Jordi Bellart

Tissue factor levels and high ratio of fibrinopeptide A:D-dimer as a measure of endothelial procoagulant disorder in pre-eclampsia

To assess coagulation activation and endothelial cell injury in normotensive and pre‐eclamptic pregnant women, a comparision was made of plama levels of tissue factor, fibronectin, fibrinopeptide A and D‐dimer. Samples were taken from 50 nonpregnant women, 40 normotensive pregnant women in the third trimester and 27 women with pre‐eclampsia after diagnosis and before treatment. High levels of fibrinopeptide A and D‐dimer were found in pre‐eclampsia women. Moreover, the ratio fibrinopeptide A:D‐dimer was much greater in the pre‐eclampsia group than in normotensive pregnant women. The levels of fibronectin and tissue factor were also higher in the pre‐eclampsia group. The increase of tissue factor levels suggests an alteration of the extrinsir coagulation pathway in pre‐eclampsia. The increase of fibrinopeptide A:D dimer ratio shows that the activation of coagulation is associated with a relative hypofibrinolysis in pre‐eclampsia.

Endothelial cell markers and fibrinopeptide A to D-dimer ratio as a measure of coagulation and fibrinolysis balance in normal pregnancy

Objective: Changes in hemostatic system were evaluated in healthy pregnant women. Methods: Blood was sampled in the 1st, 2nd and 3rd trimesters of gestation, during delivery and 3 days postpartum and plasma factors were measured using commercial tests. Results: Thrombin-antithrombin III complexes, fibrinopeptide A and D-dimer were higher during pregnancy. The endothelial cell markers, fibronectin and tissue factor, remained within the normal reference values in the healthy nonpregnant population. This result suggests no endothelial injury and shows no activation of extrinsic coagulation pathway during pregnancy. The balance coagulation/fibrinolysy is maintained during pregnancy and delivery, as shown by the ratio fibrinopeptide A/D-dimer, however, a tendency towards coagulation process is developed in the early puerperium.

Fibrinolysis changes in normal pregnancy.

The aim of this study was to evaluate the changes in fibrinolysis parameters during pregnancy. Normal pregnant women (n = 60) formed the study population. Blood samples were taken in the first, second and third trimester, during delivery and three days after delivery. Fibrinolysis parameters were estimated using commercial tests. Tissue plasminogen activator, D-dimer and plasminogen activator inhibitors (PAI-1 and PAI-2) were determined. Tissue plasminogen activator and D-dimer increased after the first trimester and reached maximum levels during delivery. Plasminogen activator inhibitors type 1 and type 2 were also higher, in particular PAI-2, and reached maximum levels in the third trimester. On the third day after delivery, fibrinolysis activity recovered, but D-dimer and PAI-2 levels remained above the normal non-pregnant range.

Diagnosis and treatment in utero of goiter with hypothyroidism caused by iodide overload

A fetal goiter was detected by ultrasonography in a woman receiving potassium iodide. After this medication was discontinued at 29 weeks, a fetal hypothyroidism was confirmed by cordocentesis, and two doses of levothyroxine were administered by amniocentesis. At 34 weeks repeated cordocentesis showed fetal euthyroidism and ultrasonography shrinkage of the goiter. Growth and development normal at 1 year.

Endothelial Cell Lesion in Preeclampsia

Morphofunctional study of umbilical cords from pregnancies complicated by preeclampsia shows both activation and lesion of endothelium. The cellular findings in umbilical cords from pregnancies complicated by preeclampsia can be summarized as: (i) higher number of cells with secretion bladders and increase in the number and size of both secretion bladders and microvilli-like protrusions; (ii) increase in collagen, fibrin, fibronectin and lipidic vesicles in the vessel wall; (iii) vacuolization of endothelial cells; (iv) presence of lipidic vacuoles and lipophages in the vessel wall; (v) erosion and disorganisation of the endothelium that exposes extracellular proteins to the blood flow. Endothelial cell cultures from preeclamptic pregnancies show kinetic disorders and cell detachment. The results confirm that an endothelial cell lesion occurs in preeclampsia and this cellular disorder can be reproduced in vitro.

Long-term hospitalization and ß-mimetic therapy in the treatment of intrauterine growth retardation of unknown etiology

A group of 98 third trimester pregnant women whose ultrasonographic studies raised the suspicion of intrauterine fetal growth retardation was studied. The patients were randomly assigned to two groups: Group A (Treatment group: 44 patients) and Group B (Control group: 54 patients). All patients were admitted to the hospital upon diagnosis for baseline evaluation. Those in Group A remained in the hospital until delivery (mean stay 15 +/- 5 days) and received treatment with 10 mg/t.i.d. of p.o. ritodrine. Group B patients were discharged after an average stay of 7 +/- 3 days. This group was not treated with ritodrine, and they were seen weekly in an outpatient setting. The prevalence of low-birth-weight infants for their gestational age was 47.73% in the treatment group and 40.74% in the control group. Of the deliveries in the treatment group, 40.9% were induced (half for fetal indications). In the control group 35.18% of the induced labors was (47.35% for fetal indications). Of the cases in the treatment group 18.18% were delivered by cesarean section, of which 62.5% were performed for fetal distress. The control group showed similar figures: 16.66% cesarean sections with 77.7% of them done for fetal distress. We observed an incidence of 20.45% of acute fetal distress in the study group against 12.96% in the control group. Such a difference is not statistically significant. The group under study demonstrated a rate of 6.82% pathological pH value in the umbilical artery, while the rate of abnormal values in the control group was 18.52%. In both groups, the greatest percentage of acidotic pH was observed in patients with IGR.(ABSTRACT TRUNCATED AT 250 WORDS)

Coagulation and Fibrinolysis Parameters in Normal and in Hypertensive Pregnancies

Objective: To evaluate the plasma levels of coagulation and fibrinolysis parameters in the third trimester of gestation and on the third day after delivery.Methods: Normal pregnant women (n = 65), pregnant women with essential hypertension (n = 10), pregnant women with gestational hypertension without proteinuria (n = 13), and pregnant women with preeclampsia (n = 12) formed the study population. Coagulation and fibrinolysis parameters were estimated using commercial tests. Antithrombin III, thrombin-antithrombin III complexes, heparin cofactor II (HCII), protein C, protein S, tissue plasminogen activator, D-dimer, and plasminogen activator inhibitors levels in uncomplicated pregnancies and in hypertensive pregnancies were determined.Results: No differences were found in coagulation inhibitor levels between normal, chronic essential hypertension, and gestational hypertension groups. However, preeclamptic women showed lower levels of antithrombin III and heparin cofactor II. The concentration of thrombin-a...