Is there a physiological intravascular coagulation in obstetrical cases?

Area of Science:

• Obstetrics and Gynecology
• Hematology
• Clinical Chemistry

Background:

• Pregnancy and labor involve significant hemostatic changes.
• Disseminated intravascular coagulation (DIC) is a critical condition involving abnormal clotting.
• Understanding normal pregnancy-related hemostatic changes is crucial for differentiating from pathological states.

Purpose of the Study:

• To investigate changes in fibrinogen, fibrin degradation products (FDPs), and paracoagulation tests during pregnancy, labor, and puerperium.
• To determine if these hemostatic changes are indicative of physiological DIC.

Main Methods:

• Blood samples were collected during the third trimester of pregnancy, labor, and puerperium.
• Plasmatic fibrinogen concentrations were measured.
• Fibrin degradation products (FDPs) were quantified.
• The paracoagulation test using serial dilution of protamine sulphate (SDPS) was performed.

Main Results:

• Significant increases in fibrinogen concentrations were observed throughout pregnancy, labor, and puerperium.
• Elevated levels of fibrin degradation products (FDPs) were detected during the same periods.
• The serial dilution of protamine sulphate (SDPS) test yielded both positive and negative results, indicating variable activation of the coagulation system.

Conclusions:

• The observed increases in fibrinogen and FDPs, along with variable SDPS test results, represent normal physiological adaptations to pregnancy and birth.
• These findings do not support the presence of a pathological process like disseminated intravascular coagulation (DIC) in uncomplicated pregnancy and labor.