Coagulogram in pregnancy

Coagulogram in pregnancy is a necessary analysis to control the health of a woman's body. The process of bearing a fetus is a special period during which various changes occur in the psychoemotional and physical plane of a pregnant woman.

Throughout the period, a woman has to constantly take various tests to be aware of the condition of both organisms. Thanks to them, you can find out6 whether there is anything threatening the fetus and pregnancy in general, and whether everything is good with the fetus?

The list of analyzes is long enough, it includes checks for infectious pathogens, the presence of antibodies to various diseases, as well as 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 (general clinical, biochemical analysis) are assigned, one of which is a coagulogram for the study of the blood coagulation system.

[1], [2]

Indications for the appointment of a coagulogram in pregnancy

Physiologically, it is laid down that during pregnancy the female organism undergoes global changes with the formation of an additional blood channel, which puts stress on the heart, vascular, respiratory and other important systems.

In addition, with an increase in the fetal mass, an increase in the uterus in size is observed, which leads to a decrease in the respiratory volume of the lungs due to the "support" of the diaphragm with the uterus, as well as increased work of the kidneys and venous vessels of the legs, the blood flow is disturbed by the presence of an obstruction in their way in the form the uterus.

Indications for the appointment of a coagulogram in pregnancy are due to the presence of concomitant pathology in a pregnant woman. This applies to varicose disease, liver disease, blood vessels and autoimmune diseases. Also, it is necessary to take into account the presence of performed surgical interventions and the intake of medications that affect the blood coagulation system.

Coagulogram in the planning of pregnancy

Before the couple decides to fill up their family with a little man, they have to prepare for this. So, partners must submit tests for the compatibility of blood groups and Rh factors, the presence of infections, systemic pathology and inflammatory disease.

The woman's organism is checked especially carefully, as it has to provide adequate nutrition and fetal growth for 9 months. To this, a woman should be ready, strengthening her health.

In addition, after delivery, the young mother will also have to monitor her nutrition and health if the baby is breastfed. In general, her analyzes will be pursued for a long time.

A coagulogram in pregnancy planning is necessary to determine the properties of the blood coagulation system. This is necessary, since it involves the risk of blood clots, resulting in possible thrombosis of the coronary arteries of the heart with the development of infarction, the branches of the lungs, as well as vessels of the brain and other blood vessels.

Increased thrombus formation can lead to spontaneous abortion and premature birth. For the fetus, it threatens the 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 the conception take place. In addition, pregnancy with normal clotting will proceed more stably and without complications.

It is strongly recommended that this study be conducted 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 pregnancy fading or spontaneous abortions);
• have a hereditary risk of getting a stroke, heart attack, thromboembolism, varicose veins;
• are engaged in heavy physical labor.

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

[3], [4], [5], [6]

How to take a coagulogram during pregnancy?

Each future mother is obliged to pass an analysis of the coagulogram, since the values and results of this study are very important for successful pregnancy and labor.

In the case of a normal pregnancy and the absence of abnormalities in the body, women advise that they conduct this study once every trimester of pregnancy, at least. In some cases, the analysis is conducted more often - it can happen, for example, if a woman suffers from cardiovascular diseases.

Before going on for the analysis, it is recommended to give up eating about 10-12 hours before the start of the study. In addition to food, juices, compotes, alcohol, coffee and tea are also banned. It is allowed to use only pure non-carbonated water without additives.

If you take any medications, or take them one to two days before the test, then be sure to notify the lab technician and write down all the names of the medications on the research form.

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

Many for the accuracy of the indicators are recommended immediately before donating blood to drink 150-200 ml of clean water at room temperature.

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

Indicators of coagulation during pregnancy

Analysis of the state of the hemostasis system is necessary to evaluate the interaction of coagulation factors, fibrinolysis and platelets, which in complex control the equilibrium of coagulation and anticoagulation systems.

Even a small change in one of these systems can lead to serious consequences, for example, DIC syndrome. At the basis of the development of this pathological condition is a violation of the processes of blood coagulation and dissolution of fibrin.

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

Among all the indicators, it should be noted APTT, the level of fibrinogen, the presence or absence of lupus anticoagulant, the number of platelets, the level of prothrombin, thrombin time, the D-dimer responsible for the thrombogenesis process in the body, and antithrombin III.

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

• Fibrinogen is a protein of the globulin group, usually a sign of inflammation or tissue necrosis. Takes part in the process of blood coagulation. The normal index of fibrinogen is 2.0-4.0 g / l, and immediately before the onset of labor it rises to 6 g / l. Indirectly displays elevated values of ESR.
• APTTV - the time of formation of a blood clot after the connection of plasma and other reagent substances. Normal indicators - from 24 to 35 seconds. In pregnancy, these values may drop to 17 seconds, which is not a cause for concern - it is simply the result of physiological increase in the indices of fibrinogen.
• Lupus anticoagulant is a representative of IgG immunoglobulins, an antibody of blood enzymes. When pregnancy should be absent. If BA is positive, this may indicate the development of gestosis, which in turn can lead to spontaneous abortion, placental infarction, or intrauterine death of the child.
• Thrombin time - its indicators reflect the state of the final stage of coagulation. Normal values of TV - from 11 to 18 seconds.
• Prothrombin is the precursor of thrombin, thrombogen. The norm is from 78 to 142%, which means the percentage ratio of the prothrombin complex to the prothrombin time of the plasma. With an increase in prothrombin levels, one can expect that premature detachment of the placenta will occur.
• Antithrombin III is a protein that prevents blood coagulation. Normal values range from 71 to 115%. When the indicators are lowered, the risk of formation of thrombi is considered to be increased. If you do not follow 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 tendency to increase from the very beginning of pregnancy, therefore by the time of the onset of labor, the values can be higher than the initial values by three or even four times. This is not considered a pathology. Normal values of D-dimer should not exceed high, otherwise, late gestosis, nephropathy, or diabetes mellitus may be suspected.
• Platelets are blood cells that are designed to provide the very process of coagulation, and indicate the state of the hematopoietic system. Platelets are formed in the bone marrow of megakaryocytes. It is the platelets that make up the bulk of the blood clot that forms in the wound with bleeding. Normal values of platelets in pregnant women - from 150 to 380 * 10 ^ 9 / l. A slight decrease in the indices is possible, which may be due to a sharp increase in the volume of circulating blood or a nutritional deficiency. If the level of platelets decreases significantly and sharply, then they speak of thrombocytopenia - excessively liquid blood, when there is a danger of bleeding and internal hemorrhages.

The decoding of the coagulogram during pregnancy should be performed by a doctor, as any results may have their own mistakes related, for example, with vitamin deficiency, nutritional errors, chronic diseases, drug use, etc. All this the doctor must take into account when deciphering the results of the study.

Decoding of a coagulogram in pregnancy

These coagulograms give an idea to the doctor about the woman's blood condition. So, with the help of this analysis, you can find out about the level of fibrinogen content, which, with the course of pregnancy, constantly rises, up to the birth. It can reach a normal 6 g / l.

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

Decoding the coagulogram in pregnancy also has indicators of lupous anticoagulant, which indicates a group of antibodies that contribute to the increase in the level of APTT. In normal pregnancy, they should not be in the blood. In case of their appearance, a systemic disease of autoimmune nature, including gestosis, should be suspected.

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

Analysis of evaluation of the hemostatic system has a rather important indicator - prothrombin, indicating a threat of premature placental detachment. It should normally fluctuate within 80-140%.

An expanded coagulogram in pregnancy

The study of blood coagulability can be ordinary and detailed. Most often, doctors resort to the usual coagulogram, which consists of four indicators: prothrombin index, APTT (the value of activated partial thromboplastin time), the amount of fibrinogen and platelets. If the doctor suspects any disturbance of the coagulation system, then he can prescribe a developed coagulogram that will demonstrate the entire picture of blood coagulation in the body. In this case, it will be possible to evaluate not only the state of the coagulation system proper, but also to predict its functionality in the future.

The detailed analysis is recommended for those who have family heredity (for example, there are patients with thromboembolism, strokes, heart attacks), as well as women with varicose veins or thrombophlebitis, or after prolonged intake of hormonal contraceptives.

[7], [8], [9]

RFMC in pregnancy

Indicators of hemostasis (soluble fibrin-monomer complexes - RFMK) - allow to assess the level and percentage of elements of blood clots, the number of which can increase with massive thrombogenesis in the circulatory system. For example, this condition can be observed with thrombosis of large main vessels, with thromboembolism of the pulmonary artery.

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

Coagulogram RMPC is characterized by increased sensitivity, in contrast to, for example, ethanol test.

An increase in the RFMC indices indicates an increasing risk of formation of intravascular thrombi.

Coagulogram in pregnancy decoding RFMC looks like this:

• in a healthy person, a normal RFMC score is 3.38-4.0 mg / 100 ml;
• during pregnancy it is allowed to increase this value by about 3 times.

D dimer

As we mentioned above, D-dimer is a product of fibrinolysis-the decomposition of a thrombus. Evaluation of this indicator should be carried out both before pregnancy and during the gestation process.

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

Normal indicators during the period of gestation fluctuate depending on the term.

• I trimester - the level can increase by 1.5 times (not more than 750 ng / ml);
• II trimester - not more than 1000 ng / ml;
• III trimester - no more than 1500 ng / ml.

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

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

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

[10], [11], [12], [13], [14]

INR

INR - indicators according to the norms of the international normalized ratio - represent the estimated value of the coagulogram, which shows the ratio of prothrombin time of a specific person and normal averaged prothrombin time. Assessment of INR is necessary to observe the state of the coagulation system during the treatment with anticoagulant drugs - anticoagulants of indirect action (eg, Phenylin, Valfarin). If such treatment is carried out, INR should be monitored at least once every three months.

Excessive excess of INR may indicate the risk of bleeding, including internal bleeding.

A decrease in the indices demonstrates the insufficient effectiveness of anticoagulant treatment, which confirms the continuing danger of formation of thrombi.

The normal indices of INR are 0.8-1.2. In the period of treatment with anticoagulants, the permissible norm is about 2.5.

The cost of a coagulogram in pregnancy

To date, coagulation can be done in virtually any laboratory. The most popular in our country are the laboratory Dila, Synevo and Invitro. Prices for the analysis of homeostasis assessment should be specified:

• D-dimer - 120-140 UAH;
• APTTV, ARTT - 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;
• deployed coagulogram - 220-840 UAH.

Remember that a coagulogram in pregnancy is a mandatory analysis, and in a women's consultation should be free of charge. Clarify this question from your gynecologist.