COAGULATION ACTIVITY AND POTENTIAL MODULATING FACTORS IN VAGINAL AND CESAREAN DELIVERY - PURPOSE

Purpose: To estimate the risk of thrombosis, we determined in this stu dy the degree and time course of thrombin formation and fibrinolysis i n women undergoing vaginal delivery or Caesarean section. The patient' s history, obstetric risk factors and APC resistance were evaluated. P atients and methods: 96 women were included in the study, 75 with vagi nal labour and 21 with primary or secondary Caesarean section. At five time points during delivery and puerperium we determined the plasma c oncentration prothrombin activation fragments F1 and FZ as marker of c oagulation activity and D-Dimers as markers for fibrinolysis. Results: We found a high turnover of coagulation factors in all women. Uterine contracitons during cervical dilatation increased F1 and FZ levels mo re than the D-Dimer concentration, indicating that they were sufficien t to activate clotting. A further increase of prothrombin fragments fo llowed by D-Dimers was seen during detachment of the placenta. D-Dimer levels reached a maximum two hours post partum. All parameters analys ed were back on baseline two days after delivery. Surprisingly, thromb in formation was less in women with Caesarean section that in patients with vaginal delivery, while the extent of fibrinolysis was lower in the latter group. Premature rupture of membranes decreased F1 and FZ l evels and caused a light increase of the D-Dimer concentration. Parity had no influence on either variable. In patients with prolonged place ntal separation the degree of coagulation was reduced and fibrinolysis was activated. Women with insufficient anticoagulant response of plas ma to activated protein C were found to have low baseline F1 and FZ le vels that increased after delivery, while the D-Dimer concentration wa s elevated at all time points. Conclusion: Coagulation is activated du ring childbirth. Caesarean section is associated with increased fibrin olysis as compared to vaginal delivery. Our data emphasises the import ance of mobilisation as soon as possible after both vaginal and Caesar ean delivery to avoid thrombosis or embolism.