Serial measurements of circulating tissue plasminogen activator and fibrin(ogen) degradation products predict outcome in gestational proteinuric hypertension.
Gestational proteinuric hypertension (GPH), a major cause of maternal death, may be characterised by hypertension and proteinuria alone or may progress to disturbed coagulation and multiorgan failure. Since the condition can only be reversed by termination of pregnancy, there is a need for reliable indicators of severity. We found circulating levels of tissue plasminogen activator (tPA) (27.98 +/- 2.12 v. 7.17 +/- 0.81 ng/ml, mean +/- SEM), fibrin(ogen) degradation products (FDP) (7.55 +/- 1.99 v. 1.92 +/- 0.47 micrograms/ml) and fibronectin (221 +/- 15.2 v. 120 +/- 15.2 micrograms/ml) to be significantly increased in 21 patients with severe GPH when compared with 21 normotensive, age- and gestational age-matched pregnant controls. More importantly, patients who developed severe GPH showed a progressive increase in tPA and FDP levels with time. This was in contrast to patients who had hypertension and proteinuria alone, in whom tPA and FDP concentrations did not increase. Parallel measurements did not reveal a fall in platelet count or an increase in urinary protein excretion in patients who subsequently progressed to severe disease. Our findings may be of assistance to clinicians faced with the need to prolong pregnancy in patients with GPH in order to ensure fetal viability.
de Jager
C A
CA
MRC/UCT Liver Research Centre, University of Cape Town.
Robson
S C
SC
Kirsch
R E
RE
Jacobs
P
P
Harvest
C
C
Dunne
T
T
Anthony
J
J
D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005353:Fibronectins / Q000097:blood; D006801:Humans; D010960:Plasminogen Activators / Q000097:blood*; D011225:Pre-Eclampsia / Q000097:blood*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies
D005338:Fibrin Fibrinogen Degradation Products; D005353:Fibronectins; D010960:Plasminogen Activators