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Minerva Ginecologica 2006 August;58(4):315-22


language: Italian

Haemocoagulative modifications correlated with pregnancy

Borrelli A. L., De Lucia D., Bernacchi M., Napolitano M., Di Domenico A., Felicetti M., Ferrara C., Meo D., Raffio R., Rivetti A., Sessa M., Tagliaferri A., Torella M.

1 Dipartimento di Ostetricia Ginecologia e Neonatologia Facoltà di Medicina e Chirurgia Seconda Università degli Studi di Napoli, Napoli 2 Dipartimento di Patologia Generale Facoltà di Medicina e Chirurgia Seconda Università degli Studi di Napoli, Napoli


Aim. The aim of this paper was to establish the physiologic changes in the coagulation and fibrinolytic systems during normal pregnancy.
Methods. One-hundred and twenty normal pregnant women were investigated in a longitudinal study involving 3 measurements: blood samples were collected at 12, 24 and 36 weeks of gestation and were assayed for prothrombin time, antithrombin III (ATIII) activity, protein C activity, protein S (PS) activity, prothrombin fragments 1+2, type 1 plasminogen activator inhibitor activity, tissue plasminogen activator antigen, plasminogen, activated protein C resistance, factors VII and VIII levels and D dimer. Student t-test, one way analysis of variance (ANOVA) and Fisher test were used for statistical analysis.
Results. Factor VII and factor VIII were always increased with respect to controls. Variance analysis showed a statistically significant reduction for anticoagulants (PS) and a rise for F1+2 and D dimer. With regard to fibrinolysis, there was an increase both for t-PA and PA1-1 during pregnancy. Moreover, the increased activity of factors of haemostasis was accompanied by an increase of activity and concentration of ATIII and acquired activated protein C resistance.
Conclusions. These findings suggest that normal pregnancy is associated with an hypercoagulable state, resulting into a moderate risk for thrombosis during the different trimesters of pregnancy. Also broad spectrum assays which measure a range of trombin/fibrin formation in serum have become an established mean to identify activation of blood coagulation and/or fibrinolysis. There is a considerable interest in the application of these assays to the diagnosis of other acquired hypercoagulable states; such as thrombophilia during pregnancy. From the viewpoint of coagulation/fibrinolysis changes, the follow-up of thrombophilia markers could be recommended when levels of coagulation parameters exceed the normal values during pregnancy.

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