Placental vascular pathology and increased thrombin generation as mechanisms of disease in obstetrical syndromes

Abstract

View the peer-reviewed version (peerj.com/articles/653), which is the preferred citable publication unless you specifically need to cite this preprint. Placental vascular pathology and increased thrombin generation as mechanisms of disease in obstetrical syndromesObstetrical complications including preeclampsia, fetal growth restriction, preterm labor, preterm prelabor rupture of membranes and fetal demise are all the clinical endpoint of several underlying mechanisms (i.e. infection inflammation, thrombosis, endocrine disorder, immunologic rejection, genetic, and environmental), therefore, they may be regarded as syndromes. Placental vascular pathology and increased thrombin generation were reported in all of these obstetrical syndromes. Moreover, elevated concentrations of thrombin-antithrombin III complexes and changes in the coagulation as well as anticoagulation factors can be detected in the maternal circulation prior to the clinical development of the disease in some of these syndromes. In this review, we will assess the changes in the hemostatic system during normal and complicated pregnancy in maternal blood, maternal-fetal interface and amniotic fluid, and describe the contribution of thrombosis and vascular pathology to the development of the great obstetrical syndromes.PeerJ PrePrints | http://dx.doi.org/10.7287/peerj.preprints.487v1 | CC-BY 4.0 Open Access |

4P-Medicine in Obstetrics: Perspectives and Opportunities

“…Есть данные, что при наличии тромбофилии в плаценте чаще определяются морфологические признаки, характерные для плацентарной недостаточности: диссоциированное формирование котиледонов, редукция терминальных ворсин, псевдоинфаркты, обеднение капиллярами терминальных ворсин. Ряд исследователей утверждают, что дефекты гемостаза ответственны за 75-80% акушерских осложнений [12].…”

Coagulation challenges in pregnancy: from thrombophilia involvement and management to the utility of thrombin generation monitoring

“…High plasma levels of thrombin are associated with the occurrence of major obstetrical syndromes, including preeclampsia, intrauterine growth restriction and recurrent abortions [30]. Elevated thrombin generation is a pathogenic factor also involved in the occurrence of preterm labor, fetal growth restriction, premature rupture of membranes, and fetal demise [31]. Increased levels of thrombin -anti thrombin III complexes, coagulation disorders or anticoagulation factors may occur in the blood before the onset of clinical manifestations of some of these obstetrical syndromes [31].…”

“…Elevated thrombin generation is a pathogenic factor also involved in the occurrence of preterm labor, fetal growth restriction, premature rupture of membranes, and fetal demise [31]. Increased levels of thrombin -anti thrombin III complexes, coagulation disorders or anticoagulation factors may occur in the blood before the onset of clinical manifestations of some of these obstetrical syndromes [31]. Heparins, because of their antithrombotic and anti-inflammatory effects, could be helpful in the prevention of these obstetrical complications.…”