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Coagulation/fibrinolysis disorder in patients with severe preeclampsia
T Kobayashi1, N Tokunaga, M Sugimura
1Department of Obstetrics and Gynecology, Hamamatsu University, School of Medicine, Japan.
Insights
Severe preeclampsia patients with less hypercoagulable states may have successful vaginal deliveries. A drop in platelet count during pregnancy could predict delivery termination, especially with worsening maternal factors.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Perinatology
Background:
- Severe preeclampsia is a complex condition affecting pregnant individuals.
- Coagulation and fibrinolysis balance is crucial during pregnancy.
- Understanding these parameters can aid in managing severe preeclampsia.
Purpose of the Study:
- To investigate coagulation and fibrinolysis parameters in severe preeclampsia.
- To correlate these parameters with clinical status and delivery mode.
- To identify potential markers for pregnancy outcomes in severe preeclampsia.
Main Methods:
- Studied 50 patients with severe preeclampsia.
- Assessed coagulation/fibrinolysis markers including antithrombin (AT), plasmin inhibitor complex (PIC), D-dimer, and thrombin-antithrombin complex (TAT).
- Compared parameters between cesarean section and vaginal delivery groups, and analyzed platelet count changes.
Main Results:
- Coagulation and clinical indices showed a strong correlation in severe preeclampsia.
- Cesarean deliveries were associated with decreased antithrombin (AT) and increased plasmin inhibitor complex (PIC), D-dimer, and thrombin-antithrombin complex (TAT).
- A larger drop in platelet count (deltaPlt) was observed in cesarean cases; increased PIC was linked to maternal factors.
Conclusions:
- Vaginal delivery may be feasible in severe preeclampsia with a less hypercoagulable state.
- Decreased platelet count during pregnancy might predict the need for termination.
- An excessive hypercoagulable state may indicate pregnancy termination, particularly with maternal complications.
Abstract:
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.