Activated protein C resistance in normal and pre-eclamptic pregnancies.

Abstract

OBJECTIVES:

A lower ratio in the classic activated protein C resistance (APC-R) test has been reported during pregnancy, which has been called 'acquired' APC-R. However, little is known about the cause of the lowered ratio, and whether or not there is a correlation with blood coagulation activation. The primary objective of our study was to determine changes in APC-R levels in each of the trimesters of normal pregnancy. The secondary objective was to confirm whether APC-R levels were lower in pregnancies complicated by pre-eclampsia than in a control group. Finally, this prospective study was performed to investigate the prevalence of APC-R among pregnant women and to elucidate its obstetric consequences.

METHODS:

We enrolled 35 healthy pregnant women and 47 pregnant women affected by pre-eclampsia in our study. The following laboratory tests were performed: prothrombin time, partial thromboplastin time, fibrinogen levels, antithrombin III, plasmatic fibronectin (as a marker of endothelial damage), haptoglobin (as a marker of intravascular haemolysis), a functional test for APC-R and analysis of factor V Leiden mutation by polymerase chain reaction.

RESULTS:

The activated protein C sensitivity ratio was lower in the pathological group than in the control group (p = 0.008 and p = 0.02, respectively). Plasmatic fibronectin was found to be higher in the pathological group than in the control group (p = 0.05). Finally, the overall prevalence of factor V Leiden mutation was 5.4%, i.e. 2/35 women (5.7%) in the control group and 3/47 women in the pathological group (6.38%).

CONCLUSIONS:

The APC ratio decreased after 20 weeks of gestation until week 42. This decrease was most pronounced in the third trimester, in which resistance was demonstrated in 34.2% of control group patients. In pre-eclampsia, we found a greater reduction of the APC ratio than in controls. We hypothesise that this is due to a decrease in the plasmatic levels of coagulation inhibitors and an increase in coagulatory factors.

• Authors: D M Paternoster, A Stella, P Simioni, A Girolami, D Snijders
• Journal: Gynecologic and obstetric investigation (Gynecol Obstet Invest) Vol. 54 Issue 3 Pg. 145-9 ( 2002) ISSN: 0378-7346 [Print] Switzerland
• PMID: 12571435 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright 2002 S. Karger AG, Basel

Chemical References

• Fibronectins
• Haptoglobins
• factor V Leiden
• Antithrombin III
• Factor V
• Fibrinogen

Topics

• Activated Protein C Resistance (blood, epidemiology, genetics)
• Adult
• Antithrombin III
• Case-Control Studies
• Factor V (genetics)
• Female
• Fibrinogen
• Fibronectins (blood)
• Haptoglobins
• Humans
• Italy (epidemiology)
• Partial Thromboplastin Time
• Polymerase Chain Reaction
• Pre-Eclampsia (blood)
• Pregnancy (blood)
• Pregnancy Trimesters
• Prenatal Diagnosis
• Prevalence
• Prospective Studies
• Prothrombin Time