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Excerpt
Background: TEG is used to manage coagulation defects in obstetric patients [1]. During normal pregnancy, coagulation changes to a state of hypercoagulability [2]. To assess abnormal haemostasis during pregnancy using TEG, a set of TEG parameters at different stages of normal pregnancy must be developed. We measured coagulation parameters in nonpregnant and pregnant women at different stages of pregnancy.
Materials and methods: Following institutional approval and patient consent, 50 ASA I and II female patients were included in this prospective study. Patients with known or suspected coagulation disorders or using drugs influencing normal coagulation were excluded, as well as patients who were actively bleeding. PT, aPTT, fibrinogen, d-dimeres, thrombocytes and TEG were determined. Five groups of 10 women were identified: nonpregnant patients (NP), patients between 13 and 25 weeks of gestation (2T), patients between 26 and 36 weeks gestation (3T), term parturients not in active labour (TNL) and term partients in active labour (TAL). All data were analysed using ANOVA with Scheffe's post hoc test whenever appropriate. Data are presented as a mean ± standard deviation.
Results: No differences in demographic data were observed between the groups. Fibrinogen (4.74 ± 68 g L−1 in the 3T-group vs. 2.47 ± 0.75 g L−1 in the NP-group), clot formation rate (α-angle of TEG: 47 ± 4 in the 3T-group vs. 36 ± 9 in NP-group) and maximal amplitude of clot formation [MA (mm): 66 ± 4 mm in the 3T-group vs. 53 ± 7 mm in the NP-group] increased significantly from the third trimester of pregnancy, indicating hypercoagulability. Labour did not influence coagulation parameters compared to nonlabouring, third trimester parturients.
Discussion: Pregnancy is associated with a hypercoagulable state. TEG reflects this hypercoagulability since both α and MA are increased. Fibrinogen also increases during the third trimester. Hypercoagulability becomes obvious from the third trimester of pregnancy. Labour does not change the TEG-parameters.
