Blood Coagulation during Normal Pregnancy, Labor, and the Puerperium

Kennan, Alfred L.; Bell, Warren N.

doi:10.1016/s0002-9378(16)37266-0

Cited by 29 publications

(8 citation statements)

References 13 publications

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“…Five groups of workers reported that there was no significant change in the platelet count during pregnancy (Bland et al, 1930;Fresh et al, 1956;Kennan and Bell, 1957;Ratnoff et al, 1954;Todd et al, 1965). By way of contrast, there were three reports of a progressive fall in platelet counts during pregnancy (Bonnar et al, 1969;Shaper et al, 1968;Ward and MacArthur, 1948).…”

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confidence: 99%

Platelet counts during normal pregnancy.

Sejeny¹,

Eastham²,

Baker³

1975

J Clin Pathol

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SYNOPSIS Eleven reports of platelet counts were found in the literature which reported a progressive increase, no change, or a progressive fall during pregnancy. The counts had been made using venous or capillary blood, with either simple dilution or red cell lysis prior to enumeration in a haemocytometer, with or without phase-contrast microscopy. It was therefore decided to examine whole blood platelet counts taken during normal pregnancy. Results from 405 venous blood samples, using an electronic platelet counter, confirmed the finding of a significant progressive fall in platelet counts during normal pregnancy, the lowest counts falling in some women outside the recognized normal range of values.

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confidence: 99%

Platelet counts during normal pregnancy.

Sejeny¹,

Eastham²,

Baker³

1975

J Clin Pathol

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“…Although these changes are of physiologic importance for minimizing the risk of blood loss, they may also increase the risk of thromboembolic complications reported previously [8,10,13,17]. In the control group, APC-SR decreased after 20 weeks of gestation until week 42.…”

Section: Discussionmentioning

confidence: 73%

“…During normal pregnancy, a plasma concentration of proteins involved in blood coagulation, the PC anticoagulant system, and the fibrinolytic system change in a direction that promotes coagulation, decreased anticoagulant and inhibits fibrinolysis [8]. Although these changes are of physiologic importance for minimizing the risk of blood loss, they may also increase the risk of thromboembolic complications reported previously [8,10,13,17].…”

Section: Discussionmentioning

confidence: 96%

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Activated Protein C Resistance in Normal and Pre-Eclamptic Pregnancies

Paternoster¹,

Stella²,

Simioni

et al. 2002

Gynecol Obstet Invest

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Objectives: A lower ratio in the classic activated protein C resistance (APC-R) test has been reported during pregnancy, which has been called ‘acquired’ APC-R. However, little is known about the cause of the lowered ratio, and whether or not there is a correlation with blood coagulation activation. The primary objective of our study was to determine changes in APC-R levels in each of the trimesters of normal pregnancy. The secondary objective was to confirm whether APC-R levels were lower in pregnancies complicated by pre-eclampsia than in a control group. Finally, this prospective study was performed to investigate the prevalence of APC-R among pregnant women and to elucidate its obstetric consequences. Methods: We enrolled 35 healthy pregnant women and 47 pregnant women affected by pre-eclampsia in our study. The following laboratory tests were performed: prothrombin time, partial thromboplastin time, fibrinogen levels, antithrombin III, plasmatic fibronectin (as a marker of endothelial damage), haptoglobin (as a marker of intravascular haemolysis), a functional test for APC-R and analysis of factor V Leiden mutation by polymerase chain reaction. Results: The activated protein C sensitivity ratio was lower in the pathological group than in the control group (p = 0.008 and p = 0.02, respectively). Plasmatic fibronectin was found to be higher in the pathological group than in the control group (p = 0.05). Finally, the overall prevalence of factor V Leiden mutation was 5.4%, i.e. 2/35 women (5.7%) in the control group and 3/47 women in the pathological group (6.38%). Conclusions: The APC ratio decreased after 20 weeks of gestation until week 42. This decrease was most pronounced in the third trimester, in which resistance was demonstrated in 34.2% of control group patients. In pre-eclampsia, we found a greater reduction of the APC ratio than in controls. We hypothesise that this is due to a decrease in the plasmatic levels of coagulation inhibitors and an increase in coagulatory factors.

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“…The coagulation poten tial, rising during pregnancy and reaching its climax at the time of parturi tion, remains, as far as can be perceived, increased until the early puerperium. In any case, at this point increased numbers of thrombocytes, high values of plasma fibrinogen, and increase in prothrombin and in factor VII as well as an increased agglutination ability of the thrombocytes can be found [Runge and H arter, 1952;Mazzetti and Lovotti, 1956;Bach, 1957;Kennan and Bell, 1957;Beller, 1960;Starzewski et al, I960].…”

Section: Clinical Picturementioning

confidence: 99%