Reference ranges of rotational thromboelastometry parameters in pregnant women and puerperas: a single-center randomized trial

2020 ◽  
Author(s):  
Ю.С. Распопин ◽  
В.В. Потылицина ◽  
А.И. Грицан ◽  
А.В. Ковалев ◽  
И.А. Ольховский
Keyword(s):  
Pregnant Women ◽  
Postpartum Period ◽  
Reference Intervals ◽  
Reference Ranges ◽  
Rotational Thromboelastometry ◽  
Early Postpartum Period ◽  
Krasnoyarsk Region ◽  
Early Postpartum ◽  
Coagulation Tests ◽  
Obstetric Surgery

Введение: В последнее время стали востребованы интегральные тесты оценки системы гемостаза у женщин во время беременности, а также во время акушерских операций, связанных с кровотечением. В нашей стране отсутствуют работы по определению популяционных норм ротационной тромбоэластометрии (РОТЕМ) у беременных, рожениц и родильниц. Цель исследования: определить пределы референсных интервалов показателей РОТЕМ во время физиологически протекающей беременности и в раннем послеродовом периоде и провести корреляционный анализ со стандартными показателями коагулограммы. Материалы и методы: Обследовано 229 женщин Красноярского края, которые были поделены на 5 групп: небеременные (контроль), беременные II и III триместров, женщины раннего послеродового периода после операции кесарева сечения и естественных родов. Все женщины были сопоставимы по возрасту, индексу массы тела, сопутствующей патологии. Референсные интервалы рассчитывали либо через среднее и стандартное отклонение (для нормального распределения), либо через медиану и 2,5 и 97,5% перцентили (для ненормального распределения). Результаты: В процессе исследования подтвердилось, что во время беременности и в раннем послеродовом периоде происходят изменения в системе гемостаза в сторону гиперкоагуляции. Показатели ROTЕM у женщин в III триместре беременности и раннем послеродовом периоде существенно отличаются от показателей небеременных в популяции. У женщин после родов вне зависимости от способа родоразрешения различий между параметрами ROTЕM не установлено. Корреляция между параметрами ROTЕM и традиционными лабораторными тестами коагуляции выявила взаимосвязь между амплитудой плотности сгустка в тесте FIBTEM и уровнем фибриногена по Клаусу. Заключение: Представлены референсные интервалы параметров РОТЕМ у женщин Красноярского края. Найдена корреляция между параметрами РОТЭМ и уровнем фибриногена. Background: Recently, integral tests for hemostasis assessment in pregnant women as well as during obstetric surgery associated with bleeding have become popular. In our country, there are no studies of population norms for rotational thromboelastometry (ROTEM) in pregnant women, parturients and puerperants. Objectives: to identify reference intervals limits for ROTEM parameters during physiological pregnancy and in early postpartum period and to carry out correlation analysis with standard coagulogram parameters. Patients/Methods: We examined 229 women in Krasnoyarsk region; they were divided into 5 groups: nonpregnant (control), pregnant women in II and III trimesters, women in early postpartum period after cesarean section and after vaginal delivery. All women were comparable in age, body mass index, and concomitant pathology. Reference intervals were calculated either as the mean and standard deviation (for normal distribution), or as the median and 2.5 and 97.5% percentiles (for abnormal distribution). Results: The study confirmed hemostasis hypercoagulation changes during pregnancy and in early postpartum period. ROTEM parameters in women in III trimester of pregnancy and in early postpartum period differ significantly from those in non-pregnant women. Differences between ROTEM parameters in puerperants, regardless of the delivery method, not found. The correlation between ROTEM parameters and traditional laboratory coagulation tests revealed a relationship between clot density amplitude in FIBTEM test and Klaus fi brinogen level. Conclusions: Reference intervals of ROTEM parameters in women of Krasnoyarsk region are presented. A correlation was found between ROTEM parameters and fibrinogen level

The laboratory control of anticoagulant thromboprophylaxis during the early postpartum period after cesarean delivery

2018 ◽  
Vol 46 (3) ◽  
pp. 251-260 ◽  
Author(s):  
Ekaterina M. Koltsova ◽  
Anna N. Balandina ◽  
Konstantin I. Grischuk ◽  
Margarita A. Shpilyuk ◽  
Elena A. Seregina ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Postpartum Period ◽  
Low Molecular Weight ◽  
Normal Range ◽  
Coagulation Assays ◽  
Early Postpartum Period ◽  
Early Postpartum ◽  
Coagulation Tests ◽  
Coagulation Assay ◽  
D Dimer

Abstract Introduction: The incidence of venous thromboembolism (VTE) after cesarean section is up to 0.6%, and the widespread use of cesarean section draws attention to this group. The dosage and duration of low-molecular-weight heparin (LMWH) prophylaxis after delivery is estimated by anamnestic risk-scales; however, the predictive potency for an individual patient’s risk can be low. Laboratory hemostasis assays are expected to solve this problem. The aim of this study was to estimate the potency of tests to reflect the coagulation state of patients receiving LMWH in the early postpartum period. Materials and methods: We conducted an observational study on 97 women undergoing cesarean section. Standard coagulation tests (Fg, APTT, prothrombin, D-dimer), an anti-Xa assay, rotation thromboelastometry and thrombodynamics/thrombodynamics-4D were performed. Coagulation assay parameters were compared in groups formed in the presence or absence of LMWH to estimate the laboratory assays’ sensitivity to anticoagulation. Results: Coagulation assays revealed hypercoagulation after delivery and a tendency toward normalization of coagulation during early postpartum. The thromboprophylaxis results revealed a higher percentage of coagulation parameters within the normal range in the LMWH group. Conclusion: This research is potentially beneficial for the application of thrombodynamics and thrombodynamics-4D in monitoring coagulation among patients with high VTE risk who receive thromboprophylaxis with heparin.

scholarly journals Laboratory reference intervals during pregnancy, delivery and the early postpartum period

2010 ◽  
Vol 48 (2) ◽  
Author(s):  
Anna Klajnbard ◽  
Pal B. Szecsi ◽  
Nina P. Colov ◽  
Malene R. Andersen ◽  
Maja Jørgensen ◽  
...  
Keyword(s):  
Postpartum Period ◽  
Reference Intervals ◽  
Early Postpartum Period ◽  
Early Postpartum ◽  
Laboratory Reference

scholarly journals Cerebrospinal Fluid CRH Levels in Late Pregnancy Are Not Associated With New-Onset Postpartum Depressive Symptoms

2015 ◽  
Vol 100 (8) ◽  
pp. 3159-3164 ◽  
Author(s):  
Alberto Moreno Zaconeta ◽  
Angélica Amorim Amato ◽  
Gustavo Barcelos Barra ◽  
Lucília Domingues Casulari da Motta ◽  
Vinícius Carolino de Souza ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Depressive Symptoms ◽  
Pregnant Women ◽  
Postpartum Period ◽  
Depression Scale ◽  
Late Pregnancy ◽  
Early Postpartum Period ◽  
Early Postpartum ◽  
Elective Cesarean ◽  
New Onset

Context: CRH participates in the hypothalamic-pituitary-adrenal axis and in neural circuits involved in the pathophysiology of depression. During pregnancy, the placenta produces large amounts of CRH, and production ceases abruptly after delivery. The relationship between CRH in the cerebrospinal fluid (CSF) during pregnancy and peripartum mood disorders has not been investigated. Objectives: The objectives were to determine whether there are differences in CSF CRH concentrations of pregnant and nonpregnant women and whether CSF CRH concentrations in late pregnancy are associated with the presence of depressive symptoms during pregnancy and in the early postpartum period. Design: This was a prospective cohort study conducted from January to April, 2011. Setting: The study was conducted in one public and two private hospitals in Brasilia, Brazil. Patients: Patients included 107 healthy pregnant women who underwent elective cesarean delivery and 22 nonpregnant healthy women who underwent spinal anesthesia for elective surgical sterilization. Intervention: CRH in CSF was measured in pregnant and nonpregnant women by ELISA. Main Outcome Measure: The association between CSF CRH concentration at delivery and maternal depression assessed before cesarean section and postpartum (4 to 8 wk) with the Edinburgh Postnatal Depression Scale (EPDS), with a cutoff of ≥ 13. Results: CRH concentration in the CSF was significantly higher in pregnant (4.1 ± 0.51 log CRH) than in nonpregnant women (3.6 ± 0.26 log CRH) (P < .001). Depressive symptoms starting after delivery occurred in 5.6% of women. CRH concentration in CSF was not different between women without depressive symptoms and women showing such symptoms during pregnancy or in the postpartum period. Conclusion: CRH concentration in the CSF was higher in pregnant women than in nonpregnant women. However, in this sample, CSF CRH in late pregnancy was not associated with new-onset depressive symptoms in the early postpartum period.

scholarly journals Exclusive Breastfeeding Is Not Associated with Maternal–Infant Bonding in Early Postpartum, Considering Depression, Anxiety, and Parity

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1184
Author(s):  
Naoki Fukui ◽  
Takaharu Motegi ◽  
Yuichiro Watanabe ◽  
Koyo Hashijiri ◽  
Ryusuke Tsuboya ◽  
...  
Keyword(s):  
Mental Health ◽  
Path Analysis ◽  
Exclusive Breastfeeding ◽  
Postpartum Period ◽  
Depression Scale ◽  
Anxiety And Depression ◽  
Women’S Mental Health ◽  
Women's Mental Health ◽  
Early Postpartum Period ◽  
Early Postpartum

It is important to clarify how the breastfeeding method affects women’s mental health, and how women’s mental health affects the breastfeeding method in the early postpartum period when major depression and other psychiatric problems are most likely to occur. This study aimed to examine this bidirectional relationship in the early postpartum period. Participants were 2020 postpartum women who completed the Hospital Anxiety and Depression Scale (HADS) and Mother-to-Infant Bonding Scale (MIBS). We obtained data for participants’ breastfeeding method for four weeks after childbirth. We performed a path analysis with factors including breastfeeding method (exclusive breastfeeding or non-exclusive breastfeeding), parity (primipara or multipara), the two HADS subscales (anxiety and depression), and the two MIBS subscales (lack of affection and anger and rejection). The path analysis showed that breastfeeding method did not significantly affect depression, anxiety, and maternal–infant bonding in the early postpartum period. Women with higher anxiety tended to use both formula-feeding and breastfeeding. Our study suggests that exclusive breastfeeding is not associated with maternal-fetal bonding in early postpartum, considering depression, anxiety, and parity.

Sign in / Sign up

Export Citation Format

Share Document