Increased D-dimer levels in twin gestation.
In normal pregnancy, the hemostatic balance is displaced toward hypercoagulability. The elevation in plasma levels of coagulation factors VII, VIII, and X and fibrinogen and the increased concentrations of plasminogen activator inhibitors [1,2] may predispose individuals to thromboembolism, especially near term [1,3]. Because human multifetal gestation requires still greater physiological alterations, the imbalance in hemostasis is further exaggerated. It has been suggested that the changes in the coagulation system near term may even mimic low-grade disseminated intravascular coagulopathy [4]. However, for the majority of women with multifetal gestation, the coagulopathy observed in the laboratory is not clinically apparent [5]. Despite the large body of research on the physiological adaptation to pregnancy, relatively little is known of the biological adaptation in general and the hemostatic changes in particular associated with multiple gestation.
Bar
J
J
Department of Obstetrics and Gynecology, Rabin Medical Center, Petah Tiqva, Israel. jbar@clalit.org.il
Blickstein
D
D
Hod
M
M
Bar-Hava
I
I
Ben-Rafael
Z
Z
Rahmany-Babai
J
J
Lahav
J
J
D000328:Adult; D000933:Antifibrinolytic Agents / Q000276:immunology / Q000378:metabolism; D001780:Blood Coagulation Tests; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000276:immunology / Q000378:metabolism*; D005340:Fibrinogen / Q000378:metabolism; D006801:Humans; D007841:Latex Fixation Tests; D011247:Pregnancy; D011263:Pregnancy Trimester, Third / Q000097:blood; D011272:Pregnancy, Multiple / Q000097:blood*; D018709:Statistics, Nonparametric; D014427:Twins
D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005340:Fibrinogen