A Review of Hemostasis in Normal Pregnancy and Puerperium

Moiz, Bushra

doi:10.21089/njhs.23.0123

Cited by 11 publications

(6 citation statements)

References 62 publications

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“…There occurs a significant decrease in fibrinolysis during pregnancy, which is in disagreement with the gradual rise in DD showing that although depressed, fibrinolysis remains an active process. [12,13] Fibrinolysis is a regulated process which depends on the balance between plasminogen activators (tPA and uPA) and inhibitors (PAI-1/2). The overall effect of hypercoagulability and hypofibrinolysis induced by pregnancy is rise in intravascular thrombosis and FDPs which include DD.…”

Section: Introductionmentioning

confidence: 99%

Variations of plasma D-dimer level at various points of normal pregnancy and its trends in complicated pregnancies

Baboolall

Zhang²,

Gong³

et al. 2019

Medicine

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D-Dimer (DD) is the smallest fragment of plasmin-mediated cleavage of fibrin. There is a progressive increase in DD concentration with advancing gestation in normal pregnancies, making the upper limit of 0.5 μg/ml used in non-pregnant population an unfavorable marker during pregnancy. Coagulation and fibrinolysis parameters are also markedly disturbed in pregnancies complicated by various pathologies. We designed this retrospective observational cohort study to investigate the trimester specific reference range for DD throughout normal pregnancy, and to compare the distribution of DD in third trimester healthy pregnancies and those complicated by preeclampsia (PE), severe preeclampsia (SPE), gestational diabetes mellitus (GDM), premature rupture of membranes (PROM) and preterm premature rupture of membranes (PPROM). In addition, we aimed to determine the diagnostic value of DD in PE and SPE. In this retrospective observational cohort study, 250 normal and 178 complicated pregnancies were included. Normal pregnancies included 88-first trimester, 101-second trimester and 61-third trimester pregnancies. Complicated pregnancy included 34 PE, 44 SPE, 32 GDM, 33 PROM, and 35 PPROM cases during the third trimester. Predefined exclusion criteria were used. The period of gestation (POG) accounted for 41.9% of the variance in DD, with strong correlation between the POG and DD. The trimester specific reference intervals were computed. The distribution for severe preeclampsia was statistically different compared to other categories in the third trimester. This exceptional distribution led to the generation of a receiver operating characteristic (ROC) curve with an area under curve of 0.828, attesting its possible role in predicting severe preeclampsia. We determined trimester specific reference intervals of DD. The role of DD has been explored, and it may be of diagnostic value in severe preeclampsia.

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Section: Introductionmentioning

confidence: 99%

Variations of plasma D-dimer level at various points of normal pregnancy and its trends in complicated pregnancies

Baboolall

Zhang²,

Gong³

et al. 2019

Medicine

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“…Pregnant women and those in the early post-partum period are at increased risk of thrombosis due to the hypercoagulable state of pregnancy. 69 Furthermore, patients with PPCM have been found to have an increased incidence of left ventricular thrombi when compared to other forms of cardiomyopathy. 5 , 13 , 51 , 70 Thus, anticoagulation may be considered in the setting of severe left ventricular dysfunction in the peripartum period to 8 weeks postpartum 53 , 55 Anticoagulation is also recommended in patients who receive bromocriptine, given its increased risk of thromboembolism, stroke and myocardial infarction.…”

Section: Managementmentioning

confidence: 99%

Peripartum Cardiomyopathy: Risks Diagnosis and Management

Carlson¹,

Schultz²,

Ramu³

et al. 2023

JMDH

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Peripartum cardiomyopathy is a rare cause of heart failure that occurs during late pregnancy or in the early postpartum period. Delays in diagnosis may occur as symptoms of heart failure mimic those of normal pregnancy. The diagnosis should be considered in any pregnant or postpartum woman with symptoms concerning for heart failure. If there are clinical concerns, labs including N-terminal pro-BNP should be checked, and an echocardiogram should be ordered to assess for systolic dysfunction. Prompt medical treatment tailored for pregnancy and lactation is essential to prevent adverse events. Outcomes are variable, including complete recovery, persistent myocardial dysfunction with heart failure symptoms, arrhythmias, thromboembolic events, and/or rapid deterioration requiring mechanical circulatory support and cardiac transplantation. It is essential that care is provided as part of a multidisciplinary cardio-obstetrics team including obstetrics, cardiology, maternal fetal medicine, anesthesiology, and nursing. All women with peripartum cardiomyopathy should have close follow-up with a cardiologist, although optimal duration of medical therapy following complete recovery is unknown. Women considering a subsequent pregnancy require preconception counseling and close collaboration between obstetrics and cardiology throughout pregnancy.

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“…Management of pregnancies with severe thrombocytopenia is still a challenge in Pakistan with main group of patients of previously known immune thrombocytopenia [42].…”

Section: Rare Causes Of Thrombocytopenia In Pregnancymentioning

confidence: 99%

Thrombocytopenia in Pregnancy; A Pakistani Perspective

Ahmad¹,

Shamsi²

2018

Natl. j. health sci.

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Thrombocytopenia in pregnancy is mostly taken as platelets less than normal lower limit. The normal limit of platelets in pregnancy is 106-120x10 9 /l [1]. Thromocytopenia is the second important cause of haematologic disorders in pregnancy, first being anemia [1-3].Gestational thrombocytopenia is responsible for approximately 75% of all cases of thrombocytopenia seen mostly in pregnancy. Another important aspect is hypertension in pregnancy. It can result in thrombocytopenia as well. These disorders constitute about 20% and immune thrombocytopenia accounts for about 4% [4,5]. Other causes of thrombocytopenia are quite uncommon in pregnancy.The aim of this review is to highlight different aspects of thrombocytopenia seen commonly in pregnancy, their impact on decisions made by physicians and obstetricians as well as causes of thrombocytopenia encountered in pregnant females in Pakistan and challenges faced by obstetricians and haematologists.

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A Review of Hemostasis in Normal Pregnancy and Puerperium

Cited by 11 publications

References 62 publications

Variations of plasma D-dimer level at various points of normal pregnancy and its trends in complicated pregnancies

Variations of plasma D-dimer level at various points of normal pregnancy and its trends in complicated pregnancies

Peripartum Cardiomyopathy: Risks Diagnosis and Management

Thrombocytopenia in Pregnancy; A Pakistani Perspective

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