Thrombin-inhibitor complexes in the blood during and after delivery

Andersson, Terje R.; Lorentzen, Bjørg; Høgdahl, Heidi; Clausen, Torun; Mowinckel, Marie‐Christine; Abildgaard, Ulrich

doi:10.1016/0049-3848(96)00057-6

Cited by 36 publications

(22 citation statements)

References 15 publications

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“…PIH, and GDM. Immediately after placental separation, enhanced platelet and coagulation activation were still evident and associated with enhanced fibrinolysis as reported previously (5,8,(10)(11)(12). This could have been contributed by the involuting uterus that assists in the clearance of fibrin deposits present after childbirth.…”

Section: Discussionsupporting

confidence: 54%

“…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). Increased fibrinolytic activity following placental separation has been observed (5,(8)(9)(10) with enhanced activation of coagulation during labor and delivery (10)(11)(12). The fibrinolytic system changes dramatically, probably due to release of plasminogen activators from the vessel walls induced by delivery that overwhelms the fibrinolytic inhibitor plasminogen activator inhibitor (PAI)-l (5,13).…”

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confidence: 92%

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

Koh

Arulkumaran

Biswas

et al. 1998

Clin Appl Thromb Hemost

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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.

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Section: Discussionsupporting

confidence: 54%

mentioning

confidence: 92%

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

Koh

Arulkumaran

Biswas

et al. 1998

Clin Appl Thromb Hemost

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“…In addition, the maternal plasma thrombin-antithrombin complex concentration increases further during labor [54] and after delivery [53,54] and decreases during the puerperium. Increased thrombin generation has been implicated as a mechanism of disease in several obstetrical syndromes including: PE [9,11,[55][56][57][58][59][60][61], delivery of small-for-gestational neonates age [11,62,63], preterm labor [64,65], and preterm prelabor rupture of membranes (PROM) [64,66].…”

Section: Thrombin In Pregnancymentioning

confidence: 97%

Over-expression of the thrombin receptor (PAR-1) in the placenta in preeclampsia: A mechanism for the intersection of coagulation and inflammation

Erez

Romero

Kim

et al. 2008

The Journal of Maternal-Fetal & Neonatal Medicine

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Placentas from pregnancies complicated by preterm PE had a significantly higher frequency of strong PAR-1 expression than placentas from women with spontaneous preterm labor. This observation is consistent with a role for PAR-1 as a mediator of the effect of thrombin on coagulation and inflammation in PE. We propose that the effects of thrombin in PE are due to increased thrombin generation and higher expression of PAR-1, the major receptor for this enzyme.

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“…During term labour, median levels of thrombin-antithrombin complexes increase at least two-fold to attain levels 3-20 times higher than in non-pregnant women [163].…”

Section: Labour Inflammation and Coagulationmentioning

confidence: 99%

Preterm Birth: A Review

Schellenberg

2006

CWHR

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Preterm birth at less than 37 weeks gestation is a substantial burden to the community, representing a major source of infant death, severe handicap, and suffering for both victims and their families. Despite considerable research, little progress has been made in its prevention, partly because preterm birth is the endpoint of a silent multifactorial syndrome which begins long before labour starts. Infectious inflammation often plays a central role, but maternal susceptibility is probably also critical. Although progestogen treatment is preventive in some women with a prior history of preterm birth this will have little impact on the overall preterm birth rate unless effective treatment can be used in a much larger population of at risk women. An accurate screening test to identify such women is needed. The discovery of a screening test and of novel treatments requires a better understanding of the underlying biomolecular events. This paper gives an overview of the physiology and molecular biology of normal and abnormal pregnancy and parturition, the causes and consequences of preterm birth, and the difficulties of predicting and preventing preterm birth.

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Thrombin-inhibitor complexes in the blood during and after delivery

Cited by 36 publications

References 15 publications

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

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

Over-expression of the thrombin receptor (PAR-1) in the placenta in preeclampsia: A mechanism for the intersection of coagulation and inflammation

Preterm Birth: A Review

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