Haemostatic, fibrinolytic and endothelial variables in normal pregnancies and pre-eclampsia.
OBJECTIVE
To determine the behaviour of the coagulation variables antithrombin III (ATIII), protein C, thrombin/antithrombin III (TATIII); fibrinolytic activity, tissue plasminogen activator antigen (t-PA), plasminogen activator inhibitors (PAI) 1 and 2, and endothelial involvement by fibronectin assay in normal and pre-eclamptic pregnancies.


METHODS
Longitudinal and cross-sectional observational study.


METHODS
Antenatal clinic and maternity hospital.


METHODS
Thirty-six primigravid normotensive caucasian patients, four of whom subsequently developed pre-eclampsia, and 12 patients with established pre-eclampsia.


METHODS
Plasma levels of PAI-1, PAI-2 and t-PA antigen were determined using an ELISA technique as were TATIII complex levels of fibronectin. ATIII and protein C plasma levels were assayed using chromogenic substrate techniques.


RESULTS
PAI-1 and PAI-2 antigen levels rose progressively throughout normal pregnancy. Among the established pre-eclamptic group compared with matched normal pregnancies, the PAI-2 antigen level was significantly lower (48.5 +/- 22.8 versus 183.5 +/- 37.4; P < 0.001), the PAI-1 antigen level was significantly higher (122 +/- 34.4 versus 79.2 +/- 19.7; P < 0.001), ATIII activity was significantly lower (87.8 +/- 27.1 versus 110.9 +/- 19.3; P < 0.001) and TATIII complex levels were significantly higher (16.9 +/- 6.4 versus 10.2 +/- 5.9; P < 0.001). Among the four initially normotensive patients who subsequently developed pre-eclampsia, fibronectin levels were significantly elevated from as early as nine weeks of gestation.


CONCLUSIONS
Significantly elevated levels of PAI-1 and fibronectin occurring early in pregnancies that subsequently develop pre-eclampsia suggest that these variables may have predictive values. PAI-2 would seem to be a marker of placental function in pre-eclampsia while increased t-PA and TATIII complex levels reflect the severity of the condition.
Halligan
A
A
Rotunda Hospital, Dublin.
Bonnar
J
J
Sheppard
B
B
Darling
M
M
Walshe
J
J
D000293:Adolescent; D000328:Adult; D000990:Antithrombin III / Q000032:analysis*; D003430:Cross-Sectional Studies; D005260:Female; D005353:Fibronectins / Q000097:blood; D006487:Hemostasis; D006801:Humans; D008137:Longitudinal Studies; D010455:Peptides / Q000097:blood*; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood*; D017396:Plasminogen Activator Inhibitor 2 / Q000097:blood*; D011225:Pre-Eclampsia / Q000097:blood*; D011247:Pregnancy / Q000097:blood*; D011486:Protein C / Q000032:analysis*; D019396:Tissue Polypeptide Antigen
D005353:Fibronectins; D010455:Peptides; D017395:Plasminogen Activator Inhibitor 1; D017396:Plasminogen Activator Inhibitor 2; D011486:Protein C; D019396:Tissue Polypeptide Antigen; D000990:Antithrombin III