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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 3  |  Issue : 1  |  Page : 60-62

Effects of perinatal complications on coagulation function in pregnant women


Department of Blood Transfusion, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200090, China

Date of Submission26-Nov-2018
Date of Web Publication11-Apr-2019

Correspondence Address:
Pei-Min Mao
Department of Blood Transfusion, Obstetrics and Gynecology Hospital of Fudan University, 128 Shenyang Road, Shanghai 200090
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2096-2924.255989

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  Abstract 


Objectives: To investigate the effects of various complications on the coagulation function of perinatal women.
Methods: A total of 210 pregnant women between November 2016 and June 2017 were recruited. The coagulation function indexes, including prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), and thrombin time (TT), were evaluated in pregnant women with group B Streptococcus (GBS), positive nonstress test (NST), scarred uterus, prenatal fever, macrosomia, gestational hypertension, gestational diabetes, premature rupture of membranes (PROMs), threatened abortion, and oligohydramnios.
Results: No significant differences were found in PT, APTT, FIB, and TT in pregnant women with GBS, positive NST, scarred uterus, macrosomia, gestational hypertension, gestational diabetes, PROMs, and oligohydramnios. Moreover, significantly decreased PT and APTT and significantly increased TT were found in pregnant women with prenatal fever compared to normal controls, whereas significantly increased TT was also observed in those with threatened abortion.
Conclusions: Among the complications that occur in pregnant women, prenatal fever and threatened abortion have important effects on coagulation function.

Keywords: Coagulation; Complication; Perinatal Period; Pregnancy; Prenatal Fever; Threatened Abortion


How to cite this article:
Yu WQ, Liu XY, Mao PM. Effects of perinatal complications on coagulation function in pregnant women. Reprod Dev Med 2019;3:60-2

How to cite this URL:
Yu WQ, Liu XY, Mao PM. Effects of perinatal complications on coagulation function in pregnant women. Reprod Dev Med [serial online] 2019 [cited 2019 Nov 22];3:60-2. Available from: http://www.repdevmed.org/text.asp?2019/3/1/60/255989




  Introduction Top


Pregnancy is a primary hypercoagulable state due to enhanced production of clotting factors, a decrease in protein S activity, and inhibition of fibrinolysis.[1],[2] These physiologic changes cause a collective change in coagulation function in the general obstetric population.[3],[4],[5] Abnormal coagulation function is a major threat to the life and health of perinatal women, and a variety of perinatal complications have different degrees of influence on the coagulation function during pregnancy. The coagulation status has particular importance not only for the pregnant women but also for their premature babies who are at a risk of developing serious health problems.[6],[7] The higher incidence and greater categories of complications in perinatal women may increase the morbidity and mortality rates in premature babies.[8],[9]

For the prediction of possible complications, such as group B Streptococcus (GBS), positive nonstress test (NST), scarred uterus, prenatal fever, macrosomia, gestational hypertension, gestational diabetes, premature rupture of membranes (PROMs), threatened abortion, oligohydramnios,[10],[11],[12] and the subsequent decision-making with respect to treatment, obstetricians need to check the coagulation status (normal or abnormal) of pregnant women. However, many laboratories only provide reference ranges for coagulation parameters in the nonpregnant population.[12],[13] Thus, it is clinically important to determine the differences in coagulation parameters between healthy pregnant women and those with complications.

In the present study, we investigated the effects of different complications on the coagulation function of pregnant women. The overall goal of our study was to provide information that could improve the diagnostic accuracy in the evaluation of pregnant women with suspected or known complications.


  Methods Top


Subjects

A total of 210 pregnant women who visited the Hospital of Obstetrics and Gynecology, Fudan University, Shanghai, China, between November 2016 and June 2017, were recruited for this study. The inclusion criteria were as follows: (1) pregnant status without prenatal complication, (2) pregnant status with a single symptom of prenatal complication, and (3) the presence of two symptoms of prenatal complications. The age range of the included perinatal women was between 22 and 37 years, and the duration of pregnancy was between 33 weeks +1 day and 39 weeks +5 days. The study protocol was approved by the Ethics Committee of the Obstetrics and Gynecology Hospital of Fudan University (2016-02), and written informed consent was obtained from each included subject.

Measurements of prothrombin time, activated partial thromboplastin time, thrombin time, and fibrinogen

Blood was collected from the subjects, and platelet-poor plasma was obtained by centrifugation (2,500 ×g for 10 min) from platelet-rich plasma containing 2.5% sodium citrate. Prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), and fibrinogen (FIB) were measured using a Sysmex CA7000 coagulation analyzer (Sysmex, Kobe, Japan), according to the previously reported method.[14]

Statistical analysis

The subjects were categorized into different groups according to the presence of GBS, positive NST, scarred uterus, prenatal fever, macrosomia, gestational hypertension, gestational diabetes, PROMs, threatened abortion, and oligohydramnios. Descriptive statistics of coagulation indicators for the different groups were reported as mean ± standard deviation. One-way ANOVA with Tukey's post hoc test was performed to compare the difference between different groups. Associations between coagulation dysfunction and the risk of adverse pregnancy outcome were tested using logistic regression analysis. All statistical analyses were performed using SPSS 22.0 software (SPSS Inc., Chicago, IL, USA), and P < 0.05 was considered to indicate a significant difference.


  Results Top


Effects of perinatal complications on coagulation function in perinatal women

As shown in [Table 1], no significant differences were found in PT, APTT, FIB, and TT in pregnant women with GBS, positive NST, scarred uterus, macrosomia, gestational hypertension, gestational diabetes, PROMs, and oligohydramnios. Significantly changed values of PT, APTT, and TT and decreased coagulation function were observed in pregnant women with prenatal fever. The results also showed significantly increased TT, indicating that threatened abortion affected the coagulation function of pregnant women.
Table 1: Coagulation function in perinatal women with different pregnancy complications

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Logistic regression analysis for the risk of coagulation dysfunction

As shown in [Table 2], prenatal fever was a risk factor for reduced PT (odds ratio [OR] = 1.07), reduced APTT (OR = 1.93), and prolonged TT (OR = 1.32), whereas threatened abortion was a risk factor for prolonged TT (OR = 1.52). These differences were statistically significant (P < 0.05).
Table 2: Logistic regression analysis for the risk of coagulation dysfunction

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  Discussion Top


Pregnancy is characterized by hypercoagulation with increasing levels of coagulation factors and suppression of fibrinolysis.[15] This state of hypercoagulation during pregnancy results in differences in the standards for routine coagulation tests from those used in the nonpregnant population.[16],[17],[18] Moreover, a higher incidence and greater categories of perinatal complications could be observed in pregnant women. The effects of these perinatal complications on the coagulation function of pregnant women are rarely reported. In the present study, we included pregnant women with or without perinatal complications to investigate the effects of different complications on the coagulation function. No significant difference was found in the PT, APTT, FIB, and TT in pregnant women with GBS, positive NST, scarred uterus, macrosomia, gestational hypertension, gestational diabetes, PROMs, and oligohydramnios. Moreover, significantly decreased PT and APTT and significantly increased TT were found in pregnant women with prenatal fever compared to the normal controls, whereas significantly increased TT was also observed in those with threatened abortion.

The routine coagulation parameters usually include PT, prothrombin activity, APTT, FIB, antithrombin, platelet count, mean platelet volume, platelet distribution width, plateletcrit, and others.[19],[20] In this study, we used four classic coagulation indicators to perform the analysis. Moreover, it has been reported that drastic changes of coagulation indicators occur during the third trimester.[15] Therefore, in the present study, we selected women with a duration of pregnancy between 30 weeks + 2 days and 40 weeks + 21 days as subjects.

Maternal fever is common in pregnancy. In the United States, 20% of pregnant women report 1 or more episodes of fever.[21] Fever episodes during pregnancy have been linked to severe brain damage and structural anomalies.[22],[23] Coagulation function changes may serve as early indicators for these structural anomalies. In our study, we observed significantly decreased PT and APTT and significantly increased TT in pregnant women with prenatal fever. Certain treatment should be applied in those patients to avoid possible severe consequences such as autism spectrum disorders.[24]

Vaginal bleeding during pregnancy occurs in about 20%–25% of known pregnancies, whereas threatened abortion is a common problem encountered in the evaluation of those presenting with vaginal bleeding.[25] Because of bleeding complication, it is reasonable to obtain significantly increased TT in pregnant women with threatened abortion.

The present study also has some limitations. First, a limited number of subjects were included, which could result in bias in the calculation of coagulation function results. Second, we did not examine the platelet count and function, which are considered to be involved in the coagulation function of the body. Therefore, further studies with more subjects and evaluating platelet count and platelet function are needed to confirm our results.

In conclusion, among the complications that occur in pregnant women, prenatal fever and threatened abortion have important effects on coagulation function.

Financial support and sponsorship

This work was financially supported by the Chinese National Nature Sciences Foundation (grant nos. 81471416 and 81771524).

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2]



 

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