1. Shortened Coagulation profile in Pregnancy - A Comparative analysis in different trimesters: Retrospective study from a tertiary care centre
Bhavika Rishi, Sarika Singh, Sunita Sharma
Department of Pathology, Lady Hardinge Medical College
Introduction
Coagulation system undergoes significant change during pregnancy
These changes in blood coagulation create a state of hypercoagulability by increasing majority of the clotting factors and this is reflected by shortened PT and aPTT. This phenomenon, probably due to hormonal changes, protects from fatal hemorrhage during delivery but predisposes to thromboembolism
Prothrombin time (PT) and activated partial thromboplastin time (aPTT) are coagulation tests used to assess coagulation
Aims and Objectives
Current study was undertaken to find the incidence of shortened coagulation profile in pregnant women. A comparison between different trimesters of pregnancy and during labour was made
Materials and Methods
A retrospective study over a period of 1 month
The cohort population consisted of 163 pregnant women, who were categorized according to different trimesters of pregnancy and for whom PT and aPTT was assessed using the ACL Elite Pro coagulation analyzer
The controls for PT and for aPTT were taken as 11.0 and 29.0 seconds respectively. Shortened PT was taken as 9.5 seconds and aPTT as 25.5 seconds
Results
Our study confirms a state of hypercoagulability in pregnancy
124 patients had a shortened coagulation profile
Further analysis of clinical outcomes showed patients who had shortened aPTT in 3rd trimester and during labour had an association with pre eclampsia and premature rupture of membranes in 28.5% and 60% of the cases respectively. A
Number of patients
Discussion
PT and aPTT - global coagulation tests used to assess the coagulation system
Hypercoaguable state in pregnancy predisposes to VTE, PE, pre eclampsia, recurrent fetal loss and placental abruption
Shortened coagulation profile prevents excessive bleeding during pregnancy but at the same time increases chances of thrombosis
Studies have shown that a shorter aPTT in women with preterm delivery could be due to the slightly elevated levels of VWF antigen and factor VIII activity
Careful monitering of patients with shortened aPTT can reduce associated morbidity and mortality and at the same time allow risk stratification of these patients
Further studies with larger cohorts and other coagulation markers are required to predict clinical outcomes in pregnant women with shortened coagulation profiles
Conclusion
Our study shows significantly lower values of PT and APTT during 3rd trimester and labour when chances of bleeding are highest, also a relation between shortened aPTT and PROM and pre eclampsia was seen.. Further studies with larger cohorts and other coagulation markers are required to predict clinical outcomes in pregnant women with shortened coagulation profiles
REFERENCES
Short Activated Partial Thromboplastin Times Are Related to Increased Thrombin Generation and an Increased Risk for Thromboembolism , Wolfgang Korte, et al Am J Clin Pathol 2000;113
The coagulation profile of preterm delivery, Anat Keren-Politansky et al. Thrombosis Research 2014;33
Thrombophilia, pre eclampsia and other pregnancy complications, Vucic et al Acta MedCrroatica 2009:Oct; 63(4)