Introduction: Obstetric haemorrhage (OH) is a major cause of maternal mortality and morbidity worldwide. Appropriate management requires understanding of normal peripartum haemostatic changes during labour, and yet there are few studies.

Aim: In this pilot study we aimed to evaluate peripartum haemostatic changes in healthy women.

Methods: We collected blood samples from 20 women peripartum, into 0.102 M trisodium citrate tubes (ratio9:1) (Becton Dickinson) from the antecubital fossa using flawless venepuncture at the following time-points:

  1. antepartum;

  2. after delivery of the placenta;

  3. 24hrs post-partum and

  4. 48hrs post-partum.

Plasma was aliquoted and stored in −70°C until the following ELIZA assays were performed: D-Dimer levels (Dade Behring, Sysmex UK), prothrombin fragments 1+ 2 (PF 1+2) (Dade Behring, Sysmex, UK) and tissue plasminogen activator antigen (t-PA:Ag) (Biopool, Trinity Biotech, UK). Prothrombin time (PT) (PT-Fib HS), activated partial thromboplastin time (APTT) (APTT micronized silica) and clauss fibrinogen (Fib-C), reagents were from Instrumentation Laboratories Ltd UK. Statistical analysis was performed using XLSTAT 2008.

Results: The median (range) age was 28 (19–36) years and the body mass index (BMI) 28.9 (21.7– 35.3).

Table 1: To show the median (range) for the haemostatic assays

Assay (normal ranges)D-dimers (4–52ug/l)PF1+2 (0.2–1.2 pmol/l)t-PA:Ag: 3–11 ng/ml)PT (12–16s)APTT (26–38s)Fibrinogen (1.52–4.12 g/l)
* p<0.05 using the Mann Whitney U test between the 1st and each of the other three samples 
Antepartum 231 (122–900) 570 (352–1533 12 (7.2–23) 12 (10–14) 31 (24–36) 5.2 (3.1–8.7) 
Post Labour 482 (117–1044) 968 (480–1858)* 18 (8.6–40.6)* 13 (10–15) 30 (24–36) 5.3 (2.2–9.8) 
24h 309 (65–931) 568 (264–1080)* 7 (4–23)* 13 (10–16)* 33 (27–41)* 5.3 (4–11) 
48hrs 235 (85–614) 648 (371–2287) 7 (3–18)* 12 (10–16) 31 (23–43) 5.7 (3.5–11) 
Assay (normal ranges)D-dimers (4–52ug/l)PF1+2 (0.2–1.2 pmol/l)t-PA:Ag: 3–11 ng/ml)PT (12–16s)APTT (26–38s)Fibrinogen (1.52–4.12 g/l)
* p<0.05 using the Mann Whitney U test between the 1st and each of the other three samples 
Antepartum 231 (122–900) 570 (352–1533 12 (7.2–23) 12 (10–14) 31 (24–36) 5.2 (3.1–8.7) 
Post Labour 482 (117–1044) 968 (480–1858)* 18 (8.6–40.6)* 13 (10–15) 30 (24–36) 5.3 (2.2–9.8) 
24h 309 (65–931) 568 (264–1080)* 7 (4–23)* 13 (10–16)* 33 (27–41)* 5.3 (4–11) 
48hrs 235 (85–614) 648 (371–2287) 7 (3–18)* 12 (10–16) 31 (23–43) 5.7 (3.5–11) 
View Large

Conclusion: These findings demonstrate that peripartum haemostasis is prothrombotic with shortened PT, APTT and prolonged fibrinogen. There is increased thrombin generation and fibrinolytic activity. t-PA antigen is most notably elevated immediately post delivery.

Topics:
hemostatics, activated partial thromboplastin time measurement, alteplase, fibrinogen, antigens, fibrin fragment d substance, bleeding in pregnancy, citrates, fibrinolytic agents, hemostasis procedures

Disclosures: No relevant conflicts of interest to declare.

Author notes

Corresponding author

2008, The American Society of Hematology
2008
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