fibrin and Eclampsia

1. The lack of a general agreement on the definition of PE makes the interpretation of laboratory findings in different series of these patients difficult. 2. Thrombocytopenia is the most common hemostatic abnormality in patients with PE and is caused by platelet consumption. 3. There is little concrete evidence that thrombin mediates the thrombocytopenia in most of these patients. 4. Immune mechanisms or severe vasospasm with resultant endothelial damage may contribute to the thrombocytopenia in some patients.

Topics: Anemia, Hemolytic; Disseminated Intravascular Coagulation; Eclampsia; Epoprostenol; Factor VIII; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinogen; Fibrinopeptide A; Humans; Hypertension; Platelet Count; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Hematologic; Thrombin; Thrombocytopenia; Thromboxane A2

Topics: Animals; Blood Cell Count; Blood Coagulation; Blood Coagulation Tests; Blood Platelets; Disseminated Intravascular Coagulation; Eclampsia; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinogen; Fibrinolysis; Hemostasis; Heparin; Humans; Hypertension; Placental Insufficiency; Pre-Eclampsia; Pregnancy

Topics: Animals; Blood Coagulation; Blood Coagulation Tests; Brain; Capillaries; Disseminated Intravascular Coagulation; Eclampsia; Female; Fibrin; Heparin; Humans; Kidney Cortex Necrosis; Kidney Glomerulus; Liver; Placenta; Platelet Adhesiveness; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Hematologic

This study reviews liver disease in toxemia of pregnancy based on 102 cases submitted to the Armed Forces Institute of Pathology. The common clinical features were right upper quadrant and epigastric pain, nausea, vomiting, and elevation of the serum transaminases. Jaundice occasionally developed. These occurred in severe preeclampsia or eclampsia and their cause was usually recognized. However, hepatic symptoms and signs did result in inappropriate diagnoses and misdirected therapy. Such confusion occurred when these were the initial problems confronting the clinician in women presenting with advanced toxemia due to poor prenatal care. They were also likely to be misleading when other more classic parameters, such as blood pressure and proteinuria, were only midly abnormal. Central nervous system complications were the common cause of death but liver disease could be partially or wholly responsible. Extensive periportal lesions, hepatic hematomas, spontaneous rupture, and infarction all contributed to hepatic injury and to morbidity. Fibrin deposition, hemorrhage, or both in the periportal areas was characteristic of the histopathology. Scanning electron microscopy validated this spectrum of change. A toxemic vasculopathy related to severe vasospasm in the hepatic arterial circulation may be responsible.

Topics: Eclampsia; Female; Fibrin; Hemorrhage; Humans; Infarction; Liver; Liver Diseases; Necrosis; Pre-Eclampsia; Pregnancy

Topics: Basement Membrane; Capillaries; Eclampsia; Endothelium; Epithelium; Female; Fibrin; Foam Cells; Humans; Kidney; Kidney Diseases; Kidney Glomerulus; Lipids; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Thrombosis

Topics: Abortion, Threatened; alpha-Fetoproteins; Eclampsia; Female; Fetal Death; Fibrin; Fibrinogen; Glycoproteins; Humans; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy, Multiple

Topics: Blood Coagulation; Disseminated Intravascular Coagulation; Eclampsia; Female; Fibrin; Fibrinogen; Humans; Kidney; Pre-Eclampsia; Pregnancy

Topics: alpha-Macroglobulins; Complement C3; Complement C4; Eclampsia; Female; Fibrin; Humans; Immunoglobulin A; Immunoglobulin E; Immunoglobulin G; Immunoglobulin M; Kidney; Kidney Glomerulus; Pre-Eclampsia; Pregnancy

Renal biopsies in 14 patients with P.E.T. or eclampsia showed constant I.F. reactions for IgM and fibrin, with frequent reactions for C1q and C3. The glomeruli showed reversible mesangial proliferation and swelling, with characterictic E.M. deposits, and segmental lesions were present in seven patients. Similar I.F. reactions occurred in three other patients with clinical diagnoses of P.E.T. whose biopsies demonstrated coexistent glomerular disease. Serum complement studies showed a significant rise in C3 in the third trimester of normal pregnancies and a further significant elevation in C1q and C3 in the third trimester of a series of unselected P.E.T. patients. In contrast, four patients from the biopsy series with eclampsia or severe P.E.T. showed profound depression of serum C3 and C4, at the time of maximum clinical severity, which was shown to return to normal in two patients. The I.F. findings confirm those of Petrucco et al (6), and, with the other data, suggest that immune-complex deposition and activation of the classical complement pathway could interrect with intravascular coagulation to produce the glomerular lesions of P.E.T. and eclampsia.

Topics: Adolescent; Adult; alpha-Macroglobulins; Complement C1; Complement C3; Complement C4; Complement System Proteins; Eclampsia; Female; Fibrin; Humans; Immunoglobulin M; Kidney; Kidney Glomerulus; Postpartum Period; Pre-Eclampsia; Pregnancy

Alternations in the coagulation mechanism were looked for in a population of eclamptic women, most of when were young, nulliparous, and without evidence of chronic vascular disease, and all of whom survived. Thrombocytopenia was identified in 29% of these women. A prolonged plasma thrombin time was demonstrated in 51% yet elevated fibrinogen-fibrin degradation products in serum were uncommon, as was fibrin monomer in plasma. Overt microangiopathic hemolysis was rare. It is concluded that disseminated intravascular coagulation, when it does occur in eclampsia, is the consequence of the disease rather than the cause. Moreover, endothelial damage, rather contents, probably initiates the thrombocytopenia and other coagulation changes.

Topics: Adolescent; Blood Cell Count; Blood Coagulation; Blood Platelets; Eclampsia; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinogen; Hemolysis; Humans; Pregnancy; Thrombin

Topics: Blood Coagulation; Disseminated Intravascular Coagulation; Eclampsia; Female; Fibrin; Fibrinolysis; Histocytochemistry; Humans; Labor, Obstetric; Pre-Eclampsia; Pregnancy

The maternal coagulation mechanism has been investigated in an effort to identify its role, if any, in the pathogenesis of eclampsia. Thrombocytopenia was identified in 28 of 95 cases (29 per cent), a prolonged thrombin time in 19 of 38 (50 per cent), abnormally elevated serum fibrinogen-fibrin degradation products in two of 65 (3 per cent), and circulating fibrin monomer in one out of 20 (5 per cent). Overt hemolysis was rare (2 per cent). Thus the pattern as well as the degree of change in the maternal coagulation mechanism differed remarkably from that typical of severe abruptio placentae and of prolonged retention of a dead fetus, the classic obstetric models of fast and slow disseminated intravascular coagulation. It is concluded that the coagulation changes when present in eclampsia are effect rather than cause. Moreover, the changes may evolve primarily from platelet adherence at sites of vascular endothelial damage as the consequence of segmental vasospasm and vasodilatation rather than be triggered by the escape of thromboplastin from the placenta into the maternal circulation.

Topics: Abruptio Placentae; Adolescent; Blood Cell Count; Blood Platelets; Disseminated Intravascular Coagulation; Eclampsia; Female; Fibrin; Fibrin Fibrinogen Degradation Products; Fibrinogen; Hemolysis; Humans; Pregnancy; Thrombin; Thrombocytopenia; Time Factors

Topics: Anemia, Hemolytic; Disseminated Intravascular Coagulation; Eclampsia; Endothelium; Female; Fibrin; Fibrinogen; Fluorescent Antibody Technique; Humans; Kidney Glomerulus; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Hematologic

Topics: Animals; Blood Cell Count; Blood Platelets; Blood Pressure; Decidua; Dietary Proteins; Eclampsia; Female; Fibrin; Pre-Eclampsia; Pregnancy; Rabbits; Serum Albumin; Sodium Chloride; Tissue Extracts

Topics: Adolescent; Chemical Precipitation; Chromatography; Disseminated Intravascular Coagulation; Eclampsia; Electrophoresis; Electrophoresis, Polyacrylamide Gel; Female; Fibrin; Fibrinogen; Humans; Immunodiffusion; Male; Molecular Weight; Pregnancy

Topics: Basement Membrane; Eclampsia; Epithelial Cells; Female; Fibrin; Humans; Kidney Glomerulus; Microscopy, Electron; Pre-Eclampsia; Pregnancy

Topics: Biopsy; Carbamates; Eclampsia; Female; Fibrin; Gestational Age; Humans; Immunosuppressive Agents; Lymph Nodes; Pre-Eclampsia; Pregnancy; Vascular Diseases

Topics: Blood Coagulation; Blood Platelets; Eclampsia; Female; Fibrin; Fibrinogen; Fibrinolysin; Fibrinolysis; Humans; Lung; Plasminogen; Pre-Eclampsia; Pregnancy; Radiography; Radionuclide Imaging; Technetium; Thrombocytopenia

The coagulation and fibrinolytic mechanisms were investigated in a group of patients with severe pre-eclampsia and eclampsia and the findings were compared with those of healthy women in late pregnancy. In patients with pre-eclampsia the following significant differences were found: (1) greater depression of plasma fibrinolytic activity (euglobulin lysis time) than in normal pregnancy, (2) a higher level of inhibitor to urokinaseinduced lysis, (3) increased levels of serum fibrin degradation products, and (4) reduced platelet counts.In patients with eclampsia a progressive increase of the level of serum fibrin degradation products was found over the three days following eclamptic seizures. No such increase occurred after grand mal seizures in late pregnancy. The findings in this study support the view that intravascular clotting is taking place in pre-eclampsia and that this disturbance of the balance between coagulation and fibrinolysis may be localized to certain areas of the vascular compartment, particularly the placental and renal circulations. Fibrin deposition in the maternal vessels supplying the placenta would impair the placental blood flow, which may explain the placental insufficiency which occurs in pre-eclampsia. Likewise fibrin deposition in the renal vasculature will result in glomerular damage and proteinuria. Hypertension may be related to the renal ischaemic changes or a compensatory response to the presence of fibrin deposition in the vascular compartment. This evidence of intravascular fibrin deposition raises the question of the possible therapeutic value of antithrombotic agents to inhibit the clotting process. On a theoretical basis such treatment might be expected to improve blood flow to the placenta and thereby fetal growth.

Topics: Adult; Blood Coagulation; Blood Platelets; Eclampsia; Embryonic and Fetal Development; Epilepsy, Tonic-Clonic; Female; Fibrin; Fibrinolysis; Fibrinolytic Agents; Humans; Hypertension; Ischemia; Kidney; Kidney Diseases; Maternal-Fetal Exchange; Placenta; Pre-Eclampsia; Pregnancy; Proteinuria; Serum Globulins

Topics: Animals; Eclampsia; Endotoxins; Female; Fibrin; Hexamethonium Compounds; Kidney Glomerulus; Magnesium; Male; Phytotherapy; Plants, Medicinal; Plants, Toxic; Potassium; Pregnancy; Rabbits; Shwartzman Phenomenon; Veratrum

Topics: Albuminuria; Eclampsia; Edema; Female; Fibrin; Humans; Hypertension; Pre-Eclampsia; Pregnancy

Serum levels of fibrinogen/fibrin degradation products, measured in African women, were significantly higher in pre-eclamptic toxaemia than in normal pregnancy, and were significantly higher with eclampsia than with toxaemia. These findings are in accord with the hypothesis that eclampsia and toxaemia are associated with disseminated intravascular coagulation, which may be responsible for certain clinical manifestations of these conditions.

Topics: Blood Coagulation Disorders; Disseminated Intravascular Coagulation; Eclampsia; Female; Fibrin; Fibrinogen; Fibrinolysis; Humans; Postpartum Period; Pre-Eclampsia; Pregnancy

Topics: Animals; Capillaries; Cricetinae; Eclampsia; Embolism; Female; Fetus; Fibrin; Humans; Infant, Newborn; Kidney; Lung; Maternal-Fetal Exchange; Microcirculation; Placenta; Pregnancy; Regional Blood Flow; Respiratory Distress Syndrome, Newborn; Transillumination; Umbilical Veins; Uterus; Veins

The levels of fibrin, fibrinogen degradation products (F.D.P.) in the serum were investigated in normal pregnancy and parturition, after caesarean section, and in patients with abruptio placentae, eclampsia, intrauterine death, and post-partum haemorrhage. No significant change occurred during normal pregnancy, but a highly significant increase was found during labour and again during the first week after normal delivery. After caesarean section the levels of F.D.P. were increased two to four hours after operation, and substantially higher levels were found three to eight days after operation than after normal delivery. High levels of F.D.P. were associated with abruptio placentae and eclampsia, and increased levels after intrauterine death and post-partum haemorrhage.An excess of F.D.P. with diminished or normal systemic fibrinolytic activity suggests that local intravascular fibrin deposition and fibrinolysis occur in normal parturition and in these complications of pregnancy. The very high levels of F.D.P. found in abruptio placentae will be important in the pathogenesis of the defective haemostasis that may accompany this complication.

Topics: Abruptio Placentae; Cesarean Section; Eclampsia; Female; Fetal Death; Fibrin; Fibrinogen; Fibrinolysis; Hemostasis; Humans; Labor, Obstetric; Postpartum Hemorrhage; Pregnancy; Pregnancy Complications

Topics: Abortion, Septic; Abruptio Placentae; Antibodies; Antigens; Blood Coagulation Disorders; Eclampsia; Embolism, Amniotic Fluid; Female; Fetal Death; Fibrin; Fibrinogen; Fibrinolysis; Hemostasis; Humans; Immunoelectrophoresis; Kidney Glomerulus; Lung; Pregnancy; Pregnancy Complications, Hematologic; Spleen; Thrombelastography

Topics: Animals; Autopsy; Cricetinae; Eclampsia; Female; Fetal Death; Fibrin; Humans; Infant Mortality; Infant, Newborn; Kidney Glomerulus; Lung; Maternal-Fetal Exchange; Methods; Microcirculation; Placenta; Placenta Diseases; Pregnancy; Pregnancy Complications; Thromboplastin; Time Factors

Topics: Eclampsia; Female; Fibrin; Humans; Pregnancy

Topics: Disseminated Intravascular Coagulation; Eclampsia; Embolism; Female; Fibrin; Humans; Placenta; Pregnancy