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Defibrination in Normal and Abnormal Parturition
Author(s) -
Kleiner G. J.,
Merskey C.,
Johnson A. J.,
Markus W. B.
Publication year - 1970
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/j.1365-2141.1970.tb01614.x
Subject(s) - medicine , fibrinolysis , fibrinogen , caesarean section , obstetrics , pregnancy , gynecology , biology , genetics
S ummary Studies of blood coagulation and fibrinolysis in women undergoing uncomplicated single delivery showed a significant fall in plasma fibrinogen and factor VIII. The levels were lowest 1–4 hr postpartum and returned to pre‐existing or higher levels within 24 hr. A significant fall in fibrinogen also occurred in women with twin delivery or caesarean section without labour. Similar changes were noted in factors V and VIII. Fibrinolytic activity was markedly decreased during delivery but increased rapidly thereafter in women with a single birth or caesarean section without labour. In women with twin delivery, it remained low. No consistent changes in the level of fibrinolytic inhibitors or plasminogen were noted. Mean levels of fibrinolytic degradation products (FDP) were in the upper level of the normal range and increased in the first 1–4 hr postpartum. These changes were even more marked in twin delivery. In women with abruptio placentae or prolonged intrauterine death (IUD), levels of fibrinogen, factors V and VIII and blood platelets were markedly reduced and generally dropped even lower during the first 4 hr after delivery, returning within 24 hr to the levels found in nonpregnant women. Levels of plasminogen and factor X were also reduced. High levels of FDP were found during labour, returning within 24 or 48 hr to the range observed in women 24 hr after normal delivery. Immunodiffusion and immunoelectrophoresis of serum in agar gel disclosed abnormal double or split precipitin lines. Sequential changes in these precipitin lines pointed to a continuing process which started before delivery, reached a maximum shortly thereafter, disappearing within the next 10–24 hr. The changes found in early (vs. late) labour, or during uterine surgery not associated with pregnancy, did not uphold the supposition that similar changes observed during normal or abnormal parturition might be due to the stresses of labour or surgery. The findings reported herein suggest that a minor degree of physiological defibrination develops during normal labour which is qualitatively similar to, but of much lesser magnitude than, the pathological defibrination syndrome (with local lysis of fibrin) commonly associated with abruptio placentae or prolonged intrauterine death.