Effect of blood loss during caesarean section on coagulation parameters.

Autor: Wasserloos A; University Clinic for Gynaecology and Obstetrics, RWTH Aachen, Germany., Thomassen MCLGD; Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands., Costa SD; Women's Hospital, Otto-von-Guericke University, Magdeburg, Germany., Zenclussen A; Experimental Obstetrics and Gynecology, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany., Tchaikovski V; Academic Teaching Hospital of RWTH Aachen University, Rhein-Maas Clinic, Germany., Hackeng TM; Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, the Netherlands., Stickeler E; University Clinic for Gynaecology and Obstetrics, RWTH Aachen, Germany., Tchaikovski SN; University Clinic for Gynaecology and Obstetrics, RWTH Aachen, Germany. Electronic address: stchaikovski@ukaachen.de.
Jazyk: angličtina
Zdroj: Thrombosis research [Thromb Res] 2021 Jun; Vol. 202, pp. 84-89. Date of Electronic Publication: 2021 Mar 21.
DOI: 10.1016/j.thromres.2021.03.010
Abstrakt: Introduction: Venous thrombosis is the leading cause of pregnancy-related maternal morbidity and mortality. The thrombosis risk is increased by caesarean section and blood loss, though underlying mechanisms of these prothrombotic changes remain unknown.
Materials and Methods: This prospective study recruited 50 pregnant women at term undergoing elective caesarean section at University Hospital Magdeburg, Germany. Blood loss during surgery was correlated with the changes in total protein S, full length TFPI (TFPI fl ), prothrombin, the endogenous thrombin potential (ETP) and resistance to activated protein C (APCsr) determined via calibrated automated thrombography.
Results: Mean blood loss was 506 ml (95%CI: 456 to 557 ml). Total protein S was 0.63 (95%CI: 0.60 to 0.67) U/ml preoperatively, decreased by 14.8% after caesarean section and almost normalised five days later. TFPI fl was 0.47 (95%CI: 0.41 to 0.53) U/ml before, remained unchanged immediately after and increased by 11.5% five days after surgery. Prothormbin was 1.10 (95%CI: 1.03 to 1.16) U/ml preoperatively, reduced by 10.4% immediately after and increased again five days after caesarean section, exceeding the preoperative values by 4.4% (-0.7 to 9.6). The ETP decreased by 3.9%, whereas the APCsr increased by 37.0% immediately after caesarean section. The changes in total protein S, prothrombin, thrombin generation and APC resistance showed a trend to be more pronounced in the subgroups with higher blood loss.
Discussion: Moderate blood loss during caesarean section hardly reduces thrombin generation but aggravates pregnancy-induced APC resistance and combined deficiency of TFPI and protein S, which can account for the increased thrombosis risk in early puerperium.
(Copyright © 2021 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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