Serial measurements of the plasma concentration of
fibrinopeptide A,
thrombin-increasable
fibrinopeptide B (reflecting B beta 1-42), desarginyl
fibrinopeptide B,
beta thromboglobulin, and
platelet factor 4 were made before, during, and after delivery in patients with
preeclampsia/
eclampsia. The data were correlated with routine coagulation studies, hematologic and renal status, as well as with the clinical manifestations. In 11 patients with mild
preeclampsia, there were small increases in the fibrinopeptides at the time of delivery, but no other hematologic changes. In 5 patients with severe
preeclampsia/
eclampsia, there were marked increases in plasma levels of fibrinopeptides and platelet alpha granule
proteins, which correlated in time with the clinical manifestations. When the changes in these patients were compared with those occurring in patients undergoing intraamniotic hypertonic saline infusion, it was noted that: (1) patients with severe
preeclampsia/
eclampsia usually presented when
plasmin action on
fibrinogen exceeded that of
thrombin; (2) in patients with
preeclampsia/
eclampsia the increase in fibrinopeptides lasted from 3 to 7 days, rather than for several hours as occurred after the infusion of hypertonic saline, indicating a more persistent stimulus to intravascular coagulation in
preeclampsia/eclampsia; (3) severe
thrombocytopenia and increased platelet
protein levels were seen in these patients and were disproportionate to the degree of increase in the
fibrinopeptide A level, suggesting that a mechanism other than
thrombin must have contributed to the platelet changes; and (4) in two patients with severe
preeclampsia/
eclampsia, high desarginyl
fibrinopeptide B levels preceded
renal insufficiency, possibly reflecting
fibrin II formation in renal vessels.