Increased D-dimer levels in twin gestation

In normal pregnancy, the hemostatic balance is displaced toward hypercoagul ability. The elevation in plasma levels of coagulation factors VII, VIII, a nd X and fibrinogen and the increased concentrations of plasminogen activat or inhibitors [1,2] may predispose individuals to thromboembolism, especial ly near term [1,3]. Because human multifetal gestation requires still great er physiological alterations, the imbalance in hemostasis is further exagge rated. It has been suggested that the changes in the coagulation system nea r term may even mimic low-grade disseminated intravascular coagulopathy [4] . However, for the majority of women with multifetal gestation, the coagulo pathy observed in the laboratory is not clinically apparent [5]. Despite th e large body of research on the physiological adaptation to pregnancy, rela tively little is known of the biological adaptation in general and the hemo static changes in particular associated with multiple gestation. (C) 2000 E lsevier Science Ltd. All rights reserved.