Coagulogram in pregnancy

A coagulogram during pregnancy is a necessary analysis to monitor the health of a woman's body. The process of bearing a fetus is a special period during which various changes occur in the psycho-emotional and physical plane of the pregnant woman.

Throughout the entire period, a woman has to constantly take various tests to be aware of the state of both organisms. Thanks to them, you can find out6 whether there is any threat to the fetus and pregnancy in general and whether everything is fine with the fetus?

The list of tests is quite long, it includes tests for infectious agents, the presence of antibodies to various diseases, as well as the inflammatory process in the body. In addition, it is necessary to know the state of the blood system. For this purpose, several blood and urine tests are prescribed (general clinical, biochemical analysis), one of which is a coagulogram - to study the blood coagulation system.

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Indications for prescribing a coagulogram during pregnancy

It is physiologically determined that during pregnancy the female body undergoes global changes with the formation of an additional bloodstream, which puts stress on the heart, vascular, respiratory and other important systems.

In addition, with an increase in the weight of the fetus, an increase in the size of the uterus is observed, which leads to a decrease in the respiratory volume of the lungs due to the uterus “supporting” the diaphragm, as well as increased work of the kidneys and venous vessels of the legs, the blood flow in which is disrupted due to the presence of an obstacle in their path in the form of the uterus.

Indications for prescribing a coagulogram during pregnancy are determined by the presence of concomitant pathology in the pregnant woman. This concerns varicose veins, liver pathology, blood vessels and autoimmune diseases. It is also necessary to take into account the presence of surgical interventions and the intake of medications that affect the blood coagulation system.

Coagulogram when planning pregnancy

Before a couple decides to add a little person to their family, they have to prepare for it. Thus, the partners must take tests for compatibility of blood groups and Rh factors, the presence of infections, systemic pathology and diseases of inflammatory genesis.

The woman's body is checked especially carefully, as it will have to provide adequate nutrition and growth of the fetus for 9 months. The woman should be prepared for this by strengthening her health.

In addition, after giving birth, the young mother will also have to monitor her diet and health if the baby is breastfed. In general, tests will haunt her for a long time.

A coagulogram when planning a pregnancy is necessary to determine the properties of the blood coagulation system. This is necessary, since it is associated with the risk of thrombus formation, which may result in thrombosis of the coronary arteries of the heart with the development of a heart attack, branches of the lungs, as well as the vessels of the brain and other blood vessels.

Increased thrombus formation can cause spontaneous abortion and premature birth. For the fetus, it poses a risk of developing congenital pathology of the brain.

The study of the blood coagulation system is very important at the stage of pregnancy planning, because if there are any violations, the doctor will be able to prescribe a course of prevention or therapy to help conception take place. In addition, pregnancy with normal coagulation will proceed more stably and without complications.

This test is highly recommended for women who:

• have a hereditary predisposition to disorders of the coagulation system;
• had a history of frozen pregnancy, spontaneous miscarriages or abortions;
• suffer from habitual miscarriage (several cases of frozen pregnancy or spontaneous abortions);
• have a hereditary risk of stroke, heart attack, thromboembolism, varicose veins;
• are engaged in heavy physical labor.

As you know, it is easier to prevent any disease than to treat it. Therefore, timely detection of problems with blood clotting and their elimination will allow you to successfully conceive, carry and give birth to a healthy child in the future.

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How to take a coagulogram during pregnancy?

Every expectant mother is required to undergo a coagulogram test, since the values and results of this study are very important for a successful pregnancy and labor.

In case of normal pregnancy and absence of abnormalities in the woman's body, specialists advise to conduct this examination once in each trimester of pregnancy, not less often. In some cases, the analysis is conducted more often - this can happen, for example, if the woman suffers from cardiovascular diseases.

Before going to take the test, it is recommended to refrain from eating food for about 10-12 hours before the start of the test. In addition to food, juices, compotes, alcohol, coffee and tea are also prohibited. It is permissible to drink only pure still water without additives.

If you are taking any medications, or have taken them one or two days before the test, be sure to notify the laboratory technician about this and write down all the names of the medications you are taking on the test form.

Before taking the test, it is recommended to sit down on a chair, calm down, and not panic, as stress and muscle tension can affect the final results of the test.

To ensure accurate results, many people recommend drinking 150-200 ml of clean water at room temperature immediately before donating blood.

As a rule, the form with the results of the coagulogram can be picked up the next day.

Coagulogram indicators during pregnancy

Analysis of the state of the hemostasis system is necessary to assess the interaction of coagulation factors, fibrinolysis and platelets, which together control the balance of the coagulation and anticoagulation systems.

Even a minor change in one of these systems can cause serious consequences, such as DIC syndrome. The development of this pathological condition is based on a violation of blood clotting and fibrin dissolution processes.

Coagulogram indicators during pregnancy can also indicate the development of antiphospholipid syndrome, which can lead to termination of pregnancy at any stage. A characteristic manifestation of this pathology is an increased risk of thrombosis in veins and arteries.

Among all the indicators, the following should be highlighted: APTT, fibrinogen level, presence or absence of lupus anticoagulant, platelet count, prothrombin level, thrombin time, D-dimer, which is responsible for the process of thrombus formation in the body, as well as antithrombin III.

Let's figure out what the coagulogram indicators should be during pregnancy.

• Fibrinogen is a globulin group protein, usually a sign of inflammation or tissue necrosis. It is involved in the blood clotting process. The normal fibrinogen level is 2.0-4.0 g/l, and immediately before the onset of labor it increases to 6 g/l. Indirectly reflects increased ESR values.
• APTT is the time it takes for a blood clot to form after plasma and other reagent substances combine. Normal values are 24 to 35 seconds. During pregnancy, these values may drop to 17 seconds, which is not a cause for concern – this is simply the result of a physiological increase in fibrinogen levels.
• Lupus anticoagulant is a representative of immunoglobulins IgG, an antibody of blood enzymes. Should be absent during pregnancy. If LA is positive, this may indicate the development of gestosis, which in turn can lead to spontaneous termination of pregnancy, placental infarction or intrauterine death of the child.
• Thrombin time – its values reflect the state of the final stage of coagulation. Normal values of TT are from 11 to 18 seconds.
• Prothrombin is a precursor of thrombin, a thrombogen. Normal values are from 78 to 142%, which means the percentage ratio of the prothrombin complex to the prothrombin time of plasma. If prothrombin values increase, premature placental abruption can be expected.
• Antithrombin III is a protein that prevents blood clotting. Normal values are from 71 to 115%. If the values are low, the risk of blood clots is considered high. If you do not monitor the amount of antithrombin, you can miss the risk of spontaneous abortion or the development of placental insufficiency.
• D-dimer is a fibrin degradation product, a protein element that remains after the fibrinolytic process. This indicator has a steady upward trend from the very beginning of pregnancy, so by the time labor begins, the values may be three or even four times higher than the initial values. This is not considered a pathology. Normal D-dimer values should not exceed high values, otherwise late gestosis, nephropathy or diabetes mellitus may be suspected.
• Platelets are blood cells that are designed to ensure the coagulation process itself and indicate the state of the hematopoietic system. Platelets are formed in the bone marrow from megakaryocytes. It is platelets that make up the main part of the blood clot that forms in a wound during bleeding. Normal platelet levels in pregnant women are from 150 to 380*10^9/l. A slight decrease in the indicators is acceptable, which may be associated with a sharp increase in the volume of circulating blood or nutritional deficiency. If the platelet level decreases significantly and sharply, then they talk about thrombocytopenia - excessively thin blood, when there is a risk of bleeding and internal hemorrhages.

Decoding of the coagulogram during pregnancy should be carried out by a doctor, since any results may have their own errors associated, for example, with vitamin deficiency, nutritional errors, chronic diseases, use of drugs, etc. The doctor must take all this into account when deciphering the results of the study.

Decoding of coagulogram during pregnancy

The coagulogram data gives the doctor an idea of the woman's blood condition. Thus, with the help of this analysis, one can find out about the level of fibrinogen, which constantly increases during pregnancy, right up until childbirth. It can normally reach 6 g/l.

The activated partial thromboplastin time indicators during pregnancy differ slightly and amount to up to 20 seconds, which is 10-15 seconds less than before pregnancy.

Decoding the coagulogram during pregnancy also has indicators of lupus anticoagulant, which indicates a group of antibodies that contribute to an increase in the level of APTT. Normally, they should not be in the blood during pregnancy. If they appear, a systemic disease of an autoimmune nature should be suspected, including gestosis.

Thrombin time is often slightly elevated in pregnant women, but should not be significantly higher than normal values – up to 18 seconds.

The analysis of the hemostasis system assessment has a rather important indicator - prothrombin, indicating the threat of premature placental abruption. It should normally fluctuate within 80-140%.

Comprehensive coagulogram during pregnancy

Blood coagulation testing can be either routine or extensive. Most often, doctors use a routine coagulogram, which consists of four indicators: prothrombin index, APTT (activated partial thromboplastin time), fibrinogen and platelet count. If the doctor suspects any coagulation system disorders, he or she can prescribe an extensive coagulogram, which will demonstrate the entire picture of blood coagulation in the body. In this case, it will be possible to assess not only the state of the coagulation system itself, but also predict its functionality in the future.

A detailed analysis is recommended for those with a burdened family history (for example, those with thromboembolism, strokes, heart attacks), as well as for women with varicose veins or thrombophlebitis, or after long-term use of hormonal contraceptives.

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RFMC during pregnancy

Hemostasis indicators (soluble fibrin-monomer complexes - SFMC) - allow to estimate the level and percentage ratio of thrombus elements, the number of which can increase with mass thrombus formation in the circulatory system. For example, such a condition can be observed with thrombosis of large main vessels, with pulmonary embolism.

Elevated levels of RFMC can be observed in the blood of patients with disseminated intravascular coagulation syndrome, in which sudden and progressive disruption of all stages of coagulation occurs. This happens, for example, in shock, severe trauma, extensive burns, systemic thrombosis, etc.

The RMFK coagulogram is distinguished by its increased sensitivity, in contrast to, for example, the ethanol test.

An increase in RFMC values indicates an increasing risk of intravascular thrombus formation.

The RFMC coagulogram during pregnancy decoding looks like this:

• in a healthy person, the normal level of RFMC is considered to be 3.38-4.0 mg/100 ml;
• During pregnancy, an increase of approximately 3 times is allowed.

D dimer

As we have already said above, D-dimer is a product of fibrinolysis – the breakdown of a blood clot. This indicator should be assessed both before pregnancy and during the gestation period.

Before pregnancy, the fibrinolysis product level should be 248 ng/ml and should not be more than 500 ng/ml.

Normal values during pregnancy vary depending on the trimester.

• I trimester – the level may increase by 1.5 times (no more than 750 ng/ml);
• II trimester – no more than 1000 ng/ml;
• III trimester – no more than 1500 ng/ml.

Thus, for physiological reasons, the D-dimer level in pregnant women increases. However, exceeding this value above the permissible limits may indicate the development of:

• diabetes mellitus;
• kidney pathologies;
• late toxicosis;
• liver pathologies;
• premature detachment of the placenta.

A decrease in the D-dimer level is observed much less frequently. Such a decrease is not an indicator of any pathology, but in most cases serves as a reason for more thorough studies of the functional coagulation capacity of the blood. In such cases, a consultation with a hematologist is mandatory.

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MNO

INR – indicators according to the norms of the international normalized ratio – represent the calculated value of the coagulogram, which demonstrates the ratio of the prothrombin time of a specific person and the normal average prothrombin time. Evaluation of INR is necessary for monitoring the state of the coagulation system during treatment with anticoagulants – indirect anticoagulants (for example, Phenylin, Valfarin). If such treatment is carried out, INR monitoring should be carried out at least once every three months.

Excessive increase in INR values may indicate the risk of bleeding, including internal bleeding.

The decrease in indicators demonstrates the insufficient effectiveness of anticoagulant treatment, which confirms the continuing risk of blood clots.

Normal INR values are 0.8-1.2. During treatment with anticoagulants, the acceptable norm is about 2.5.

Cost of coagulogram during pregnancy

Today, a coagulogram can be done in almost any laboratory. The most popular in our country are the Dila, Synevo and Invitro laboratories. Prices for conducting a homeostasis assessment analysis should be clarified:

• D-dimer – 120-140 UAH;
• APTT, APTT – activated partial thromboplastin time – 60-80 UAH;
• Antithrombin – 45-145 UAH;
• Lupus anticoagulant – 160-400 UAH;
• Fibrinogen – 50-110 UAH;
• Thrombin time – 30-70 UAH;
• Prothrombin test – 50-80 UAH;
• detailed coagulogram – 220-840 UAH.

Remember that a coagulogram during pregnancy is a mandatory test and should be done free of charge at the antenatal clinic. Check this with your gynecologist.