Intravascular coagulation during pregnancy and the puerperium

Vaginal vein thrombosis in pregnancy

Vaginal vein thrombosis in a pregnant woman is reported. This entity should be differentiated from vaginal arteriovenous fistula which may cause severe antepartum, intrapartum and post-partum haemorrhage. The humoral and mechanical factors which favour the occurrence of varicosities and thrombosis are briefly described. Surgical management is suggested as being both simple and effective.

The maternal autopsy

Careful study of reports prepared for the Confidential Enquiries into Maternal Deaths in England and Wales has made it clear that many maternal autopsy reports are not as informative as they might be. This is, in part at least, because no pathologist who does not work in a maternity unit can expect to see more than a handful of such deaths in a working lifetime. This paper describes briefly the particular features to look for at autopsy, stresses the importance of taking adequate material for histology and discusses some of the more significant histological findings, both of conditions which cause death and of those commonly associated with it.

Viral hepatitis complicating pregnancy: mortality trends in Saudi Arabia

The striking mortality in viral hepatitis associated with pregnancy, regularly observed in developing countries, has shown a significant decrease in Saudi Arabia during a period of unprecedented economic growth. However, the risk of fatal hepatitis in the pregnant Saudi woman remains approximately four times that for the nonpregnant woman. The explanation for the observed mortality trend is not apparent, but is unlikely to be the result of improved nutritional status of the population alone, or because of treatment of severe hepatitis with adrenal corticosteroids. Disseminated intravascular coagulation may be one factor that decisively influences the outcome of hepatitis in the pregnant woman.

Conditions for collection of serum samples for the measurement of fibrin(ogen) degradation products by radioimmunoassay of fragment E

A number of conditions have been assessed for the collection of serum samples for the measurement of fibrin(ogen) degradation products using a radioimmunoassay for degradation fragment E, which permits precise quantitation of differences. Blood should be collected using minimal venous occlusion into glass tubes containing 10 mg/ml of epsilon amino caproic acid and allowed to clot at 4 to 20 degrees C for at least 4 hours before centrifugation. The serum may be stored at 4 or -20 degrees C. Samples from patients receiving anticoagulant therapy should be treated with 10 IU of thrombin per ml.

Soluble fibrinogen/fibrin complexes in pre-eclampsia

Significantly increased concentrations of soluble fibrinogen/fibrin complexes were found in plasma samples from ten normal pregnant women when compared with ten non-pregnant age-matched controls. In ten women with pre-eclampsia mean soluble complex concentration was more than three times that in the age, parity, and gestation matched pregnant controls. Soluble fibrinogen/fibrin complexes are also found in the plasma of patients in various hypercoagulable and thrombotic states, including disseminated intravascular coagulation. These findings provide additional evidence that pre-eclampsia is associated with disseminated intravascular coagulation.

Intravascular coagulation in obstetrics: Serial dilution protamine sulfate test throughout labor

Serial dilution protamine sulfate tests (SDPS) were performed in 191 women during labor. It was found that 27 per cent of women with uncomplicated pregnancies and 42 per cent with complicated pregnancies had positive SDPS tests, the highest incidence being between three and six hours of labor. These findings support the previous report of a physiologic disseminated intravascular coagulation in pregnancy but make the SDPS test of little value in obstetric cases.

Circulating levels of fibrin/fibrinogen degradation fragment E in normal pregnancy, and in association with intrauterine growth retardation and perinatal asphyxia

Levels of fibrin/fibrinogen degradation products have been measured by aspecific and sensitive radioimmunoassay for degradation fragment E (FgE) in pregnant patients. Maternal FgE levels rose from the 16th week reaching a plateau at the 36th week in normal pregnancy. There was no correlation between maternal FgE levels and maternal age, parity or the occurrence of perinatal asphyxia. A minority of patients (5 per cent) with evidence of intrauterine growth retardation showed prolonged elevation of FgE levels.