COAGULATION ACTIVATION MARKERS AND THROMBIN GENERATION TEST RESULTS IN COMPLICATED PREGNANCY
Premature abruption and placenta praevia are the leading causes of maternal mortality from bleeding. However, there is a lack of information on the hemostasis system state in these patients. Another dangerous pregnancy complication is preeclampsia. Despite the increased risk of venous thromboembolic complications preeclampsia is not an independent indication for antenatal thromboprophylaxis.The aim of the study was to determine the signi cance of brin monomer concentration and thrombin generation test measurement in group of pregnant women with preeclampsia, placenta praevia and placenta accreta.Materials and methods. The study included 204 women: group I - 86 pregnant women with preeclampsia; group II - 11 pregnant women with placenta praevia and placenta accrete (laboratory results are indicated for two time-points: group IIa - at 36-37 weeks of gestation and group IIb - within 24 hours after caesarean section); group III - control, 107 women with uncomplicated pregnancy during I (n=95) and II-III trimesters (n=12) of gestation. Routine blood clotting tests, brin monomer and D-dimer concentrations, as well as thrombin generation test parameters were measured.Results. An increase of the brin monomer and D-dimer concentration was found in groups I, IIa and IIb in comparison with group III. Thrombin generation test results in groups I, IIa and IIb were characterized by a signi cant proportion of pathological ndings. A correlation between the brin monomer level and the blood loss volume and with the risk of postpartum hemorrhage (r=0.70 and r=0.67, respectively; p <0.05) was found in group IIa. The brin monomer cut-o value for the prediction of postpartum hemorrhage development (AUC 0.893±0.118 (95% CI 0.567-0.996), p=0.001, sensitivity 75%, speci city 100%) was determined as8.25 μg/ml.Conclusion. Measurement of brin monomer concentration in the group of pregnant women with preeclampsia is a perspective approach for pregnancy outcomes improvement, also as for blood loss and postpartum hemorrhage prediction in the group of pregnant women with placenta praevia and placenta accreta. Thrombin generation test has advantages in clinical cases associated with necessity of comprehensive blood hemostatic potential assess.