Coagulation/fibrinolysis disorder in patients with severe preeclampsia.
We investigated coagulation/fibrinolysis parameters in 50 patients with severe preeclampsia. The coagulation and clinical indices in patients with severe preeclampsia were 1.595 and 1.414, respectively. These indices show a strong correlation between the clinical status and coagulation/fibrinolysis abnormalities. Among patients with severe preeclampsia, a significant decrease in antithrombin (AT) (p = 0.002) and a significant increase in plasmin inhibitor complex (PIC) (p = 0.002), D-dimer (p < 0.05), and thrombin-antithrombin complex (TAT) (p = 0.001) were observed in cases terminated by cesarean section compared with those cases of vaginal delivery. There was no significant difference in platelet count (Plt), however, deltaPlt (the difference between platelet counts in early gestation and before delivery) was significantly larger (p < 0.05) in cases that ended in cesarean section. Furthermore, among cases terminated by cesarean section, a significant increase in PIC (p < 0.01) was observed when pregnancies were terminated because of maternal factors compared with those terminated because of fetal factors. These results suggest that (1) even in patients with severe preeclampsia, vaginal deliveries can be successful when they display a less hypercoagulable state; (2) a decrease in Plt during pregnancy may be a predictive marker for the termination of pregnancy; and (3) an excessive hypercoagulable state in patients with severe preeclampsia may be associated with the termination of pregnancy, especially when there is an aggravation of maternal factors.
Kobayashi
T
T
Department of Obstetrics and Gynecology, Hamamatsu University, School of Medicine, Japan.
Tokunaga
N
N
Sugimura
M
M
Suzuki
K
K
Kanayama
N
N
Nishiguchi
T
T
Terao
T
T
D000328:Adult; D000933:Antifibrinolytic Agents / Q000097:blood; D000990:Antithrombin III / Q000032:analysis; D000991:Antithrombins / Q000032:analysis; D001724:Birth Weight; D001772:Blood Cell Count; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005342:Fibrinolysis / Q000502:physiology*; D005865:Gestational Age; D006801:Humans; D010447:Peptide Hydrolases / Q000032:analysis; D011225:Pre-Eclampsia / Q000378:metabolism* / Q000503:physiopathology; D011247:Pregnancy; D012720:Severity of Illness Index; D019851:Thrombophilia / Q000378:metabolism* / Q000503:physiopathology; D000979:alpha-2-Antiplasmin / Q000032:analysis
D000933:Antifibrinolytic Agents; D000991:Antithrombins; D005338:Fibrin Fibrinogen Degradation Products; D000979:alpha-2-Antiplasmin; C046193:antithrombin III-protease complex; C036309:fibrin fragment D; D000990:Antithrombin III; D010447:Peptide Hydrolases