Role of fibrin in a model of pregnancy toxemia in the rabbit

Sequential studies in pre-eclampsia using plasma fibrinogen chromatography

The technique of plasma fibrinogen chromatography was used to study sequential changes in coagulant and fibrinolytic activity in six patients with severe pre-eclampsia. Plasma soluble fibrinogen-fibrin complex and plasma fibrinogen-fibrin degradation product levels were measured as indices of coagulant and fibrinolytic activity respectively. Clinical deterioration antenatally was accompanied by increasing coagulant and decreasing fibrinolytic activity, while a more stable clinical picture was associated with steady coagulant and increasing fibrinolytic activity. Following delivery, a surge in fibrinolytic activity accompanied or preceded clinical recovery. The pattern of increased coagulant and diminished fibrinolytic activity would seem to favour the development of disseminated intravascular coagulation in these patients and it is possible that the balance between coagulant and fibrinolytic activity may influence the clinical course and outcome of the pregnancy.

Use of coagulation tests to predict the clinical progress of pre-eclampsia

The clinical manifestations of severe pre-eclampsia are normally separated from those of mild pre-eclampsia and normal pregnancy on arbitrary grounds. A clinical index, based on the increase in diastolic blood-pressure and the presence of proteinuria, was developed to reflect the spectrum of disease from mild to severe pre-eclampsia. This was related to a coagulation index based on the platelet-count, plasma-factor-VIII, and serum-fibrinolytic-degradation-products. The two indices were shown to be strongly correlated. All cases of perinatal death associated with pre-eclampsia had coagulation indices in the most severely abnormal range. These results suggest that intravascular coagulation is a highly characteristic feature of pre-eclampsia and that the coagulation index may be of value in monitoring the progress of the disease.

The functional role of intravascular coagulation renal disease

There is evidence of intravascular coagulation in accelerated hypertension and pre-eclamptic toxaemia, in all types of nephritis and in the haemolyticuraemia syndrome. The kidneys have a two-fold defence mechanism, namely mesangial cell phagocytosis and endothelial cell fibrinolytic activity. Intravascular coagulation occurs in all those types of shock that result in acute renal failure: more often than not the primary cause is endotoxinaemia.