title: The role of tissue factor in normal pregnancy and in the development of preeclampsia: A review.
abstract: BACKGROUND
  Tissue factor (TF) is a key element for normal gestation, especially in the first trimester. TF levels are hence raised in pregnancy, producing an adaptive hypercoagulable state. Potentiated hypercoagulability however, is associated with disorders of pregnancy such as pre-eclampsia but the results of TF and its inhibitor, tissue factor pathway inhibitor (TFPI), measurement, in pre eclampsic women are ambiguous and the data conflicting. This review covers the current knowledge status of the role of TF assessment in pregnancy with a focus on its diagnostic utility.
  
  
  METHODS
  A review of the literature using the following key words: tissue factor, thrombosis, inflammation, pregnancy, preeclampsia.
  
  
  RESULTS
  The published literature shows raised and unchanged TF levels in various studies of pre-eclampsia along with equally conflicting data for TFPI. The various study designs and methods used in these studies makes valid comparison difficult. Meta analysis of 34 randomized trials showed that low-dose aspirin in early phases of gravidity (starting from the 16th week or earlier) significantly reduces the incidence of preeclampsia.
  
  
  CONCLUSIONS
  Overall, the results of the literature search together with knowledge of the structure and biological effects of TF, suggest that measuring the level of plasma TF/TFPI is not ideal for determining the actual levels of TF in the uteroplacental circulation. The current view that endothelial dysfunction is the trigger for preeclampsia, suggests that aspirin may be an effective prophylaxis. Further research will be necessary: measuring the expression of tissue factor on monocytes using flowcytometry and comparing the development of this expression during normal pregnancy and pregnancy complicated by preeclampsia, for example. Another possibility is immunohistochemical determination of the level of TF expression directly in placental tissue.
authors.affiliation: Department of Hemato-oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.
authors.forename: Jana
authors.initials: J
authors.lastname: Prochazkova
authors.affiliation: Department of Hemato-oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.
authors.forename: Ludek
authors.initials: L
authors.lastname: Slavik
authors.affiliation: Department of Hemato-oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.
authors.forename: Jana
authors.initials: J
authors.lastname: Ulehlova
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc.|Department of Midwifery, Faculty of Health Sciences, Palacky University Olomouc.
authors.forename: Martin
authors.initials: M
authors.lastname: Prochazka
mesh_terms: D001777:Blood Coagulation / Q000502:physiology; D005260:Female; D006801:Humans; D011225:Pre-Eclampsia / Q000097:blood / Q000209:etiology*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D013925:Thromboplastin / Q000502:physiology*
chemical_list: D013925:Thromboplastin
keywords: inflammation; preeclampsia; pregnancy; thrombosis; tissue factor