FIBRINOLYSIS AFTER DELIVERY - CESAREAN-SECTION VERSUS VAGINAL DELIVERY

Caesarean section is associated with higher risk of thromboembolism th an normal vaginal delivery. In order to elucidate if altered fibrinoly sis contributes to this increased risk, 15 women who delivered by Caes arean section were observed in the 37th to 40th week of pregnancy, 1 h , 3 and 10 days after delivery and compared to 15 women who delivered vaginally. Before delivery no differences in fibrinolytic variables we re observed between the two groups. The immediate post-delivery period was associated with significant (all p<0.05) and similar increases in tissue-type plasminogen activator (t-PA) activity (149 vs 129%, all f igures: Caesarean section vs vaginal delivery) and t-PA antigen (46 vs 75%) and significant (all p<0.05) decreases in plasminogen activator inhibitor (PAI) activity (66 vs 69%) and PAI-1 antigen (74 vs 82%) in both groups. Only euglobulin activity was less enhanced (60 vs 159% in crease, p<0.05). Three days after delivery all variables, except PAI a ctivity, decreased significantly (all p<0.05) compared to values 1 h a fter delivery (t-PA activity: 37 vs 41%; t-PA antigen: 43 vs 51%; PAI- 1 antigen: 80 vs 58%) and similarly in both groups. From the 3rd to th e 10th day euglobulin activity, t-PA activity and t-PA antigen slightl y increased. The venous occlusion test, which was performed before del ivery, 3 and 10 days after delivery revealed no significant difference s in fibrinolytic responses to such stimulation between the two groups investigated. It was concluded that changes in t-PA and PAI-1 observe d after Caesarean section are not significantly different from those o bserved after normal vaginal delivery and therefore presumable do not contribute to increased risk of thromboembolism after Caesarean sectio n.