Changes of Coagulation and Fibrinolytic Status Detected by Thromboelastography (TEG6s®) in Pregnancy, Labor, Early Postpartum, Postpartum Hemorrhage and Heparin Treatment for Perinatal Venous Thrombosis

The aims of this study are to evaluate coagulation and fibrinolytic features using TEG6s (R) in normal pregnant courses, in the early postpartum period and in cases with postpartum hemorrhage (PPH) caused by uterine atony. We also analyze cases with deep venous thrombosis (DVT) and/or pulmonary embolism (PE) under treatment with unfractionated heparin. The non-pregnant women (n = 13) and healthy pregnant women (at 9-13 weeks of gestation (n = 13), at 27-30 weeks of gestation (n = 14), at 35-38 weeks of gestation (n = 14)) were cross-sectionally studied, while the normal pregnant women at delivery (n = 14) were sequentially investigated. Blood samples from those patients with PPH (n = 15) and DVT and/or PE (n = 11) were also obtained and compared with those of normal women. Significant changes of clot formation parameters were observed in all parameters and, interestingly, fibrinolytic parameter (LY30) was maintained at a low value even within 120 min after placental delivery (median of LY30; 0) and also in cases with uterine atony (median of LY30; 0.1). The parameter that indicates the effectiveness of heparin showed strong correlation (R = 0.788) with activated partial thromboplastin time. Thromboelastography may be less sensitive to fibrinolysis in the conditions of uterine atonic bleeding.

Automated summary

The aims of this study were to evaluate coagulation and fibrinolytic features using TEG6s (R) in different pregnancy stages and in cases with postpartum hemorrhage caused by uterine atony or deep venous thrombosis and/or pulmonary embolism. Significant changes in clot formation parameters and maintenance of low fibrinolytic parameter LY30 were observed after placental delivery and in cases with uterine atony. The effectiveness of heparin showed strong correlation with activated partial thromboplastin time.