Haemostatic trends in normal pregnancy in Chinese women

Anandakumar²,

Montán³

et al. 1993

Gynecol Obstet Invest

In pre-eclampsia (PE), reduced levels of plasma urokinase-like plasminogen activator (u-PA) and plasminogen activator inhibitor-2 (PAI-2), and increased levels of plasma tissue-type plasminogen activator (t-PA) antigen were seen. The majority of moderate and severe pre-eclamptic women (7 out of 10) ended up with pre-term delivery as compared with 2 out of 11 who went on to term. Patients with moderate and severe PE had significantly lower levels (mean ± SD, ng/ml) of PAI-2 (58.4 ± 34.9) and u-PA antigen (1.61 ± 0.62) as compared to those with mild PE (95.6 ± 39.3 and 1.61 ± 0.62 and 2.12 ± 0.61, respectively). Significantly raised t-PA antigen (14.6 ± 5.7 ng/ml) was seen in moderate and severe PE as compared with mild PE (9.9 ± 3.4 ng/ml). PAI-1 activity was significantly raised only in moderate and severe PE as compared with normal pregnancy. There were no significant differences in thrombin-antithrombin-III complexes, D-dimer and Β-thromboglobulin levels between the PE group and normal pregnancy, although these parameters were above the non-pregnant levels. Platelets in PE were within the range found in normal pregnancy. It appears that measurements of plasma u-PA and PAI-2 levels in patients with PE may have prognostic value in determining the outcome of pregnancy in this pregnancy disorder.

Section: Discussioncontrasting

confidence: 35%

Section: Outcome O F Pregnancymentioning

confidence: 91%

See 1 more Smart Citation

Plasminogen Activators, Plasminogen Activator Inhibitors and Markers of Intravascular Coagulation in Pre-Eclampsia

Anandakumar²,

Montán³

et al. 1993

Gynecol Obstet Invest

“…Most studies reported hemostatic activity during pregnancy (1)(2)(3)(4). Enhanced coagulation activation in early pregnancy has been suggested in Caucasians (1) and Asians (4); and in Asians increased fibrinolytic activity and fibrinolytic inhibitors were found in late pregnancy (4,5) while others have reported decreased fibrinolytic activity in Caucasians (6,7).…”

mentioning

confidence: 93%

The Influence of Labor and Placental Separation on Hemostasis in Term Pregnancy

Clin Appl Thromb Hemost

Arulkumaran

Biswas

et al. 1998

We studied the hemostatic effects in 68 term preg nant subjects with normal pregnancy (n = 39), gestational diabetes mellitus (n = 21), pregnancy-induced hypertension (n = 8), during labor, after placental separation, and at 24 hours postpartum. During labor, a hypercoagulable state with en hanced fibrinolysis and platelet activation along with elevated plasminogen activator inhibitor-1 and plasminogen activator inhibitor-2 were seen. In all cases following placental separa tion, enhanced fibrinolysis persisted with further elevated tissue plasminogen activator antigen and D-dimer levels, increased thrombin generation and platelet activation with decreasing plasminogen activator inhibitor-1 levels. By 24 hours postpar tum, thrombin generation (thrombin-antithrombin complex) decreased to a nonpregnant level except for pregnancy induced hypertension, but enhanced prothrombin activation (F1+2) was evident in normal, gestational diabetes mellitus and pregnancy- induced hypertension. Reduced total protein S and antithrom bin III activity with normal protein C and elevated fibrinogen levels seen during labor were not affected by delivery. How ever, although factor VII showed a decreasing trend at 24 hours postpartum it remained elevated above the normal nonpregnant level. At 24 hours postpartum, a hypercoagulable state still persisted in normal, gestational diabetes mellitus and preg nancy-induced hypertension term pregnancy accompanied by enhanced fibrinolysis and elevated plasminogen substrate for fibrinolysis, suggesting a critical dynamic equilibrium between a thrombotic and hemorrhagic state.

“…Profound alterations in the coagulation and fibrinolytic systems occur during pregnancy and these changes enhanced a state of hypercoagulability in the Caucasians [6,32] and ethnic Chinese women [19]. Fibrinolysis and its inhibitors, plasminogen activator inhibitor-1/2 (PAI-1/2) were also increased during pregnancy which reached maximum levels at the late third trimester or during labor [3,8,9] and in Asians [20,26].…”

Section: Introductionmentioning

confidence: 99%

Coagulation and fibrinolysis in viable mid-trimester pregnancies of normal, intrauterine growth retardation, chromosomal anomalies and hydrops fetalis and their eventual obstetric outcome

Journal of Perinatal Medicine

Anandakumar²,

Biswas³

1999

A total of 71 pregnant women diagnosed by ultrasound to have viable fetus in late mid- trimester pregnancies of normal, IUGR, hydrops fetalis and chromosomal anomalies were studied for their coagulation, fibrinolytic and inhibitor levels with association on eventual obstetrics outcome. A hypercoagulable state was observed in all the pregnancies studied. However, higher hypercoagulation evidenced by significantly raised prothrombin formation and clot elasticity together with higher levels of D-dimer, uPA antigen and PAI-1 than observed in normal pregnancy suggests a hyperfibrinolytic/inhibitor state in hydrops fetalis pregnancy associated with bad obstetric outcome. In IUGR pregnancy associated with good outcome further enhanced clot elasticity was seen whilst no significant differences were observed in pregnancy with chromosomal anomalies when compared to uncomplicated normal pregnancy. Our study suggests that in hydrops fetalis pregnancy, further enhanced prothrombin formation and hyperfibrinolysis/inhibitor at late mid-trimester is associated with a poor obstetric outcome.