstat System Analyzer (QQSA) is a new, delocalized, cartridge-based hemostasis measuring device based on Sonic Estimation of Elasticity via Resonance, allowing an early identification of coagulopathies. The aim of this observational study was to assess the time in obtaining a fibrinogen level with QQSA.Methods: from April to November 2022, a prospective observational study was performed in the Montpellier university Hospital. Adult women ≥24 weeks pregnant suffering from an ongoing PPH (defined by a blood loss ≥500 mL within 24 hours) after vaginal delivery or cesarean section and requiring an emergency assessment of coagulation were included. According to local recommendations, venous blood sampling was simultaneously collected for standard laboratory testing and for QQSA. Results: over the study period, 126 PPH occurred among 2,101 deliveries. Sixty women benefited from both assays. French guidelines and local recommendations were followed during procedures. Assessment of the fibrinogen level was faster using QQSA than standard coagulation test through hospital laboratory. QQSA reduced the delay of fibrinogen level acknowledgement by 29 [22; 40] minutes. Coagulation parameters tested with QQSA, compared to a standard laboratory test, had a good performance. Respective correlation ratio for fibrinogen contribution to clot stiffness, platelet contribution to clot stiffness, clot stiffness and clotting time were 0.80, 0.67, 0.27 and 0.04, respectively. The ROC curve for the detection of fibrinogen <3 g/L allowed for an identification of fibrinogen contribution to clot stiffness threshold at 2.7 hPa with a sensitivity of 1 and a specificity of 0.84 and an area under the curve =0.938. Conclusion: during PPH, when biological assays are needed, QQSA provides quick results of coagulation test as fibrinogen level. The performance of coagulation parameters acquired by Sonic Estimation of Elasticity via Resonance was excellent for fibrinogen and platelet contribution to clot stiffness, but less for clot stiffness and clotting time. QQSA use resulted in a significant decrease in the delay to obtain a hemostasis evaluation during PPH.