Coagulation and Fibrinolysis in Preeclampsia and Neonates

Abstract

Coagulation and fibrinolysis were determined in 67 Indonesian women admitted to the University Hospitals for delivery in Medan. They were diagnosed to be at term gestation (mean 39.3 +/- 1.1 weeks) with moderate and severe preeclampsia (n=32) and in labor, and 8 had preterm labor (gestation mean 33.5 +/- 2.6 weeks). Twenty-seven normal pregnant women in labor (gestation mean 39.7 +/- 1.0 weeks) served as controls. Cord blood from 23 neonates from normal pregnancy and 31 neonates from preeclampsia was also evaluated. Preeclamptic women in labor showed further enhanced coagulation activation (F(1+2)) with raised urokinase-like plasminogen activator (u-PA) activity and reduced plasminogen activator inhibitor-2 (PAI-2) levels. In preterm preeclampsia, significantly reduced antithrombin III (ATIII) and PAI-2 levels with further elevated tissue-type PA (t-PA) antigen and plasminogen activator inhibitor-1 (PAI-1) antigen were seen compared to normal pregnancy. These would suggest a state of enhanced thrombin generation with elevated fibrinolytic/inhibitor proteins in preterm preeclampsia. The reduced PAI-2 levels seen in preeclampsia have been suggested to be associated with reduced placental function. Neonates born to mothers of either normal pregnancy or preeclampsia at term showed similar hemostatic changes with reduced fibrinogen, ATIII, t-PA, u-PA antigen, PAI-1 levels, and coagulation activation compared to their respective maternal plasma levels. No significant differences in hemostatic parameters studied between the neonates of both cohorts were seen, and this would suggest that the neonates were protected from the adverse effects of preeclampsia and their hemostatic system was physiologically balanced.

Association of antithrombin-III and platelet count with pregnancy induced hypertension

“…21 In our study, the plasma AT-III levels of normal pregnant women as compared to healthy non-pregnant women were lower but the difference was not statistically significant. This was in consistent with the study done by Maryam-Sadat Hosseini et al 22 In our study and in the other studies, 23,24 performed on preeclamptic pregnant women; AT-III levels were significantly lower than those of healthy non-pregnant and normal pregnant women. Our study reveals that as compared to mild preeclamptic group, the lower levels of AT-III in severe preeclamptic…”

The coagulation system of extremely preterm infants: influence of perinatal risk factors on coagulation

“…However, the samples of those studies were not drawn from the newborn but exclusively from the umbilical cord. 8,9 Considering that the birth process itself alters several coagulation factors the results are not comparable. 4 If prematurity was caused by placental disorders (group B) or chorioamnionitis (group C), the infants had significantly lower levels of factors II, VIII and X when compared with the infants born to mothers with preeclampsia (group A), whereas factor V and VII levels were approximately equal.…”

Umbilical Cord Blood Changes in Neonates from a Preeclamptic Pregnancy

“…PAI-2 can be considered a marker of placental function, as it is mainly synthesized at trophoblastic tissue. In PE a decrease in plasma PAI-2 seems to occur (Roes et al, 2002;Tanjung et al, 2005;Sartori et al, 2008), suggesting a modification of placental function. Considering the increased PAI-1 and the decrease of PAI-2, some authors suggest that the rise in the ratio PAI-1/PAI-2 in maternal plasma may be considered a marker of PE (Chappell et al, 2002;Hunt et al, 2009).…”

“…Considering the increased PAI-1 and the decrease of PAI-2, some authors suggest that the rise in the ratio PAI-1/PAI-2 in maternal plasma may be considered a marker of PE (Chappell et al, 2002;Hunt et al, 2009). Several authors report that tissue plasminogen activator (tPA), one of the physiological plasminogen activators, is increased in PE (Belo et al, 2002a;Tanjung et al, 2005;Hunt et al, 2009). Increased levels of D-dimers (fragments of fibrin degradation products) were also reported in PE (Belo et al, 2002a;Hunt et al, 2009), reflecting an increase in the activation process of coagulation and fibrinolysis.…”

“…Several studies describe a significant increase in plasma levels of PAI-1 in cases of PE compared to normal pregnancy (Belo et al, 2002a;Tanjung et al, 2005;Sartori et al, 2008;Hunt et al, 2009). The expression of PAI-1 is also elevated in placentas from PEc pregnant women, and PAI-1 plasma levels seem to be positively correlated with the severity of placental damage (Estelles et al, 1998).…”