HEMOSTASIS IN THE UTEROPLACENTAL AND PERIPHERAL CIRCULATIONS IN NORMOTENSIVE AND PREECLAMPTIC PREGNANCIES

OBJECTIVE: Our purpose was to determine the hemostatic changes in the uteroplacental and peripheral circulations in normotensive and pre-ecl amptic pregnancies. STUDY DESIGN: This prospective, observational stud y involved 2 patient groups. Group 1 consisted of 30 normotensive wome n and 22 women with pre-eclampsia who were followed up longitudinally through pregnancy and post partum, Group 2 consisted of 20 women with established pre-eclampsia and 19 normotensive control subjects, all un dergoing cesarean section. Plasma levels of thrombin-antithrombin III complex, soluble fibrin, plasmin-alpha(2)-antiplasmin complex, and fib rin-degradation product (D-dimer) were measured in blood drawn from th e antecubital vein (group 1) and from both the antecubital and uterine veins (group 2). Data were analyzed by analysis of variance. RESULTS: In group 1 levels of thrombin-antithrombin ill complex, soluble fibri n, and fibrin-degradation product were significantly higher during nor mal pregnancy than at 6 weeks post partum. Plasmin-alpha(2)-antiplasmi n complex levels did not change. No differences between the pre-eclamp tic and normotensive pregnancy groups were found for any of the hemost atic markers. In group 2 normotensive women undergoing cesarean sectio n, thrombin-antithrombin III complex and soluble fibrin levels were si gnificantly higher in the uterine Vein than in the antecubital vein. I n group 2 women with pre-eclampsia, thrombin-antithrombin III complex and fibrin-degradation product levels were significantly higher in the uterine vein than in the antecubital vein. In addition, plasmin-alpha (2)-antiplasmin complex and fibrin-degradation product levels were hig her and soluble fibrin levels were lower in the uterine vein in the pr e-eclamptic group than in the normotensive group. CONCLUSION: Both the coagulation and fibrinolytic systems are activated during normal preg nancy. Activation of these systems is more marked in the uteroplacenta l circulation than in the systemic circulation in bath normotensive an d pre-eclamptic pregnancies. An abnormal pattern of hemostasis occurs in the uteroplacental circulation in pre-eclampsia.