Document Detail

Coagulation and fibrinolysis changes in normal pregnancy. Increased levels of procoagulants and reduced levels of inhibitors during pregnancy induce a hypercoagulable state, combined with a reactive fibrinolysis.
MedLine Citation:
PMID:  9175686     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To establish the physiologic changes in the coagulation and fibrinolytic systems during normal pregnancy and puerperium. STUDY DESIGN: One hundred and seventeen normal pregnant women were investigated in a longitudinal study involving five measurements: blood samples were collected at 10, 20, 30, 36 weeks and on the second day puerperium and were assayed for prothrombin time (PT expressed in INR), activated partial thromboplastin time (PTT), fibrinogen (FBG), antithrombin III activity (AT III), protein C activity (PC), protein S activity (PS), prothrombin fragments 1+2 (F1+2), type 1 plasminogen activator inhibitor activity (PAI) and tissue-plasminogen activator antigen (t-PA). Student t-test, One Way Analysis of Variance (ANOVA) and Bonferroni test were used for statistical analysis. P<0.05 (two tails) was assumed to indicate a significant difference. RESULTS: Fibrinogen concentrations were always increased with respect to controls (P<0.001), while protein S was always decreased, with values averaging 60% of those of controls from the 10th week of pregnancy onwards (P<0.001). Variance analysis showed a statistically significant increase with gestational age for procoagulant factors (INR: P<0.001; FBG: P<0.001), a reduction for anticoagulants (PC: P<0.0001; PS: P<0.0001), and a rise for F1+2 (P<0.0001). With regard to fibrinolysis, there was an increase both for t-PA (P<0.0001) and PAI-1 (P<0.0001) during pregnancy. The t-PA values were always comprised in the normal range. PAI-1 were increased with respect to control values starting from 31st week. The most significant variations in the procoagulants (expressed by PT and FBG) were recorded up to the 20th week (P<0.001); from the 30th week onwards, they remained stable until after the delivery. The same was true for protein S levels (P<0.001), except that the difference between the 10th and the 20th weeks was not statistically significant. The level of F1+2 gradually increased throughout pregnancy (P<0.001), and then fell in the puerperium (P<0.001). CONCLUSIONS: The parameters showing the greatest variation during pregnancy were PT, FBG, PS, F1+2 and PAI-1. The existence of a hypercoagulable state in pregnancy was suggested by the increased levels of F1+2.
F Cerneca; G Ricci; R Simeone; M Malisano; S Alberico; S Guaschino
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of obstetrics, gynecology, and reproductive biology     Volume:  73     ISSN:  0301-2115     ISO Abbreviation:  Eur. J. Obstet. Gynecol. Reprod. Biol.     Publication Date:  1997 May 
Date Detail:
Created Date:  1997-07-22     Completed Date:  1997-07-22     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0375672     Medline TA:  Eur J Obstet Gynecol Reprod Biol     Country:  IRELAND    
Other Details:
Languages:  eng     Pagination:  31-6     Citation Subset:  IM    
Department of Obstetrics and Gynecology, University of Trieste, Italy.
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MeSH Terms
Analysis of Variance
Anticoagulants / metabolism*
Blood Coagulation / physiology*
Blood Coagulation Factors / physiology*
Case-Control Studies
Fibrinolysis / physiology*
Longitudinal Studies
Postpartum Period / blood*
Pregnancy / blood*
Reference Values
Reg. No./Substance:
0/Anticoagulants; 0/Blood Coagulation Factors

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