fibrin and Abortion--Spontaneous

Maternal floor infarction/massive perivillous fibrin deposition (MFI/MFD), chronic histiocytic intervillositis (CHIV) and villitis of unknown etiology (VUE) are lesions of the placenta which are characterized morphologically. The cause is thought to be pathological immunotolerance/rejection reaction at the fetomaternal interface. The risk of recurrence is elevated and the lesions can lead to severe pediatric diseases.. This article provides an overview of the pathological and anatomical characteristics of each of these lesions, including diagnostic criteria, suspected etiology, clinical relevance and suggested therapy options.. A selective search of the literature was carried out and experiences from own diagnostic clientele are presented.. While MFI/MFD and CHIV occur more rarely, VUE is relatively common occurring in up to 15 % of placentas at term. Both MFI/MFD and CHIV can occur in the first and second trimester, while VUE typically manifests in the third trimester. All lesions can lead to intrauterine growth retardation or abortion and have a tendency towards disease recurrence. Furthermore, VUE and MFI/MFD can be associated with an adverse neurodevelopmental outcome in the children. For all these entities potential therapy strategies have been reported, which are mainly based on anticoagulation and immunosuppression in subsequent pregnancies.

Topics: Abortion, Spontaneous; Chorionic Villi; Chronic Disease; Female; Fetal Growth Retardation; Fibrin; Histiocytosis; Humans; Infant, Newborn; Infarction; Placenta; Placenta Diseases; Placental Circulation; Pregnancy; Pregnancy Trimester, Third; Recurrence; Risk Factors

Topics: Abortion, Spontaneous; Blood; Blood Coagulation Tests; Blood Platelets; Cerebral Hemorrhage; Ecchymosis; Factor XIII; Factor XIII Deficiency; Female; Fetal Death; Fibrin; Hematoma; Hemorrhage; Hemorrhagic Disorders; Humans; Infant, Newborn; Placenta; Pregnancy; Pregnancy Complications, Hematologic; Umbilical Cord

Massive perivillous fibrin deposition (MPVFD) and chronic intervillositis (CI) are related rare pathological correlates of severe intrauterine growth restriction (IUGR) and fetal loss with high recurrence rates. No standard management has been established.. A patient underwent termination of pregnancy at 21 weeks for severe early onset IUGR. Placental histology showed mixed CI with MPVFD. Several months later, the patient became pregnant and was managed with prednisone and aspirin (ASA) but miscarried at 16 weeks. Placental pathology showed MPVFD and focal CI. For two subsequent pregnancies, she was treated with intravenous immunoglobulin (IVIG), heparin, and ASA. Both pregnancies resulted in healthy near-term deliveries with normal placentas.. IVIG, heparin, and ASA can be an option in patients with recurrent pregnancy loss due to MPVFD and CI.

Topics: Abortion, Habitual; Abortion, Spontaneous; Adult; Anticoagulants; Aspirin; Chorionic Villi; Dalteparin; Female; Fetal Growth Retardation; Fibrin; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Placenta; Placenta Diseases; Platelet Aggregation Inhibitors; Pregnancy

Topics: Abortion, Spontaneous; Anticoagulants; Aspirin; Blood Platelets; Cell-Derived Microparticles; Female; Fibrin; Heparin; Humans; Phosphatidylserines; Placenta; Pregnancy; Pregnancy Trimesters; Thrombosis

The aim of this study was to investigate the structure and function of fibrinogen obtained from a patient with normal coagulation times and idiopathic thrombophilia. This was done by SDS-PAGE and DNA sequence analyses, scanning electron microscopy, fibrinopeptide release, fibrin polymerisation initiated by thrombin and reptilase, fibrinolysis, and platelet aggregometry. A novel heterozygous point mutation in the fibrinogen Aα chain, Phe98 to Ile, was found and designated as fibrinogen Vizovice. The mutation, which is located in the RGDF sequence (Aα 95-98) of the fibrinogen coiled-coil region, significantly affected fibrin clot morphology. Namely, the clot formed by fibrinogen Vizovice contained thinner and curled fibrin fibers with reduced length. Lysis of the clots prepared from Vizovice plasma and isolated fibrinogen were found to be impaired. The lysis rate of Vizovice clots was almost four times slower than the lysis rate of control clots. In the presence of platelets agonists the mutant fibrinogen caused increased platelet aggregation. The data obtained show that natural mutation of Phe98 to Ile in the fibrinogen Aα chain influences lateral aggregation of fibrin protofibrils, fibrinolysis, and platelet aggregation. They also suggest that delayed fibrinolysis, together with the abnormal fibrin network morphology and increased platelet aggregation, may be the direct cause of thrombotic complications in the patient associated with pregnancy loss.

Topics: Abortion, Spontaneous; Adult; Batroxobin; Blood Coagulation; Blood Coagulation Tests; Female; Fibrin; Fibrinogen; Fibrinolysis; Heterozygote; Humans; Platelet Aggregation; Point Mutation; Pregnancy; Protein Conformation; Thrombin; Thrombophilia; Time Factors

Chronic histiocytic intervillositis of unknown etiology (CIUE) is a rare placental inflammatory disease, associated with severe obstetric complications. Its pathophysiologic mechanism remains to be elucidated.. To establish anatomical-clinical correlations to improve our understanding of CIUE pathophysiology.. Retrospective study of all cases of CIUE occurring during a 9-year period in a university tertiary hospital center.. CIUE was diagnosed in 69 pregnancies in 50 different women, after early spontaneous abortions (30.4%), late spontaneous abortions (13.0%), in utero deaths (26.1%), and live births (30.4%). Of 39 fetuses surviving to at least 22 weeks, 24 had severe intrauterine growth restriction (61.5%) and 18 died in utero (46.2%). Twelve in utero deaths occurred before 32 weeks of gestation (66.7%). Substantially elevated alkaline phosphatase levels (>600 IU/L) were observed in 55.6% of cases. Microscopic examination of placentas showed that both spontaneous early abortions and intrauterine growth restriction were significantly associated with more intense fibrin deposits.. A diagnosis of CIUE must be considered in cases of severe obstetric complications. We hypothesize that the elevated alkaline phosphatases (ALP) observed during the pregnancy demonstrate the presence of syncytiotrophoblastic lesions due to histiocytosis in the intervillous space, before fibrin deposits cover them.

Topics: Abortion, Spontaneous; Adolescent; Adult; Alkaline Phosphatase; Chorionic Villi; Female; Fetal Death; Fetal Growth Retardation; Fibrin; Histiocytes; Histiocytosis; Humans; Inflammation; Placenta Diseases; Pregnancy; Premature Birth; Retrospective Studies

A small proportion of miscarriage specimens obtained by uterine evacuation exhibit increased perivillous fibrin/oid deposition (PVFD). To understand the significance of this finding, the authors reviewed cases from 5/20/02 to 11/10/04 in which surgical pathologists recognized this finding and documented it in their reports. Of 55 cases initially collected, 29 contained at least 30 villi on the slide with at least 50% of villi showing adherent fibrin/oid, and showed no molar change or extensive coagulative necrosis. Review of these 29 cases identified 2 patterns of fibrin/oid deposition: nodular (8 cases) and diffuse (21 cases). A maternal and gestational age-matched control group was collected (21 cases). The diffuse pattern of PVFD encased villi and had tinctorial characteristics of fibrin. Its pattern is similar to that seen in maternal floor infarction and massive perivillous fibrin deposition. The nodular pattern is an exaggerated form of the nodular deposition of matrix-type fibrinoid seen in normal placentas. Comparison of the 3 groups identified a longer duration of vaginal bleeding before uterine evacuation in the diffuse pattern (P=0.001). One patient had a history of 8 miscarriages, 2 of which were represented in this study. All other obstetrical factors studied showed no significant difference between the 3 groups. Thus, diffuse PVFD in miscarriage specimens is associated with prolonged vaginal bleeding and not with maternal thrombophilia or autoimmune disease. Rarely, a patient showing this pattern may have a history of repeated miscarriages.

Topics: Abortion, Spontaneous; Adult; Chorionic Villi; Female; Fibrin; Humans; Immunohistochemistry; Infarction; Placenta Diseases; Placental Circulation; Pregnancy; Uterus

Antiphospholipid syndrome is characterized by recurrent pregnancy loss, thrombosis, and antiphospholipid antibodies. However, some women with clinical features of antiphospholipid syndrome test negative for antiphospholipid antibodies ("antiphospholipid-like syndrome"). Women with antiphospholipid and antiphospholipid-like syndromes have serum immunoglobulin G that harms murine pregnancy, suggesting that the mechanisms of fetal death may be similar in both groups. The objective of our study was to determine whether patients with antiphospholipid and antiphospholipid-like syndromes share pathophysiology by comparing the histology of gestational tissues from these groups.. Placenta and abortion specimens were obtained from 44 pregnancies in 26 women with antiphospholipid syndrome and 37 pregnancies in 21 women with antiphospholipid-like syndrome. Of these, 16 pregnancies with antiphospholipid syndrome and 8 with antiphospholipid-like syndrome were treated with a variety of medications intended to improve pregnancy outcome. Placentas from 31 elective pregnancy terminations and 40 pregnancies complicated by idiopathic preterm delivery served as an additional control group. Twenty histologic parameters were systematically assessed by a single investigator who was blinded to the clinical status of the specimens. Histopathologic findings were compared among groups using multivariate logistic regression analysis.. Antiphospholipid syndrome pregnancies included 15 spontaneous abortions, 13 fetal deaths, and 16 live births. Pregnancies in the antiphospholipid-like syndrome group resulted in 5 spontaneous abortions, 30 fetal deaths, and one live birth. Gestational tissues from antiphospholipid and antiphospholipid-like syndrome pregnancies were similar for every histologic feature tested. Decidua from women with both antiphospholipid and antiphospholipid-like syndromes had more necrosis, acute and chronic inflammation, and vascular thrombus compared to controls. Placental tissue from antiphospholipid and antiphospholipid-like syndrome pregnancies showed more infarction, intravascular fibrin deposition, syncytial knot formation, and fibrosis than controls. Histologic features were variable within groups. There were no histologic differences in tissues from live births and pregnancy losses, or in treated and untreated pregnancies.. Placental histopathology is similar in antiphospholipid and antiphospholipid-like syndrome pregnancies, suggesting that these disorders may share pathophysiology. Histologic findings in women with APS are non-specific and may not differentiate between women with APS and APS-like syndromes.

Topics: Abortion, Spontaneous; Adult; Antibodies, Antiphospholipid; Antiphospholipid Syndrome; Chorionic Villi; Decidua; Female; Fetal Death; Fibrin; Fibrosis; Humans; Inflammation; Logistic Models; Necrosis; Placenta; Pregnancy; Thrombosis; Trophoblasts

Massive perivillous fibrin deposition (MPFD) is associated with intrauterine growth retardation and first-trimester and second-trimester spontaneous abortion. Histologically, villi near the maternal interface are completely surrounded by fibrinoid material. This work compared the expression of thrombomodulin (TM) and endothelial protein C receptor (EPCR) in early miscarriage specimens with and without MPFD. Ten specimens with a gestational age of 7-12 weeks (mean 10 weeks) and 10 age-matched miscarriage specimens lacking MPFD were sampled. Formalin-fixed paraffin-embedded sections were stained with monoclonal antibodies against TM and EPCR using an immunoperoxidase method. The slides were independently reviewed by two pathologists using a semiquantitative grading system. Among unaffected villi, there was no difference in staining for TM or EPCR in cases of massive perivillous fibrin deposition compared with the control group. In the MPFD cases, loss of membrane positivity was noted for both TM and EPCR at the junction between normal villous epithelium and villous epithelium with deposition of fibrin. This could imply an underlying defect of trophoblastic protein C activation. Alternatively, it may represent a degenerative change secondary to impedence of oxygen and nutrient supply to the trophoblastic epithelium.

Topics: Abortion, Spontaneous; Adult; Chorionic Villi; Enzyme Activation; Female; Fibrin; Glycoproteins; Humans; Immunoenzyme Techniques; Placenta Diseases; Pregnancy; Pregnancy Trimester, First; Protein C; Thrombomodulin

Disruption of the mouse gene encoding the blood coagulation inhibitor thrombomodulin (Thbd) leads to embryonic lethality caused by an unknown defect in the placenta. We show that the abortion of thrombomodulin-deficient embryos is caused by tissue factor-initiated activation of the blood coagulation cascade at the feto-maternal interface. Activated coagulation factors induce cell death and growth inhibition of placental trophoblast cells by two distinct mechanisms. The death of giant trophoblast cells is caused by conversion of the thrombin substrate fibrinogen to fibrin and subsequent formation of fibrin degradation products. In contrast, the growth arrest of trophoblast cells is not mediated by fibrin, but is a likely result of engagement of protease-activated receptors (PAR)-2 and PAR-4 by coagulation factors. These findings show a new function for the thrombomodulin-protein C system in controlling the growth and survival of trophoblast cells in the placenta. This function is essential for the maintenance of pregnancy.

Topics: Abortion, Spontaneous; Animals; Blood Coagulation; Cell Division; Embryo Loss; Embryo, Mammalian; Female; Fibrin; Fibrinogen; Fibrinolysin; In Situ Hybridization; In Situ Nick-End Labeling; Male; Mice; Mice, Inbred C57BL; Placenta; Pregnancy; Pregnancy Maintenance; Protein C; Receptor, PAR-2; Receptors, Thrombin; Thrombin; Thrombomodulin; Thromboplastin; Trophoblasts

Spontaneous abortion of normal karyotype embryos in mice and in humans is associated with an increase in uterine T helper (Th) 1 type proinflammatory cytokines, tumour necrosis factor (TNF)-alpha, interferon-gamma and interleukin (IL)-1, and a deficiency of Th2/3 type cytokines, IL-4, IL-10, and transforming growth factor (TGF)-beta2. In mice, Th1 cytokines up-regulate a novel prothrombinase, fgl2, which via thrombin, leads to activation of polymorphonuclear leukocytes that terminate the pregnancy. Here we show that Th1 cytokines up-regulate fgl2 mRNA in fetal trophoblast and secondary decidua of CBA/JxDBA/2 and CBA/JxBALB/c matings, and promote fibrin deposition. This pattern is accompanied by a high rate of abortion. However, the spontaneous abortion rates in abortion-prone CBAxDBA/2 matings and in low abortion rate CBAxBALB/c matings were significantly lower than that expected from the frequency of implantations with high levels of fibrin and fgl2 mRNA(hi). As the glycoprotein OX-2 occurs in the pregnant rat uterus and can deviate cytokine responses to Th2/3, we investigated OX-2 in pregnant CBA/J mice. We found OX-2 mRNA was present at the same sites as fgl2 mRNA, but was reduced in response to Th1 cytokines. Furthermore, anti-OX-2 raised the abortion rate to predicted levels, while recombinant OX-2 dramatically reduced the abortion rate. Fgl2 prothrombinase may provide a mechanism explaining pregnancy loss, and conversely, successful pregnancy may be due in part to OX-2-dependent activation of maternal tolerance mechanisms at the feto-maternal interface.

Topics: Abortion, Spontaneous; Animals; Antigens, CD; Antigens, Surface; Base Sequence; Cytokines; Decidua; DNA Primers; Female; Fibrin; Fibrinogen; Gene Expression; Humans; In Situ Hybridization; Male; Mice; Mice, Inbred BALB C; Mice, Inbred CBA; Mice, Inbred DBA; Pregnancy; RNA, Messenger; Thromboplastin; Trophoblasts

The management of patients with first-trimester spontaneous abortions is handicapped by two problems: difficulty in recognizing conceptions that abort because of abnormal karyotypes and an incomplete understanding of what causes abortions with normal karyotypes. Our goals in this study were to define features useful in distinguishing normal from abnormal karyotype and to identify pathological processes contributing to abortions with a normal karyotype. The study population consisted of 668 well-characterized first-trimester spontaneous abortions derived from a larger study of 1,054 consecutively karyotyped spontaneous abortions. Clinical factors increased in specimens with normal karyotype were maternal age younger than 20 years (P=.0003) and autoimmune markers (P=.0474). Developmental features associated with abnormal karyotype were developmental stage less than 6 weeks (P=.0017), hydropic villi greater than 1 mm (P=.0004), and villi with two or more dysmorphic features (P=.0001). Developmental stage greater than 11.5 weeks was increased with normal karyotype (P=.0001). Histological features increased in specimens with a normal karyotype were chronic intervillositis (P=.0003), increased perivillous fibrin deposition with intermediate trophoblast (P=.0006), decidual plasma cells (P=.0040), deciduitis without plasma cells (P=.0660), and chronic villitis (P=.1581). Overall, 19% of samples with a normal karyotype versus 8% with abnormal karyotype had one or more of these findings (P < .0001). Autoimmune markers, chronic intervillositis, and increased perivillous fibrin with intermediate trophoblast all had positive predictive values greater than 85% for normal karyotype, whereas dysmorphic villi had a positive predictive value of 90% for abnormal karyotype. Patients with recurrent spontaneous abortion and normal karyotype were more likely to have one or more of the histological features listed above (31%) than patients with normal karyotype and no prior abortions (13%) and patients with recurrent abortion and abnormal karyotype (11%).

Topics: Abortion, Spontaneous; Adult; Chorionic Villi; Decidua; Female; Fibrin; Gestational Age; Humans; Karyotyping; Maternal Age; Pregnancy; Pregnancy Trimester, First; Prevalence; Trophoblasts

Fibrinogen St. Gallen I was detected in an asymptomatic Swiss woman. Routine coagulation tests revealed a prolonged thrombin and reptilase time. Functionally measured fibrinogen levels were considerably lower than those determined immunologically. Polymerization of fibrin monomers derived from purified fibrinogen was delayed in the presence of either calcium or EDTA. Normal fibrinopeptide A and B release by thrombin was established. An abnormal degradation of fibrinogen St. Gallen I by plasmin was observed. Fragment D1 of normal fibrinogen was fully protected against further proteolysis in the presence of 10 mM calcium, whereas fibrinogen St. Gallen I was partially further degraded to fragments D2 and D3. In the presence of 10 mM EDTA, the conversion of variant fragment D1 to D2 was accelerated whereas the degradation of fragment D2 to D3 was delayed in comparison to degradation of fragments D1 and D2 of normal fibrinogen. Three high-affinity calcium binding sites were found in both normal and variant fibrinogen. Mutation screening with SSCP analysis suggested a mutation in exon VIII of the gamma-chain gene. Cycle sequencing of this gene portion revealed a single base substitution from G to T of the base 7527, leading to replacement of gamma 292 glycine by valine. The same mutation has already been described for the fibrinogen variant Baltimore I. Molecular modeling was performed of a part of the gamma-chain containing the mutation site, based on recently published X-ray crystal structures of human fibrinogen fragment D and of a 30 kD C-terminal part of the gamma-chain. Significant structural alterations due to the substitution of glycine by valine at gamma 292 were observed, e.g. spreading of the protein backbone, probably leading to a modified accessibility of the plasmic cleavage sites in the gamma-chain at 356 Lys and 302 Lys. A shift of gamma 297 Asp that is involved in interactions of fragment D with the Gly-Pro-Arg-Pro-peptide was noted by molecular modeling. The latter observation is compatible with delayed polymerization of fibrin monomers.

Topics: Abortion, Spontaneous; Afibrinogenemia; Amino Acid Substitution; Binding Sites; Biopolymers; Blood Protein Electrophoresis; Calcium; DNA Mutational Analysis; Exons; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinogens, Abnormal; Fibrinolysin; Humans; Menorrhagia; Middle Aged; Models, Molecular; Mutation, Missense; Nephelometry and Turbidimetry; Point Mutation; Polymerase Chain Reaction; Polymorphism, Single-Stranded Conformational; Pregnancy; Protein Conformation; Thrombin Time; Uterine Hemorrhage

This study reviewed the histopathology of endometrial curettings following spontaneous abortion in diabetics and controls. The two groups did not differ significantly for an array of histologic features. The relationships between histopathology and diabetic White class, diabetic nephropathy or retinopathy, first trimester hemoglobin A1 percentage, and first trimester serum magnesium level were studied. The only significant correlation found was between diabetic retinopathy and decidual congestion with the presence of venous fibrin.

Topics: Abortion, Spontaneous; Decidua; Diabetic Retinopathy; Endometrium; Female; Fibrin; Glycated Hemoglobin; Histocytochemistry; Humans; Magnesium; Pregnancy; Pregnancy in Diabetics

Incidence, risk factors and morphological features of the intravascular coagulation (IC) in 160 women who had died during pregnancy, after abortion and delivery were studied. IC was established in 118 (73.8%) of them. The main risk factors leading to IC were shock (59.3%), sepsis (28.8%), toxemia of pregnancy (incl. eclampsia) (25.4%), Caesarean section (19.5%), fetal death in utero (12.7%), amniotic fluid embolism (9.3%), and abruptio placentae (7.6%). Disseminated intravascular coagulation (DIC) was established in 66% of the cases, and local intravascular coagulation (univisceral localisation of microthrombi) in 28%. In the resting 6% of the cases there was consumptive coagulopathy without microthrombi. Lungs, pituitary gland, uterus, kidneys and adrenals were the most frequently affected organs. Necrosis in the parenchymal organs, hyaline membrane formation in the lungs and consumptive coagulopathy were particularly frequent in the cases with DIC. The leading causes of death were acute renal failure and ARDS. It was established that prolonged intensive care including artificial ventilation, massive blood transfusion, as well as surgical treatment, aggravate the course and morphological features of IC.

Topics: Abortion, Spontaneous; Adult; Bulgaria; Capillaries; Cause of Death; Cross-Sectional Studies; Disseminated Intravascular Coagulation; Female; Fibrin; Humans; Incidence; Pregnancy; Pregnancy Complications, Hematologic; Puerperal Disorders; Risk Factors

Topics: Abortion, Spontaneous; Allergy and Immunology; Chorionic Gonadotropin; Decidua; Endometritis; Environment; Estriol; Estrogens; Female; Fibrin; Genetics; Hematoma; Humans; Maternal-Fetal Exchange; Myocardial Infarction; Placenta; Placenta Diseases; Pregnancy; Pregnancy, Prolonged; Staining and Labeling; Thrombosis; Trophoblasts

Topics: ABO Blood-Group System; Abortion, Spontaneous; Adult; Age Factors; Bacteriuria; Blood Coagulation; Blood Coagulation Tests; Blood Group Antigens; Delivery, Obstetric; Disseminated Intravascular Coagulation; Estrogens; Female; Fibrin; Fibrinogen; Fibrinolysis; Humans; Lactation; Parity; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious; Protamines; Puerperal Disorders; Smoking; Staphylococcus; Time Factors

Topics: Abortion, Spontaneous; Animals; Antifibrinolytic Agents; Bradykinin; Endometrium; Female; Fibrin; Fibrinogen; Fibrinolysin; Fibrinolysis; Fibrinolytic Agents; Humans; Kinins; Plasminogen; Pregnancy; Rats; Serotonin; Uterus

Topics: Abortion, Spontaneous; Agar; Curettage; Decidua; Endometrium; Extraembryonic Membranes; Female; Fibrin; Fibrinolysis; Histological Techniques; Humans; Menstruation; Metrorrhagia; Plasminogen; Pregnancy; Thrombin

Topics: Abortion, Spontaneous; Adolescent; Adult; Female; Fibrin; Histocytochemistry; Humans; Placenta; Pregnancy; Trophoblasts

Topics: Abortion, Spontaneous; Adult; Extraembryonic Membranes; Female; Fibrin; Glycosaminoglycans; Histocytochemistry; Humans; Hydatidiform Mole; Ovum; Pregnancy; Pregnancy Complications

Topics: Abortion, Spontaneous; Adult; Decidua; Extraembryonic Membranes; Female; Fibrin; Gestational Age; Glycosaminoglycans; Histocytochemistry; Humans; Ovum; Placenta; Pregnancy; Uterus

Topics: Abortion, Spontaneous; Adult; Blood Coagulation Disorders; Blood Coagulation Tests; Female; Fibrin; Fibrinogen; Fibrinolysis; Heparin; Humans; Immune Sera; Immunoelectrophoresis; Pregnancy; Pregnancy Complications; Shwartzman Phenomenon; Thrombelastography

Topics: Abortion, Spontaneous; Biopsy; Blood Coagulation; Blood Coagulation Disorders; Female; Fibrin; Humans; Pregnancy; Uterus

Topics: Abortion, Induced; Abortion, Spontaneous; Afibrinogenemia; Female; Fibrin; Fibrinogen; Fibrinolysis; Hemostasis; Humans; Pregnancy; Uterine Hemorrhage

Topics: Abortion, Criminal; Abortion, Induced; Abortion, Spontaneous; Abruptio Placentae; Afibrinogenemia; Blood Coagulation; Criminals; Female; Fibrin; Humans; Placenta; Pregnancy

Topics: Abortion, Induced; Abortion, Spontaneous; Female; Fibrin; Fibrinolysis; Humans; Immunization; Obstetrics; Pregnancy; Rh-Hr Blood-Group System; Vaccination

Topics: Abortion, Induced; Abortion, Spontaneous; Female; Fibrin; Hemorrhage; Humans; Pregnancy; Pregnancy Complications

Topics: Abortion, Induced; Abortion, Spontaneous; Blood; Female; Fibrin; Fibrinolysis; Genital Diseases, Female; Gynecology; Humans; Neoplasms; Obstetrics; Pregnancy; Uterine Neoplasms; Uterus

Topics: Abortion, Induced; Abortion, Spontaneous; Female; Fibrin; Hemorrhage; Humans; Obstetrics; Pregnancy