PREGNANCY HYPERCOAGULABILITY

ALLEN OCTAVIANO CUDIAMAT

COAGULATION AND FIBRINOLYSIS

During normal pregnancy, both coagulation and
fibrinolysis are augmented but remain balanced to
maintain hemostasis.
Increased concentrations of all clotting factors,
except factors XI and XIII, and increased levels of
high-molecular-weight fibrinogen complexes.
clotting time of whole blood does not differ
significantly in normal pregnant women
The percentage of high-molecular-weight fibrinogen
is unchanged

fibrinolytic
activity is reduced in normal pregnancy
tPA activity gradually decreases over the course of
normal pregnancy.
plasminogen activator inhibitor type 1 (PAI-1) and
type 2 (PAI-2) (which inhibit tPA and regulate fibrin
degradation by plasmin) increase during normal
pregnancy.
These changes indicate that the fibrinolytic system is
impaired, but countered by
increased levels of plasminogen and
decreased levels of another plasmin inhibitor, alpha
2 antiplasmin.

SUCH CHANGES SERVE TO ENSURE HEMOSTATIC

BALANCE DURING NORMAL PREGNANCY.
PLATELETS
the average platelet count was decreased slightly during pregnancy to 213,000/L
compared with 250,000/L in nonpregnant control women.
thrombocytopenia - below the 2.5th percentile (platelet count of 116,000/mL).
Decreased platelet concentrations are partially due to the effects of HEMODILUTION.
INCREASED PLATELET CONSUMPTION, leading to a greater proportion of younger, and
larger platelets.
beginning in midpregnancy, production of thromboxane A2, which induces platelet
aggregation, progressively increases.
REGULATORY PROTEINS
natural inhibitors of coagulation
proteins C, S, and Z and antithrombin
thrombophilias
Inherited or acquired deficiencies of natural regulatory proteins

account for many thromboembolic episodes during pregnancy

Between the first and third trimesters, levels of activated PROTEIN C decrease
from about 2.4 to 1.9 U/mL, and free PROTEIN S decreases from 0.4 to 0.16 U/mL
PROTEIN Z is a vitamin-K dependent glycoprotein that inhibits activation of factor X.
20-percent increase across pregnancy.
ANTITHROMBIN remain relatively constant throughout gestation and the early
puerperium