Hemostasis in Pre-Eclampsia

Abstract

Pre-eclampsia (P-EC) is a multisystem disorder exclusive to pregnancy. It complicates ~2 to 8% of all pregnancies and remains a major cause of maternal mortality. P-EC is characterized by a profound hypercoagulable state. The delicate hemostatic balance that must be maintained in the uteroplacental circulation during pregnancy makes this system vulnerable to perturbation. An abnormal hemostatic pattern occurs within the uteroplacental circulation in P-EC compared with normal pregnancy. Much recent research has focused on the epidemiological link between inherited thrombophilia and P-EC. The data suggest a weak statistical association, indicating an improbable primary role in the pathogenesis. Without clear evidence, low molecular weight heparins have been widely used to reduce recurrence of P-EC in thrombophilia-positive women. This practice now should be reviewed. Future research needs to focus on improving our basic scientific understanding of the role of the hemostatic system in human placentation.

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

“…[26,27] Even though the pathogenesis of PE is not fully elucidated, activation of inflammatory cytokines and coagulation pathways plays a central role. It is documented that in PE and SPE, the endothelial dysfunction leads to a rise in tPA and PAI-1, [14,28] with a net result of hypercoagulability and dampened fibrinolysis in preeclampsia. However, as a manifestation of placental insufficiency, PAI-2 which has a local role in placental functioning during pregnancy is decreased in SPE and early onset PE (<34 weeks), with a lower PAI-1:PAI-2 ratio.…”

Coagulation and prothrombotic state parameters: a clinical analysis during early pregnancy

“…The main mechanism involves one molecule of PAI-2 combined with one molecule of t-PA, and then the later loses its activity. Hence, less plasminogen is transformed into plasmin, and fibrinolytic activity is decreased [5][6][7].…”

The diagnostic accuracy of the usage of the &lt;i&gt;Fetal Medicine Foundation&lt;/i&gt;’s (FMF) on-line risk calculator with first-trimester ultrasound for screening for preeclampsia in high-risk pregnant Brazilian population

“…Together, they were used to assess the risk for early, intermediate and late PE. The theoretical 3.0% cut-off risk for pre-eclampsia was defined for the index test (the ultrasound scan + the FMF On-Line Risk Calculator), based upon previous pre-eclampsia prevalence studies in different populations [1][2][3], before confirmation using the reference standard.…”

“…Pre-Eclampsia (PE) is a multisystem disorder exclusive to pregnancy characterized by hypertension and proteinuria that develops after 20 weeks of gestation [1][2][3][4]. PE affects 2% -10% of all pregnancies and is an important cause of morbidity and maternal and perinatal mortality [1][2][3]5,6].…”

“…PE affects 2% -10% of all pregnancies and is an important cause of morbidity and maternal and perinatal mortality [1][2][3]5,6]. Early screening of women with a potential risk of developing pre-eclampsia is justified because it allows the possibility of early intensive maternal and fetal monitoring, thereby avoiding adverse outcomes.…”