Involvement of fibrinolytic factors in mid trimester amniotic fluid with development of severe early-onset preeclampsia

Impaired placental development is a well-known pathogenesis in preeclampsia , The present study was undertaken to elucidate the involvement of fibrinol ytic factors in amniotic fluid in, midtrimester with development of severe early-onset preeclampsia. Amniotic fluid was obtained by amniocentesis at 1 5 to 18 weeks of gestation. All specimens were retrospectively identified a ccording to the hospital records as coming from gestations that later had s evere early-onset preeclampsia (severe preeclamptic group, n = 9) or gestat ions with normal outcomes (control group, n = 73), Fibrinolytic factors suc h as tissue plasminogen activator (t-PA), plasminogen activator inhibitor t ype 1 (PAI-1), and t-PA-PAI-1 complex (PAI-C) of specimens were measured by enzyme-linked immunoassay, In the control group, concentrations of t-PA as well as PAI-1 in amniotic fluid remained at similar levels from 15 to 18 w eeks, although PAI-1 levels were more than 10 times higher compared with t- PA levels. Levels of t-PA and PAI-1 in the severe preeclamptic group were n ot different from those of the control group. PAI-C levels gradually decrea sed from 15 through 18 weeks of gestation in the control group. PAI-C level s of the severe preeclamptic group were significantly lower than those of t he control group (55.5 +/- 18.0% versus control; mean +/- standard deviatio n [SD], p <0.001). PAI-C, as the most specific indicator of the early stage of fibrinolytic activities, showed lower levels in midtrimester amniotic f luid in the severe preeclamptic group, suggesting fibrinolytic activities o f amniotic fluid may have a significant role in the development of severe e arly-onset preeclampsia via impaired placental development in the latent st age of preeclampsia.