Restrictive versus liberal fluid administration strategy (REFILL study) in postpartum hemorrhage and its effects on thromboelastometry (ROTEM®) values: a randomized, controlled trial

J Int Med Res. 2023 Aug;51(8):3000605231171007. doi: 10.1177/03000605231171007.


Objective: Current obstetric guidelines for postpartum hemorrhage (PPH) vary in fluid resuscitation management. This study aimed to evaluate the effect of fluid management on coagulation parameters in early PPH.

Methods: We performed a multicenter, randomized trial. Women who had 500 mL of blood loss in the third stage of labor were randomized to receive a restrictive fluid administration strategy or a liberal fluid administration strategy. A rotational thromboelastometry panel was performed in 72 patients. We evaluated within-group and between-group differences in the EXTEM clotting time (CT), EXTEM amplitude at 10 minutes (A10), INTEM CT, and FIBTEM A10. We also evaluated the mean fibrinogen concentration, activated partial thromboplastin time, and partial thromboplastin time in the total study population (n = 249).

Results: There were no significant differences in hemostatic parameters between the groups after correction for baseline values.

Conclusions: In women with PPH <1500 mL, there is no clinically relevant effect of a restrictive or liberal fluid administration strategy on thromboelastometric hemostatic and regular coagulation parameters.

Keywords: Thromboelastometry; coagulation parameter; fibrinogen; labor; postpartum hemorrhage; resuscitation.

Publication types

  • Randomized Controlled Trial
  • Multicenter Study

MeSH terms

  • Blood Coagulation
  • Female
  • Hemostatics*
  • Humans
  • Postpartum Hemorrhage* / therapy
  • Pregnancy
  • Thrombelastography


  • antineoplaston A10
  • Hemostatics