A study of intrapartum and postpartum bleeding based on changes in blood coagulation and fibrinolysis during pregnancy

The relationship between changes in blood coagulation and fibrinolysis during pregnancy and intrapartum-postpartum bleeding was studied as a trial prediction of abnormal bleeding during vaginal delivery in 27 subjects without any complications. The following results were obtained: In the third trimester, shortening of prothrombin time and activated partial thromboplastin time, increases in fibrinogen, platelet epinephrine, collagen aggregation, and plasminogen, and a decrease in alpha 2-plasmin inhibitor were marked as compared with those in the first trimester. In the same subjects, the relationship between changes in blood coagulation and fibrinolysis in the first and third trimesters and intrapartum-postpartum bleeding was studied by the independent matched pair test. There were significant correlations (p less than 0.005, p less than 0.001) between prothrombin time (r = -0.68862) and activated partial thromboplastin time (r = -0.77027). In the subjects whose prothrombin time and activated partial thromboplastin time in the third trimester were shorter than those in the first trimester, intrapartum and postpartum bleeding increased. The subjects whose prothrombin time and activated partial thromboplastin time in the third trimester were less by more than 0.52 seconds and more than 3.98 seconds, respectively, than those in the first trimester experienced abnormal bleeding exceeding 500 ml during delivery. In the intrapartum and postpartum bleeding group, shortening of prothrombin time and activated partial thromboplastin time, decreases in fibrinogen and alpha 2-plasmin inhibitor and an increase in platelet aggregation were more significantly observed than in the intrapartum and postpartum normal bleeding groups.(ABSTRACT TRUNCATED AT 250 WORDS)