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Plasminogen activators and inhibitors in normal late pregnancy, postpartum and in the postnatal period
1Department of Obstetrics and Gynaecology, National University of Singapore, National University Hospital.
Insights
Pregnancy alters fibrinolysis, with elevated tissue plasminogen activator (t-PA) and urokinase plasminogen activator (u-PA). This shift, along with plasminogen activator inhibitors (PAI), reduces the body's ability to prevent blood clots during pregnancy.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Cardiovascular Physiology
Background:
- Pregnancy is associated with significant physiological changes affecting the hemostatic system.
- Understanding alterations in the fibrinolytic system during and after pregnancy is crucial for managing thromboembolic risks.
Purpose of the Study:
- To investigate the dynamic changes in key fibrinolytic factors during late pregnancy and the postpartum period.
- To assess the impact of these changes on the potential fibrinolytic response to stress.
Main Methods:
- Measurement of tissue plasminogen activator (t-PA), urokinase plasminogen activator (u-PA), and plasminogen activator inhibitors (PAI) levels.
- Analysis of these levels in late pregnancy, postpartum, and at 6 weeks postnatal.
Main Results:
- t-PA and u-PA were elevated in late pregnancy, persisting at 6 weeks postpartum.
- PAI-2 levels remained elevated postpartum but decreased by 6 weeks.
- PAI activity was absent postpartum, returning to nonpregnant levels later.
Conclusions:
- Pregnancy significantly reduces the potential fibrinolytic response to stress.
- These alterations in fibrinolysis during pregnancy increase the risk of thromboembolism.
Abstract:
Tissue plasminogen activator (t-PA), urokinase plasminogen activator (u-PA) and plasminogen activator inhibitors (PAI) are elevated in late pregnancy with t-PA and u-PA remaining so at 6 weeks postnatal. PAI-2 remains at postpartum but was absent by 6 weeks postnatal unlike PAI activity which was absent at postpartum and returned to nonpregnant level at postnatal. The potential fibrinolytic response to stress is much reduced in pregnancy thus increasing the risk of thromboembolism.