A rapid test for abruptio placentae: evaluation of a D-dimer latex agglutination slide test

The predictive value of pre-delivery laboratory test results for the severity of placental abruption and pregnancy outcome

INTRODUCTION

To analyze the relationship between placental abruption severity and maternal pregnancy outcome and to explore the predictive value of pre-delivery laboratory test results for the severity of placental abruption.

METHODS

The clinical datas of 126 patients with placental abruption diagnosed and treated in our hospital over the past 4 years were retrospectively analyzed. The severity of placental abruption was divided into degrees I to III. The pre-delivery laboratory results of all patients and data on maternal and fetal delivery outcomes were collected.

RESULTS

The analysis of maternal outcomes showed that the volumes of antepartum, intrapartum and postpartum hemorrhage and the rates of utero-placental apoplexy, uterine compression sutures and vascular embolization significantly increased with increasing placental abruption severity. Fetal delivery data revealed that 1- and 5-min Apgar scores decreased significantly with increasing placental abruption severity. Pre-delivery laboratory findings suggest that the white blood cell count, hemoglobin, hematocrit, platelet count, albumin, aspartate aminotransferase (AST), creatinine, prothrombin time (PT), prothrombin activity, prothrombin time - international standardization ratio (INR), D-dimer, fibrinogen (FIB), and fibrin degradation products (FDP) changed significantly with increasing placental abruption severity. Further analysis by Spearman and Pearson correlation found that the pre-delivery volume of antepartum hemorrhage, D-dimer, FDP and other indicators were correlated with placental abruption severity.

CONCLUSIONS

The harm of placental abruption to pregnant women and neonates increases with increasing abruption severity. Some laboratory test results can be predictors of placental abruption degree.

Trauma in pregnancy: anatomical and physiological considerations

Management of a pregnant trauma victim is a relatively rare but stressful event, not least due to the need to consider two patients. Initial management by a trauma team should follow a structured approach applicable to all trauma patients, combined with knowledge of the specific problems encountered in pregnancy. This review outlines important anatomical and physiological changes that occur during pregnancy and their relevance to initial assessment and treatment. It discusses the epidemiology of trauma in pregnancy, the presentation and manage ment of specific problems and the methods of fetal assessment.

D-dimer concentration outliers are not rare in at-term pregnant women

OBJECTIVES

To determine the D-dimer levels in pregnant women at term and the differences between pregnant women with different D-dimer levels.

DESIGN AND METHODS

The plasma D-dimer concentrations in pregnant women at term were identified in a cross-sectional study. The clinical indicators that are potentially relevant to D-dimer levels were compared between the pregnant women with different D-dimer levels (i.e., normal, mildly increased, and severely increased).

RESULTS

There were always some D-dimer concentration outliers in the pregnant women at term regardless of the presence or absence of complications, and there were no significant differences in maternal age, gestational age, gravidity, parity, blood count, blood coagulation, or liver function between the pregnant women with different D-dimer levels.

CONCLUSIONS

D-dimer levels may vary significantly during pregnancy for unknown reasons. This variation, particularly in pregnant women at term, might lead to questionable diagnostic information regarding coagulation.

Retrospective study of risk factors and maternal and fetal outcome in patients with abruptio placentae

Introduction:

Abruptio placentae (AP) which is a major cause of maternal morbidity and perinatal mortality globally is of serious concern in the developing world. We retrospectively analyzed the AP cases and evaluated its impact on fetal and maternal outcomes.

Materials and Methods:

The present study was undertaken from September 2007-August 2009 at a tertiary care center attached to medical college; patients of AP were selected from all cases with minimum of 28 weeks of gestation, presenting with antepartum hemorrhage. Patients underwent complete obstetrical investigations and were managed according to maternal and fetal condition.

Results:

4.4% incidence rate of AP was documented accounting for 318 cases during the study period. Most of cases were unbooked, with an average age of 34.5 years (range, 18-44) and nearly two-third of the patients were from lower socioeconomic class. Anemia was observed in 96% of patients, with 3.5 and 68% incidence of maternal and fetal mortality, respectively.

Conclusion:

We observed a higher than expected frequency of AP and neonatal mortality in our study population, which is of major concern. We envisage need for mass information regarding the importance of antenatal maternal care and improvement in nutritional status, which may reduce the frequency of maternal and fetal morbidity and mortality associated with AP.

[Abruptio placentae]

Retroplacental haematoma (RPH) is a complication affecting 0.25 to 0.4% of all pregnancies and 4% of severe PEs. It is of acute onset, usually unpredictable and its symptoms are not specific: Isolated metrorrhagia, foetal distress, uterine hypertonicity. Clinical, biological and sonographic features suggesting a RPH can be early or late. Haemoconcentration and the forming of notches on Doppler examination of the uterus can appear weeks before the event, whereas raised D-Dimers and foetal tachycardia are identified within days of the event. Although Caesarian section reduces the perinatal death rate by 20 to 50% in a setting of RPH with a live foetus, vaginal delivery is indicated in cases of RPH with fetal demise, following the control of haemorrhagic shock, clotting disorders and uterine hypotonicity.

D-Dimer Testing in Pregnancy

During pregnancy, elevated markers of coagulation and fibrinolytic system activation, such as D-Dimer, indicate increased thrombin activity and increased fibrinolysis following fibrin formation. Testing for D-Dimer during pregnancy could therefore be useful for the diagnosis and prediction of a venous thromboembolic event (VTE) or pregnancy-related complications, and for monitoring antithrombotic treatment. This approach, however, is hampered by the fact that even an uncomplicated pregnancy in healthy women is accompanied by a substantial increase of D-Dimer. Thus, prior to clinical application reference values of D-Dimer according to gestational age need to be established. A substantial increase of D-Dimer during pregnancy is seen despite thromboprophylaxis with low molecular weight heparin (LMWH) indicating that further studies are needed to evaluate monitoring of LMWH during pregnancy and to investigate the optimal beginning and dose of LMWH thromboprophylaxis in pregnant women.

Trauma in pregnancy

Over the past 60 years, trauma has become the leading cause of morbidity and mortality in the pregnant patient. The emotional and physiological challenges of treating two patients simultaneously adds to an already stressful situation. Resuscitation of the pregnant trauma patient is discussed from the prehospital setting to disposition. Also discussed are non-invasive monitoring tools, such as tocodynanomometry and ultrasonography.

Pooled patient samples as reference material for D-Dimer

A low-D-Dimer concentration has a high negative predictive value for thromboembolic events. Actual and proposed applications include exclusion diagnosis of DIC, DVT and pulmonary embolism (1-7), follow up of cancer therapy (8) and diagnosis of abruptio placentae(9). A variety of tests are commercially available. Unfortunately, due to differences in standardization protocols, the cut-off normal/pathological of one test can usually not be used for another(10). As was shown by Nieuwenhuizen, one way to at least reduce these discrepancies is to use patient material as a reference(11). We have used this approach to standardize the latex test Tinaquant a D-Dimer against the ELISA test Asserachrom D-Dimer.