Fibrinolytic Enzyme System and Pregnancy

Bonnar, J.; McNicol, G. P.; Douglas, A. S.

doi:10.1136/bmj.3.5667.387

Cited by 145 publications

(56 citation statements)

References 20 publications

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“…Fibrinolytic activity has been reported to be diminished in the last trimester of pregnancy (5,(8)(9)(10)12) when measured with the euglobulin clot lysis time and the fibrin plate lysis method. Moreover, several antiplasmins showed a signifieant trend to an increase during pregnancy, which might also imply a decrease in fibrinolytic activity (2,6).…”

Section: Discussionmentioning

confidence: 99%

“…Interaction of plasmin and fibrin produces the so called D-dimers, D-fragment dimers originating from cross-linked fibrin. There is much evidence that during pregnancy fibrinolytic activity (measured by means of thc euglobulin clot lysis method and the fibrin plate method) is diminished, especially in the last trimester (5,(8)(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

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Blood Coagulation and Fibrinolysis During Normal Pregnancy

Wersch¹,

Ubachs²

1991

Clinical Chemistry and Laboratory Medicine

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Summary: Fifty-six pregnant women (gestational age 6-40 weeks) were evaluated for their coagulation activation (fibrin monomers and thrombin-antithrombin III complex) and for their fibrinolysis profile by determining tissue plasminogen activator, plasminogen activator inhibitor, plasminogen, a 2 -antiplasmin-and D-dimer. Fibrin monomers and thrombin-antithrombin III complexes were found to be significantly increasing with gestational age. All the fibrinolytic parameters showed a steady growth with the progress of the pregnancy, with the exception of tissue plasminogen activator which showed a significant decrease with gestational age, but mainly within the reference ränge. These results suggest a Stimulation of the coagulation System and an activation of fibrinolysis with ongoing pregnancy, although the increasing oc 2 -antiplasmin and plasminogen levels and the decreasing tissue plasminogen activator concentrations do not conform to this trend.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Blood Coagulation and Fibrinolysis During Normal Pregnancy

Wersch¹,

Ubachs²

1991

Clinical Chemistry and Laboratory Medicine

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“…1,33,34 This fibrinolytic shut-down occurs despite the increased levels of plasminogen, as found in our and other studies. 11,[31][32][33] Conversely, the plasma levels of the protease inhibitor alpha2-antiplasmin during normal pregnancy was found to be both unchanged 35 and increased, 36,37 while in the present study we noted a slight decrease in the third trimester. These widely varying findings could be due to differences in assay techniques.…”

Section: Discussionmentioning

confidence: 30%

“…As with antithrombin III, the fluctuations in platelet counts, though statistically significant, were within the normal range for nonpregnant controls. The steady decline in fibrinolytic activity during pregnancy is believed to be due to both a placenta-derived inhibitor 1,11,[31][32][33] and progressive decrease of plasminogen activator release by endothelial cells. 1,33,34 This fibrinolytic shut-down occurs despite the increased levels of plasminogen, as found in our and other studies.…”

Section: Discussionmentioning

confidence: 99%

Hemostasis in Pregnant Saudi Women

et al. 1990

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A cross-sectional study of various hemostatic variables was undertaken in women during the three trimesters of normal pregnancy. In the third trimester of pregnancy, there was significant elevation of plasma fibrinogen, 55%; factor VIII activities, 64%; factor VIII:ristocetin cofactor, 44% ; factor VIII-related antigen, 49% ; factor X, 9% ; and plasminogen, 19%, and a reduction of antithrombin III, 10%; alpha2-antiplasmin, 7%; and platelet count, 20%, compared with those values obtained in healthy nonpregnant controls. These fluctuations developed gradually during the first and second trimesters. Prothrombin time, partial thromboplastin time, thrombin time, and reptilase time were similar in pregnant women and nonpregnant controls. Platelet aggregation in response to adenosine diphosphate, collagen, adrenaline, and arachidonic acid was significantly reduced in pregnant women compared to controls. The reduced platelet aggregability in Saudi pregnant women may counterbalance the increased plasmatic coagulation potential, thereby minimizing the risk of thromboembolic disease during pregnancy.

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“…There is also a decrease in the level of antithrombin 111 [3] and of plasma fibrinolytic activity [4]. Although the hyperdynamic circulation of pregnancy means that the overall circulation time is reduced, venous return from the lower limbs is decreased as the pregnant uterus obstructs the inferior vena cava.…”

Section: Discussionmentioning

confidence: 99%

Fatal pulmonary embolism following spinal anaesthesia for Caesarean section

1992

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SummaryPulmonary embolism remains one of the commonest causes of maternal death. Regional blockade is reported to decrease the incidence of postoperative thrombo-embolic disease. We describe a case in which a fatal pulmonary embolism followed an emergency Caesarean section for which the patient was given a spinal anaesthetic. We believe it to be thejirst time this has been reported. Key wordsAnaesthesia; obstetric. Anaesthetic technique, regional; spinal. Complications; pulmonary embolism.The report on Confidential enquiries into maternal deaths in the United Kingdom 1985-87, shows that pulmonary embolism and hypertensive disorders of pregnancy remain the most common causes of maternal mortality [I]. Of the 13 postpartum deaths from pulmonary embolism, seven followed Caesarean section, suggesting that the risk after operative delivery is markedly increased compared with vaginal delivery. Case historyAn unmarried 29-year-old primiparous woman presented in spontaneous labour at 41 weeks' gestation. Her antenatal course had been uneventful and did not include any periods of immobilisation. She weighed 97.4 kg, smoked 10 cigarettes a day and had been normotensive throughout her pregnancy.Labour initially progressed well, during which she required for analgesia one intramuscular injection of pethidine 100 mg and Entonox. After 9 h her labour failed to progress because of cephalopelvic disproportion and an emergency Caesarean section became necessary. There was no fetal distress. The pre-operative haemoglobin level was 12 g.dl-' and baseline readings of heart rate 100 beats.min-', blood pressure 130/85 mmHg and an oxygen saturation of 96% when breathing air were obtained. After premedication with 30 ml of sodium citrate the patient's circulation was preloaded with 1500 ml compound sodium lactate solution. She was turned onto her right side and a 26 g spinal needle was inserted at the L2-3 interspace. Clear cerebrospinal fluid was obtained and 2.5 ml of hyperbaric 0.5% bupivacaine was injected into the subarachnoid space. A bolus dose of 9 mg of ephedrine was given intravenously as prophylaxis against hypotension.Twelve minutes later the patient was delivered of a live female infant weighing 4.08 kg, with Apgar scores of 9 at 1 min and 10 at 5 min. The operation was complete 53 min after the spinal injection. There were no episodes of hypotension and the blood loss was estimated to be 400 ml. The patient recovered well, did not develop a headache and was sitting out of bed 20 h after the operation. She required three intramuscular injections of papaveretum 20 mg for analgesia in the first 24 h and nothing after that. On the second postoperative day her temperature was 37.9" C, but this settled spontaneously. It was noted that her calves were not tender. All observations remained normal, but owing to social circumstances she was not discharged until the eighth postoperative day.

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Fibrinolytic Enzyme System and Pregnancy

Cited by 145 publications

References 20 publications

Blood Coagulation and Fibrinolysis During Normal Pregnancy

Blood Coagulation and Fibrinolysis During Normal Pregnancy

Hemostasis in Pregnant Saudi Women

Fatal pulmonary embolism following spinal anaesthesia for Caesarean section

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