APTV in the blood: what is it, causes of low and high, norms in the coagulogram. Why and when is a coagulogram prescribed during pregnancy Coagulogram during pregnancy transcript
Every pregnant woman undergoes a series of tests. Some of them are mandatory, while others are subject to certain indications. Blood tests allow you to evaluate the work of the female body and identify possible complications in the course of pregnancy in time. The list of necessary includes a coagulation analysis -.
Why take this test during pregnancy
The state of the circulatory system is an important indicator of the health of a pregnant woman. Deviations from the norm may indicate the development of serious complications. Coagulogram - an analysis that shows the level of blood clotting () in the body. In medicine, it is also called "hemostasiogram". This is a rather complex study that allows you to determine the work of the coagulation and anti-coagulation systems.
Pregnancy involves many changes in the physical and psycho-emotional plane. The work of the circulatory system of a woman is no exception. At this time, hemostasis indicators increase. So the female body is gradually preparing for the appearance of an additional circle of blood circulation and for the inevitable blood loss during childbirth.
For the expectant mother and baby, any changes in the coagulorogram can mean the development of pathology. With a reduced level of hemostasis, severe blood loss and placental abruption are possible. If the indicator is increased, there is a threat of the formation of blood clots (blood clots), which will inevitably lead to fetal hypoxia. In addition, the tendency to thrombosis can threaten blockage of the vessels of the pulmonary artery. Thrombosis of the veins of the lower extremities and veins of the small pelvis is also possible.
Important! Blood clotting disorders, if not properly monitored and treated, can lead to premature birth or miscarriage.
Video: why blood clotting indicators are important
In what cases is a clotting analysis indicated?
A planned analysis is carried out three times during the entire pregnancy:
- When registering with a gynecologist.
- At 22–24 weeks (II trimester).
- At 30-36 weeks (III trimester, shortly before childbirth).
It should be noted that a coagulogram is performed 1 time per trimester only in the normal course of pregnancy.. In some cases, additional research is recommended. This happens when a woman is diagnosed or suspected of having:
- autoimmune diseases;
- phlebeurysm;
- liver disease;
- Rhesus conflict with the father of the child;
- vascular, endocrine pathologies;
- disorders of the circulatory system,
- disorders of the genitourinary system;
- predisposition to bleeding or increased clotting;
- miscarriage of a previous pregnancy;
- multiple pregnancy;
- disorders of the placenta;
- anemia or iron deficiency anemia (more details:);
- tendency to thromboembolism, heart attacks, stroke.
The bad habits of the expectant mother are also an indication for constant monitoring of blood clotting.
A pregnant woman may be assigned an extended analysis of the coagulogram. This happens in case:
- the presence of any complications in the I and III trimester (edema, increased pressure);
- preeclampsia (toxicosis of the second half of pregnancy);
- multiple pregnancy;
- pregnancy after long infertility;
- women's predisposition to blood diseases.
If the doctor deems it necessary, a clotting test will be done monthly.
How to prepare for the procedure
Blood is taken from a vein. Before the study, it is not recommended to eat for 8-12 hours. The analysis is given only in the morning on an empty stomach. You should also not drink coffee, tea, compotes and other drinks. It is allowed to drink only ordinary non-carbonated water.
Before the study, a woman needs to calm down, as it has been proven that tension and stress affect the result.
If a woman is taking any medications, it is imperative to inform the laboratory assistant about this in advance and prescribe the names of the medications in the analysis form.
Video: proper preparation for a blood test
Decoding of indicators and norm
The clotting analysis contains eight leading indicators:
- Fibrinogen is a protein produced by the liver. It is the main element of thrombosis. Thanks to the uteroplacental circulation, its indicators gradually increase as the day of delivery approaches. Deviation from the norm indicates inflammatory process passing in the body of a woman.
- Activated partial thromboplastin time (APTT) is the period during which one blood clot forms. In pregnant women, this value decreases slightly, which is the norm. A large decrease in the level indicates the risk of blood clots, while an increase indicates a predisposition to bleeding.
- Thrombin time (TV) - the period of blood clotting. It increases during pregnancy. Deviation from the norm often occurs when there is a malfunction in the liver.
- Lupus anticoagulant - an indicator of the formation of antibodies. Normally, they should not be found in the blood of a pregnant woman. Their appearance, as a rule, indicates autoimmune diseases, preeclampsia, the presence of blood clots in the arteries and veins.
- Platelets are blood cells that take an active part in the clotting process and are responsible for the state of the hematopoietic system. During pregnancy, their level slightly decreases, and a significant decrease indicates the presence of a progressive disease.
- D-dimer is an indicator of the thrombus formation procedure. During pregnancy, it rises slightly. A sharp increase indicates the development of diabetes, kidney disease or preeclampsia.
- Antithrombin III is a protein that slows down the process of blood clotting. A decrease in its amount means a tendency to form blood clots, and an increase in its level means an increased risk of bleeding.
- Prothrombin is a component of blood plasma. An increase in the level may signal placental abruption.
With a normal pregnancy, four indicators of the coagulogram are usually sufficient:
- APTT;
- prothrombin;
- fibrinogen;
- platelets.
If necessary, make a detailed picture of blood coagulation. Even a slight deviation from the norm can lead to serious consequences.
The interpretation of the results of the coagulogram is carried out only by a doctor, since there are errors in the indicators that may be associated with chronic diseases of a woman, malnutrition, intake medicines.
Table: coagulogram norm
Possible changes by trimester
Indications change somewhat during pregnancy. The fact is that the woman's body is preparing for the upcoming birth and blood clotting increases.
Table: range of acceptable blood clotting values during pregnancy
Index | Norm during pregnancy |
||
I trimester | II trimester | III trimester |
|
fibrinogen | |||
thrombin time | |||
Lupus coagulant | absent |
||
platelets | 120–415 x 10 billion/l |
||
up to 750 ng/ml | |||
Antithrombin III | the lower limit gradually decreases from 74% to 70% the upper limit is 115–116% |
||
Prothrombin | |||
After passing the first test for blood clotting in a pregnant woman, an increased number of platelets, a slightly increased density of fibrogens, and a shorter period of blood clotting are normally detected, compared with the usual norm for an adult. In addition, D-dimer indicators throughout pregnancy change upwards. This value should be assessed both before pregnancy and throughout the entire process of bearing a baby. But the indicators of prothrombin should not change.
Pathological deviations from the norm
A strong deviation from the norm in the direction of decrease or increase may indicate the development of:
- diabetes mellitus of pregnant women;
- diseases of the liver, kidneys.
Lack of blood clotting inevitably leads to uterine bleeding and miscarriage, and increased clotting leads to the formation of blood clots, which causes insufficient oxygen supply to the fetus and hypoxia (oxygen starvation).
It should be borne in mind that a change in the values of the coagulogram is also possible with late toxicosis (preeclampsia), which leads to serious consequences:
- intrauterine growth retardation;
- premature birth;
- placental abruption;
- heart and kidney failure.
In addition, the doctor pays attention to the indicator of antibody formation (lupus anticoagulant). In the normal course of pregnancy, it is absent. Its appearance indicates the presence in the woman's body of autoimmune diseases. As a rule, the time of formation of one blood clot (APTT) immediately increases.
Detection of lupus anticoagulant occurs when:
- rheumatoid arthritis (joint damage);
- (malfunction of the immune system, in which inflammation develops in various organs and tissues of the body);
- ischemic stroke (impaired cerebral circulation).
A deviation from the norm of this value may indicate:
- development of thrombosis of blood vessels;
- placental infarction - a sharp cessation of its blood supply;
- intrauterine fetal death;
- spontaneous abortion.
When treated with heparin, a positive value of the lupus anticoagulant indicator is also observed, this is normal.
If treated with anticoagulants medicines(Warfarin, Fenilin), it is necessary to regularly monitor the value of the INR (international normalized ratio). This is the ratio of the actual prothrombin time determined during the analysis and the average value of the prothrombin time. The allowable rate is 2.5.
If the pathology is detected in time, the chances of preventing its further development are very high.
A coagulogram is a mandatory blood coagulation test that every pregnant woman undergoes. You should not immediately get upset, and even more so panic, if the indicators deviate slightly from the average values. Listen to the recommendations of your doctor in order to correct any unwanted changes in a timely manner.
A coagulogram is a study of the blood coagulation system. A coagulogram allows you to identify the features of a clotting disorder in a pregnant woman and some complications of pregnancy and, therefore, to conduct the correct treatment.
In the normal course of pregnancy, the activity of the blood coagulation system as a whole increases. This is a natural process associated with the appearance of the uteroplacental circulation. It is due to the fact that the body of a pregnant woman is preparing for an increase in blood volume during childbearing and for possible blood loss during childbirth.
A coagulogram should be taken once a trimester, and in the presence of deviations in hemostasis (a set of components of blood vessels and blood, the interaction of which maintains the integrity of the vascular wall and stops bleeding in case of damage to the vessels) - more often, as directed by a doctor.
Blood for analysis is taken from a vein in the morning on an empty stomach.
The main indicators of the coagulogram
fibrinogen- a protein, a precursor of fibrin, which forms the basis of a clot during blood clotting. Normal values are 2.0-4.0 g/l. Fibrinogen is a sensitive indicator of the presence of inflammation and necrosis (necrosis) of tissues, the main plasma protein that affects the ESR value (erythrocyte sedimentation rate). It increases with increasing fibrinogen concentration. During pregnancy, starting from the end of the first trimester, there is a natural increase in plasma fibrinogen content and reaches maximum values (up to 6 g/l) on the eve of childbirth. This is due to the appearance of an additional circle of blood circulation - uteroplacental.
APTT- activated partial thromboplastin time, normal - 24-35 s. This is the clotting time, depending on the presence of clotting factors. The definition of APTT, along with other indicators, is used in the diagnosis of disseminated intravascular coagulation (DIC), which is discussed below. In pregnant women, there is a shortening of the APTT to 17-20 s due to an increase in the amount of fibrinogen.
Lupus anticoagulant- normally should not be produced in a pregnant woman. This is a group of antibodies (IgM and IgG) to the outer shell of platelets. The presence of these antibodies is accompanied by an increase in APTT. These antibodies appear in autoimmune diseases (when the immune system is directed against its own organs), in the pathology of pregnancy (preeclampsia - a complication that worsens the condition of the mother and fetus and is manifested by an increase in blood pressure, the appearance of edema, protein in the urine). For such patients thromboses of arteries and veins are characteristic. Pregnancy against the background of such a pathology is often complicated by spontaneous abortion, placental infarction, and fetal death.
Thrombin Time (TV)- normal - 11-18 s. This is the time of the last stage of blood coagulation: the formation of fibrin from fibrinogen under the action of thrombin. Given that during pregnancy, the content of fibrinogen increases, therefore, the thrombin time lengthens, but remains within the specified limits. The definition of TB is used to detect defects in the production of fibrinogen (for example, fibrinogen may increase with liver pathology) and to assess the anticoagulant activity of the blood.
Prothrombin- normal values - 78-142%. This indicator is defined as a percentage, as it allows you to determine the activity of the prothrombin complex of the patient's plasma in comparison with the measured prothrombin time of the control plasma. One of the most important indicators of the coagulogram, which characterizes the state of the blood coagulation system, is the time of the second stage of coagulation - the formation of thrombin from prothrombin. An increase in this indicator in pregnant women may be with premature detachment of the placenta.
How does the blood coagulation system work?
The process of blood clotting consists of several stages. At the first stage, in case of mechanical or chemical damage to the wall of a blood vessel, a special substance is released - thromboplastin, which triggers coagulation reactions. The second stage is the activation of coagulation factors - special proteins that are normally always present in the blood, which ensure the formation of a blood clot at the site of damage to the vascular wall. The third stage is the activation by thrombin (a natural component of the blood coagulation system, which is formed in the body from prothrombin) of the inactive fibrinogen protein, turning it into active fibrin, which forms the basis of the clot. Platelets and other blood cells are "entangled" in fibrin networks, platelets contract the clot, compress it and form a mature thrombus that closes the defect in the vascular wall.
In contrast to the coagulation system, the anticoagulation system works in the body. The coordinated work of these systems allows you to maintain a normal state of blood.
Antithrombin III- normal values - 71-115%. It is a protein of the anticoagulant system, a thrombin inhibitor. It has a depressing effect on the processes of blood coagulation. The amount of antithrombin III is determined by inhibition (binding of thrombin in the control sample). Its decrease can lead to thrombosis. For expectant mothers, the determination of this indicator is important when using anticoagulants - drugs that reduce blood clotting. These drugs are used during pregnancy with an increase in blood clotting, since this condition leads to pregnancy, the formation of placental insufficiency, etc. A decrease in the level of antithrombin III by 50% of the norm indicates the risk of thrombosis.
D-dimer- normal - less than 248 ng / ml. This is an indicator of thrombus formation (the process of thrombus formation, which consists of the three successive stages described above) and fibrinolysis (dissolution of fibrin). The determination of this indicator is important in clinical practice for the diagnosis of thrombosis. In pregnant women, starting from early pregnancy, the level of D-dimer in the blood gradually increases. By the end of the gestation period, its values \u200b\u200bcan be 3-4 times higher than the initial level - this is a variant of the norm. Significantly higher levels of D-dimer are observed in women with a complicated pregnancy - as well as in pregnant women with diabetes, kidney disease.
platelets- These are the formed elements of the blood involved in ensuring hemostasis. Platelets are formed in the bone marrow. The norm of platelets is 150-400 thousand / μl. A moderate decrease in the number of platelets (up to 130 thousand / mkl) can sometimes be observed in healthy pregnant women. Thrombocytopenia - a significant decrease in the number of platelets - may result from a decrease in platelet production, increased destruction or consumption. Platelet production is reduced with malnutrition. Platelet consumption is increased in DBS.
A coagulogram should be taken once a trimester, and if there are deviations in hemostasis, more often, as prescribed by a doctor.
Blood clotting disorders in pregnant women. Complications and consequences
The balance between the coagulation and anticoagulation systems is maintained through the interaction of platelets, coagulation factors and the fibrinolysis process. Violation affecting any of these links can cause serious complications of pregnancy. Among these complications, the most dangerous is DIC (disseminated intravascular coagulation). This syndrome develops due to the activation of the coagulation system, on the one hand, and the fibrinolysis system, on the other. DIC in pregnant women can be caused by various reasons. Among them:
- premature - abruption of a normally located placenta before the birth of a child. In 80% of cases, this disease is accompanied by bleeding from the genital tract, sometimes a hematoma forms behind the placenta. Bleeding is associated with a decrease in plasma concentrations of coagulation factors, fibrinogen and platelets;
- amniotic fluid embolism is a rare but dangerous complication that develops during complicated labor, due to the intake amniotic fluid into the mother's bloodstream, the vessels of the lungs, leading to acute respiratory failure and shock. DIC develops as a result of a massive intake of tissue thromboplastin, a substance that triggers the process of blood coagulation, into the bloodstream;
- endometritis - inflammation of the inner lining of the uterus - developed after childbirth, can be complicated by a fulminant form of DIC.
One of the reasons for the termination of pregnancy of various periods is antiphospholipid syndrome(AFS). APS is a complex of symptoms characterized by venous and arterial thrombosis. Pregnant women are at increased risk of pregnancy and spontaneous abortions due to a violation of the increase in the number of vessels of the placenta with development - a violation of the basic functions of the maternal placenta, leading to serious violations of the intrauterine development of the fetus, as well as due to vascular changes. To diagnose APS, in addition to increasing thrombus formation, antibodies to phospholipids (the outer shell of membranes) are determined.
A coagulogram is a blood clotting test. Deciphering the coagulogram shows the norm or pathology of the blood coagulation system. The most serious complications of pregnancy - venous thrombosis, preeclampsia, thrombophilia and some others can be recognized in a timely manner thanks to a coagulogram. In pregnant women, the risk of venous disease is 5 times higher than in non-pregnant women, which is why the coagulogram must be measured during pregnancy and more than once!
The coagulation (coagulation) system is an emergency blood service, it works at the time of bleeding in childbirth and it has no price, but it is fraught with a terrible threat if it starts to work in the body of a pregnant woman ahead of time! Read more about Queen Cleopatra and Elena Proklova.
During pregnancy, coagulation changes, at the beginning and in the middle of pregnancy, subtle mechanisms of adjustment to the blood supply of two organisms, two bodies prevail, blood is fluid, glides freely through the thinnest vessels, freely passes into the most secluded corners of two bodies, in childbirth, on the contrary, it closes bleeding vessels due to the formation of blood clots. Blood clots are good at the time of bleeding and very bad if there is no bleeding.
The coagulation function of the blood during normal pregnancy changes, there is an increase in coagulation factors. This is natural, since an additional circle of blood circulation appears, which provides nutrition to the fetus and blood supply to the uterus. The body of the expectant mother is preparing for possible blood loss during childbirth. A blood test for coagulation in pregnant women is carried out three times, and in the case of altered indicators, more often.
The coagulogram makes it possible to evaluate all stages of blood coagulation not only in pregnant women, but also in any other patients. Any significant deviations indicate a pathological course and even the risks of abortion at different times. Hemostasis is the body's ability to maintain the qualitative and quantitative composition of blood. With normal hemostasis, the course of pregnancy occurs without deviations. With an increase in the level of thrombus formation, there is a certain risk for the blood vessels of the placenta. The formation of tiny blood clots in the placenta is one of the main causes of fetal hypoxia. Blood clots can also form in the large veins of the mother's body. There is a possibility of placental abruption and profuse bleeding with the possibility of developing a very dangerous complication - DIC. Syndrome of disseminated intravascular coagulation. This syndrome develops with severe bleeding and is characterized by the fact that the harmonious coagulation system ceases to work as a single system, there is a discord, an imbalance in blood coagulation, and all this ends sadly - multiple organ failure.
Basic indicators
There are many indicators of coagulation. Now you can determine the various coagulation factors, of which there are many. But there are basic ones that can tell a lot about how the pregnancy proceeds and what to fear.
Depending on the laboratory, an abbreviated or expanded analysis of the coagulogram is done. The abbreviated coagulogram contains the indicators FIBRINOGEN, APTT, PROTHROMBIN, and other indicators can be determined in the expanded coagulogram.
Deciphering the coagulogram
fibrinogen
Fibrinogen is a protein that is a precursor of fibrin. Norms for non-pregnant women are about 2.0 - 4.0 g / l. Elevated levels in non-pregnant women indicate that there is inflammation or necrosis. From 13-14 weeks, fibrinogen normally rises and reaches 6 g / l before childbirth.
- non-pregnant 2.3 - 5 g / l;
- first trimester 2.4-5.1 g/l;
- second trimester 2.9-5.4 g/l;
- third trimester 3.7 - 6.2 g / l;
APTT
APTT is the coagulation time or activated partial clotting time, normally in non-pregnant women it is 24-35 s and depends on many factors. The APTT changes in seconds in the event of an accident in the body and is mainly used to investigate unexplained bleeding or abnormalities in certain properties of the blood. This test can be used to help the doctor assess the severity of the situation in case of prolonged bleeding.
APTT in pregnant women can normally be lower than 24. As the delivery approaches, the APTT may decrease to 18-20 as the body prepares for blood loss and the amount of fibrinogen increases. A shorter APTT signals the threat of DIC.
An increase in APTT indicates that the blood does not coagulate well, hypocoagulation. There are many reasons for this and it is always a pathology, for example, there is a deficiency of coagulation factors in the blood.
An example of a disease with a deficiency of a clotting factor is hemophilia, as they used to say, a royal disease. Women do not suffer from classical hemophilia, but their sons do. Read about
The famous carrier of the hemophilia gene was Queen Victoria, she did not get sick, but she passed this gene on to her child, Duke Leopold. Later, her gene got to the Russian Tsarevich Alexei Nikolaevich. Even if no one in the family has clotting problems, the newborn may be born already sick. Approximately one third of children with positive test for hemophilia do not have relatives with this disease. Watch the video at the end of the article.
This examination is also necessary before surgery to find out if the woman is at increased risk for uncontrolled bleeding.
Prothrombin- determined as a percentage compared to the control plasma sample. Normally 80-140%.
thrombin time
This indicator characterizes the final stage of coagulation: the formation of fibrinogen from fibrin. This process requires thrombin.
Thrombin time characterizes the properties of plasma and its ability to clot. Doctors usually order this test to evaluate how well clotting medications are working or to check for clotting during pregnancy. Liver disease, hemophilia, and other coagulation disorders may show abnormal thrombin time. The definition of this indicator is used to detect abnormal liver function in the production of fibrinogen.
Normal value range
- in a non-pregnant adult woman: 12.7 to 15.4 seconds;
- 1st trimester of pregnancy: 9.7 to 13.5 seconds;
- 2nd trimester: 9.5 to 13.4 seconds;
- 3rd trimester: 9.6 to 12.9 seconds;
An increase in prothrombin time may indicate a threat of bleeding or the formation of hematomas. This test shows a deficiency of vitamin K, prothrombin and other elements in the blood.
Prothrombin index reflects the speed of certain coagulation links and is calculated on the basis of prothrombin time. It should not go beyond: 70-140. Deviations from normal values warn of placental abruption.
The remaining indicators of the coagulogram are prescribed by the doctor according to the indications. Not all laboratories do a detailed coagulogram.
Deciphering the extended coagulogram
Lupus anticoagulant It's an SOS signal!
Lupus anticoagulant - this indicator in a pregnant woman should be equal to zero "0". This antigen should not be in the blood of a healthy pregnant woman. It characterizes the presence of antibodies (IgM and IgG) to the outer membrane of platelet cells. This increases the APTT accordingly. Such antibodies arise if there are autoimmune diseases or preeclampsia appears - toxicosis of the second half of pregnancy. With these diseases, thrombosis of large and small vessels occurs. Pregnancy that occurs with such a pathology, in most cases, ends with self-abortion, heart attack, placental abruption, intrauterine fetal death.
Antithrombin III- norm: 72 - 116%. This T system protein is a thrombin inhibitor or blood system factor. It inhibits some processes of blood clot formation. Its decrease can lead to the fact that thrombosis occurs.
- Non-pregnant - 101.5 ± 12.7,
- 10 weeks – 101.4 ± 10.3,
- 20 weeks – 104.2 ± 12.5,
- 30 - 36 weeks – 102.8 ± 13.5
D-dimer- norm: less than 248 ng / ml.
It is a protein that appears after the breakdown of fibrin. D-dimer increases with the course of pregnancy and reaches its highest values by the period of childbirth. Abnormal, high levels of D-dimer are characteristic of women with preeclampsia and pregnancy that is accompanied by diabetes mellitus or kidney disease.
- D-dimer can also be indicated in mg/ml:
- in non-pregnant women, the norm is 0.24–0.5;
- 13 - 14 weeks - the norm - 0.75;
- 20 weeks - 1; 21 40 weeks to 1.5.
platelets These are red blood cells, without which hemostasis is impossible. The norm of platelets is 150-400 thousand / μl outside of pregnancy.
Pregnant women have their own platelet norm! Up to 130 thousand / μl - the norm - a slight decrease in their number in uncomplicated pregnancy. Severe thrombocytopenia (very few platelets) distress signal - a threat of DIC.
There are a lot of erroneous opinions about the coagulogram of pregnant women on the Internet. The decoding should be done ONLY by an obstetrician gynecologist or a laboratory assistant working in a antenatal clinic. During pregnancy, its own norm, different from the norm of non-pregnant women! It is STRICTLY IMPOSSIBLE to use the advice of mothers on the forums to decipher such a complex study.
Hair stand on end when you read what terrible decisions future moms make after deciphering the analysis by all the bright non-medical minds of the Internet. They drink medicines, poison themselves and their unborn baby!
The period of pregnancy is one of the most important and responsible in the life of every woman. And each future mom wants to do everything so that her child is born strong and healthy. An important condition for this is that it is necessary to undergo many tests and health checks in a timely manner, and regularly visit a gynecologist.
When observing pregnancy in each antenatal clinic, a number of mandatory and auxiliary medical tests are prescribed, which are given if certain indicators are present. In most cases, a coagulogram during pregnancy is mandatory - despite the complex name, which is very frightening for many - it is essentially just another blood test showing the level of its coagulability.
Features of blood circulation during pregnancy
In a coagulogram during pregnancy, the decoding is different, and without the necessary knowledge, the analysis will be difficult to interpret correctly. At the same time, during pregnancy, the indicators and the norm can be completely individual.
Blood clotting is the ability of the body to constantly maintain the amount and composition of blood in a stable form. That is, it is in some way a mobile balance for the body. With the course of pregnancy, these coagulograms will change somewhat, as the body begins to more intensively prepare for natural blood loss during the upcoming birth.
So, during pregnancy, the level of coagulation will have higher rates because the total blood volume also increases. This is because a pregnant woman has an additional circle of circulation in her body, and also due to the fact that during childbirth the body loses a lot of blood, it produces it with a margin in advance. Therefore, the norm for a pregnant woman will be completely different and only a doctor can make conclusions about the state of health here.
What is analysis and why is it needed?
For pregnant women, the proper functioning of the circulatory system is extremely important - this is one of the key indicators of health. A coagulogram can reveal in pregnant women (or a hemostasiogram) a tendency to the appearance of blood clots, bleeding. In addition, the analysis will show the possibility of developing various pathologies associated with the fetus, such as placental abruption, all kinds of complications during childbirth, and much more.
This analysis is mandatory and is given three times during pregnancy at the following stages:
- Immediately upon admission to the antenatal clinic in order to monitor pregnancy;
- In the period at 22-24 weeks;
- Between 30 and 36 weeks.
There may also be special indications for the delivery of such an analysis. An unscheduled delivery of a hemostasiogram analysis is preceded by:
- Before pregnancy there was infertility for a long time;
- There were cases of non-carrying of pregnancy;
- Various complications, such as multiple pregnancy, fetal lag regarding intrauterine development, and others;
- The presence in a pregnant woman of such destructive habits as smoking;
- Bruising when there were minor bruises, bleeding from the nose or gums during brushing.
Additionally, the analysis of the coagulogram of pregnant women can be used for decoding in order to determine abnormalities in the functioning of the liver, in order to track certain negative processes. An analysis is prescribed for women with vascular problems, varicose veins and with an Rhesus conflict with dad. In some situations, an extended coagulogram is performed and it can even be carried out monthly, if the supervising specialist considers such an approach reasonable.
When blood clotting is impaired, there is a serious threat to the fetus due to possible miscarriage, bleeding, or placental abruption. But with increased coagulability, there may be problems of their own, such as the appearance of a blood clot, insufficient oxygen supply to the fetus, and further hypoxia.
Blood clots also cause serious problems such as stroke, heart attack, premature birth and miscarriage. The danger of these situations is that in ordinary life such problems may not make themselves felt, but eventually lead to a critical situation. The risk group also includes women with a negative Rh factor, because their immune system, when carrying a fetus, can begin to fight with its own antibodies, mistaking them for foreign ones.
Preparation for passing the analysis
Blood for this analysis is taken from a vein present in the crook of the arm. In order for the norm and results to be determined correctly, it is necessary to properly prepare for any analysis. The coagulogram will also require physical and moral preparation. First of all, a woman should be mentally as calm as possible, only slight excitement is permissible. Before the test, at least an hour before, it is not recommended to physically strain in any way.
To obtain reliable indicators, you should not eat before the analysis - it is better if it is taken on an empty stomach and the last meal, including juices, coffee and tea, was at least 8 hours ago. You should especially refrain from sweets and chewing gum. You can drink only pure non-carbonated water. If the mother has bad habit smoking, refrain from it, too, half an hour before the examination.
Deciphering the results
There is a certain norm for indicators for pregnant women, but only a doctor should make final diagnoses and prescribe the necessary treatment measures. The thing is that not only pregnancy affects the results - a woman may have some chronic diseases, there will be deviations in the analysis, but nevertheless, the pregnancy will proceed safely.
Coagulogram norms during pregnancy: table
Therefore, only a specialist can decipher everything correctly, and a pregnant woman, on the basis of statistics, independently learns only general information. In general, the coagulogram includes 8 key indicators by which the doctor can accurately determine even small deviations.
What is the main focus:
- Fibrinogen is a protein that forms the basis for a blood clot during clotting. Exceeding the norm leads to a tendency to the appearance of thrombosis, and insufficiency may indicate toxicosis. The norm for standard cases of fibrinogen is from 2 to 4 g / l, for pregnant women this figure is 6 (at the same time, the level is constantly increasing towards the approach of childbirth).
- APTT is interpreted as activated partial thromboplastin time, which means the period of time during which blood clotting occurs. For a healthy ordinary person, this indicator is equal to 24-35 seconds, and in pregnant women, due to an increase in fibrinogen, clotting occurs faster - in about 17-20 seconds.
- Thrombin time is another important indicator of the coagulogram, indicating the duration of the last clotting period. The average norm is 11-18 seconds, for pregnant women it is higher. Deviations in this parameter may indicate malfunctions in the liver.
- Prothrombin is another protein present in plasma that precedes thrombin and is also involved in clot formation. The density of the blood and its ability to coagulate will depend on the concentration of this protein. The optimal indicator is from 78 to 142%. If the norm in a pregnant woman is exceeded, then this may be a sign of placental abruption.
- Platelets are special blood cells that are formed directly in the bone marrow. During pregnancy, platelet counts decrease slightly, and if the drop is strong, this indicates the presence of the disease. At the same time, the normal indicator is from 131 to 402 thousand / μl.
- D-dimer is a factor responsible for thrombosis in the human body. Plays an important role for the timely diagnosis of thrombosis. In pregnant women, this parameter gradually increases, but if the jump is sharp, then there may be diabetes or kidney problems. The standard indicator is from 33 to 726 ng / ml.
- Antithrombin III is a protein that slows down the clotting process, with a deviation of 50% or more, there is a risk of developing thrombosis. Should be present between 70 and 115%.
- Specific antibodies - according to this criterion, the presence of lupus anticoagulant in the body is determined. It should not be in a good way (with the exception of taking certain drugs during pregnancy), and if such a factor was nevertheless found, then the woman has pathologies that should be determined by the doctor in a timely manner.
The development of deviations can be largely influenced by excess weight or other individual characteristics of the organism. It is extremely important to take this analysis and other necessary ones in a timely manner during pregnancy and carefully prepare for them. This is the only way to protect your health and future baby.
As soon as a woman becomes pregnant, her whole life becomes different. The body is rebuilt, preparing for the growth of the fetus, the physiology is changing, completely new views on life appear, the emotional state changes.
But one more important point there is an account in the antenatal clinic and endless tests, including a coagulogram, which greatly complicates life during gestation. What kind of analysis is this, how often it needs to be done and why - we will consider below.
What is a coagulogram?
A coagulogram (clotting test) is a common blood test that helps to investigate its clotting ability: are there any violations in the form of increased or decreased clotting.
It is done without fail, since with its help the hemostasis system is examined, the propensity of the future mother's body to blood clots and bleeding, which affects the pathological development of the child, difficult or premature births, miscarriages, and other disorders, is also determined. Presenting the results of the hemostasis system in graphical form is also called a hemostasiogram.
When analyzing the coagulogram, the main and additional indicators of coagulation are checked (presented in the table below).
| Coagulogram | |
|---|---|
| Kinds | Indicators |
| 1. Main | |
| 2. Prothrombin, including Mno | |
| 3. APTT | |
| 4. Thrombin time | |
| 2. Extended | Basic indicators |
| + additional | |
| 5. Index of antithrombin III (AT3) | |
| 6. D-dimer | |
| 7. Lupus anticoagulant |
Violations when an extended coagulogram is prescribed
Coagulogram norms during pregnancy
A coagulation test is an important diagnostic for normal childbearing. The indicators of the norm of the coagulogram for a pregnant woman are presented in the table below.
| P / n | Coagulogram norm during pregnancy table | ||
|---|---|---|---|
| Coagulogram indicators | Significance for pregnant women by trimester | ||
| 1 | Fibrinogen (factor I) | norm | 1st trimester |
| 4-5 g/l | 2nd trimester | ||
| 6 g/l | 3rd trimester | ||
| Protein in the first trimester of a pregnant woman is the same as the norm, and after that it rises | |||
| 2 | thrombin time | 11-18 seconds | 1st, 2nd and 3rd trimester |
| If the thrombin time is lowered, then if the vessels or organs are damaged, it can lead to metrorrhagia, and if it is increased, then to liver dysfunction. | |||
| 3 | Activated partial thromboplastin time (APTT) | 17-20 sec | |
| In a woman in position, the value is too high relative to the norm | |||
| 4 | Prothrombin | 78-142 % | throughout pregnancy |
| Increasing the value leads to placental abruption | |||
| 5 | prothrombin time | up to 18 seconds | throughout pregnancy |
| The value during pregnancy is normal. If there are significant differences, then you need to urgently undergo an examination and eliminate the cause of its change. | |||
| 6 | Lupus anticoagulant | no antibodies | |
| The number of antibodies should show a zero value, otherwise it indicates an autoimmune complication of pregnancy | |||
| 7 | 78-130 units | 1st trimester | |
| 85-135 units | 2nd trimester | ||
| 90-140 units | 3rd trimester | ||
| An increase in value indicates that vein thrombosis is possible. | |||
| 8 | Antithrombin III | 75-125% | throughout pregnancy |
| If antithrombin 3 is lowered, this warns of a possible thickening of the blood and the creation of blood clots, and if it is increased, bleeding | |||
| 9 | D-dimer | 0-525 ng/ml | 1st trimester |
| 438-1200 ng/ml | 2nd trimester | ||
| 888-2085 ng/ml | 3rd trimester | ||
| Indicates the formation of blood clots: a slight increase for pregnant women is not terrible, but its sharp increase can be the cause of kidney disease, diabetes and other complications. |
In the coagulogram table, the normal values of the indicators, according to the results of a laboratory analysis of coagulability, will give the result of isocoagulation.
Isocoagulation is a definition that means that the state of the coagulation system is normal, and therefore the pregnancy proceeds normally, so there is nothing to worry about.
If preeclampsia or another violation of the course of pregnancy is confirmed, then coagulation occurs with violations, then treatment should be started immediately, or intravascular disseminated coagulation syndrome (DIC) may develop.
This syndrome occurs in stages.
- Hypercoagulability- Stage 1, in which numerous blood clots occur that interfere with the normal vascular pathway between the mother and fetus.
- Hypocoagulation- Stage 2, when blood clots are destroyed due to the weakening of the factors responsible for clotting.
- Acoagulation- the last stage, at which blood incoagulability occurs, uterine bleeding develops, which is dangerous for the life of the mother and child.
But remember, even if the results of the analysis are far from normal, but the coagulogram was done on time, and the treatment is performed promptly, then many risks can be eliminated.
The need and frequency of testing for clotting during pregnancy
For pregnant women, a coagulogram is an extremely important analysis. With its help, they monitor the balance of the coagulation and anticoagulation systems.
- The absence of such a balance carries, as mentioned above, consequences that threaten the health of the future mother and fetus.
- An imbalance in the direction of the anticoagulant system can induce metrorrhagia, placental abruption, blood loss during and after childbirth in a woman in labor, and in the direction of the coagulation system, it thickens the blood, forming blood clots. At the same time, a child who receives oxygen exclusively from the placenta experiences oxygen starvation - hypoxia develops, brain pathologies may develop, a woman suffers from pain in her legs and the development of thrombosis, and this can also cause a heart attack, stroke or miscarriage.
The procedure for passing the test is as follows: before taking blood, it is better to starve, that is, take the test on an empty stomach. Blood is taken from a vein at the elbow bend, your attending physician deciphers the result of the hemostasiogram.
With normal indicators, diagnostics are done as planned three times:
- During the registration of a pregnant woman (usually this is 1 trimester);
- In the second trimester;
- A week or two before childbirth, which is especially important for women who are being prepared for childbirth with a caesarean section.
In case of complications or abnormal course of pregnancy, homeostasis is checked much more often in order to adequately respond and prescribe effective treatment.
The norm indicators for a woman during this period, due to changes in physiology, are somewhat different from those before conception, since the female body sets up another blood circulation through the utero-placental-fetal blood flow (insurance against significant blood loss). Therefore, the diagnosis of the results of the coagulogram can only be done by your accounting doctor.
Hemostasiogram of indicators during pregnancy and interpretation of the results
What determines the coagulability indicators:
- This is a special protein, which is the main component of a blood clot, produced in a healthy person by the liver and it is distributed by the movement of blood through all blood vessels. If there is a damaged place in the vessel, then this protein turns into insoluble fibrin, which becomes the main component of the thrombus that clogs the damage to the vessel, thereby stopping the outflow of fluid from it. Such a thrombus, with a normal number of elements, will exist at the site of the lesion until the wound is completely healed.
Stop bleeding In case of a lack of factors 1 and 2, it can cause metrorrhagia, and if they are in excess, then unhealthy blood clots will appear - those that come off and wander through the vessels, interfering with the free vascular path. The rate of fibrinogen is measured in mg/dl or g/l, with g/l leaving mg/dl*0.555/100. By the end of the period before childbirth, the value increases slightly. And its reduced value should not fall over 0.5 g / l according to the coagulogram, since this is very dangerous for health.
An increase in protein may be the cause of:
- Inflammatory diseases;
- Pathologies of protein metabolism;
- Surgical intervention before taking tests for diagnostics;
- Skin lesions by action high temperature(burn);
- Increased amount of estrogen;
- A small number of hormones that the thyroid gland must produce.
A critical decrease in fibrinogen (below 0.5 g/l) is dangerous:
- The development of DIC;
- Lack of vitamins C and B12;
- Failure of the heart or liver;
- postpartum complications;
- Acute promyelocytic leukemia.
It requires thrombolytic treatment.
thrombin time- this is the period during which plasma combines with thrombin to create a thrombus.
APTT- the time period for the creation of a blood clot, which checks how well the coagulation system works and the sufficiency of plasma factors in the blood.
The lengthening of the time period indicates the presence of a pregnant woman:
- DIC-syndrome of the 2nd or 3rd stage;
- Hemophilia A, B, C;
- Accelerated production of antibodies to phospholipids.
A shortened gap can be the cause of:
- DIC-syndrome of the 1st stage;
- Thrombosis;
- Injury to the vein during sampling.
Prothrombin(factor 2) is a complex protein, one of the main factors of homeostasis that determines the quality of blood clotting, which is produced by the liver with the help of vitamin K.
According to the coagulogram, its increase is dangerous:
- The formation of blood clots;
- Damage to the heart muscle;
- thromboembolic syndrome.
clot formation A decrease in prothrombin indicates:
- A low number of fibrinogens in the blood and the development of hypofibrinogenemia;
- Low content of vitamin K - in children it manifests itself as hemorrhagic diathesis;
- Deficiency of prothrombin causing metrorrhagia.
Prothrombin also rises and falls due to the fact that a woman in a position takes drugs that slow down or enhance the action of coumarin.
INR(prothrombin time)- this is the period of time when a thrombin clot is created when Ca and tissue factor enter the blood.
Lupus anticoagulant- These are antiphospholipid antibodies - Ig class M, G, which, in the case of pathologies of the immune system, are produced to disrupt the impermeability of platelet membranes. Its presence is dangerous with complications and miscarriage.
Soluble fibrin monomeric complex (SFMK)- this is an intermediate consumption that appears as a result of the splitting of fibrin lumps, which are very difficult to determine due to their rapid elimination from the plasma. It is allowed to increase the rate of Rfmk in the 2nd trimester and until the end of the term.
Antithrombin III is a protein whose main task is to prevent hemostasis and the appearance of clots.
D-dimer- this is the period of creation of a thrombus and splitting of fibrin. This number gradually increases during pregnancy.
conclusions
The hemostasiogram is of great importance, both for the life and health of a pregnant woman with her unborn child. And if the coagulogram is normal, then there is nothing to worry about, respectively, there is no danger to the health of the mother and fetus. But if the indicators are outside the normal range, then you need to contact your doctor for advice as soon as possible.
The main thing is not to panic, but to go through all the examinations that your doctor prescribes, so that, if necessary, you can adjust the treatment to get good results.
