The Dynamics of the Hemostatic Parameters in Physiological Pregnancy and After Delivery

Abstract

Nowadays hematologists and obstetrician-gynecologists have little data about the peculiarities of hemostatic parameters and the maintenance of hemostatic balance at different stages of physiological pregnancy. However, it is necessary to know the norms for the determination of pathologic deviations in the system and medical decision making. The article presents the dynamics of 50 hemostatic parameters in women in pregravid period, at different stages of physiological pregnancy, and 2-3 days after vaginal delivery studied in 301 Caucasian (white) women. The parameters that characterize different components of hemostatic system were taken into account-vascular-platelet, coagulant, anticoagulant, and Fibrinolytic. Thrombin generation test was used as an integrated method to study hemocoagulation.According to the obtained results, some parameters were identified. These parameters could be an objective prerequisite for the prescription and monitoring the effects of antiaggregants and low molecular heparins during pregnancy with the aim of thromboprophylaxis. It is suggested that hyperproduction of Tissue Factor (TF) and thrombin (in relation to reference ranges) should play a possible role in initiation not only intravascular blood coagulation but also the end of pregnancy. It might be of importance in understanding the causes of preterm delivery. The described mechanism, preventing thrombus formation in late pregnancy, is associated with the enhancement of fibrinolytic reactions in blood circulation. This mechanism can lead to the degradation of soluble fibrin polymer (with the formation of D-dimers) before its conversion into gel or fibrin clot (fibrin insolubile). The obtained data could be useful in future to identify pregnant women at risk dealing with thrombosis, bleeding and obstetrics complications during pregnancy and delivery.Keywords: Blood coagulation markers; Coagulation factors; Fibrinolysis; Hemostatic system; Physiological anticoagulants; Pregnancy; Thrombin generation Citation: Моmot AP, Semenova NA, Belozerov DE, Trukhina DA, Kudinova IY (2016) interest since these data can be useful for the differential diagnostics of bleeding causes, as well as for the identification of patients needed in thromboprophylaxis.Moreover, simultaneous identification of a lot of parameters, characterizing coagulation, anticoagulant and fibrinolytic activity of blood could allow obtaining the important information about dynamically changing hemostatic balance during pregnancy, which is normally accompanied by neither bleedings nor thromboses. The study of these parameters is expected to explain the causes of 3-4 fold increase in D-dimers level in late physiological pregnancy, to select objective factors for initiation and cessation of heparinprophylaxis and to solve other problems associated with pregnancy complications.The aim of this study is to determine the allowed values and the dynamics of changes of a wide range of hemostatic parameters at different stages of physiological pregnancy and the first few day...

Features of the course of the gestational process with the carriage of genotypes F5L:G(1961)A and F2:G(20210)A and inheritance options

“…Возможно изучение фенотипической проявленности тромбофилического генотипа, в том числе в ассоциации с клинической реализацией в виде плацентоопосредованных осложнений. Ранее нами было показано, что у нормозиготных носителей относительно мутации Лейден -генотип F5L:G(1961)G -APC-R составляет более 0,80 по НО, а активность протромбина при «диком» генотипе F2:G(20210)Gне более 140 % [16]. Также в ранее представленных исследованиях определено, что для развития плацентоопосредованных осложнений беременности характерно снижение APC-R  0,49 по НО [17] и повышение активности протромбина в плазме крови выше 180 % [18], т. е. клиническая реализация тромбофилического генотипа определяется его фенотипической проявленностью.…”