The microangiopathy of pregnancy

Published: June 5, 2009
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Hypercoagulabilty occurs in uncomplicated pregnancies, beginning already during the first trimester of gestation. Fibrinogen and factor VIII levels show a progressive increase, accompanied during the second trimester by an increase in VWF levels, while factor XIII levels progressively decrease to 50% during the third trimester.1 This is consistent with increased in vivo thrombin generation and fibrin formation,2 leading to an increased antithrombin turnover.3 Protein S levels show major modifications, reaching 50% levels of normal at term.1 During pregnancy a condition of acquired protein C resistance is relatively common, due to the increase in factor VIII and V levels and, more important, to their increased state of activation.4,5 Global fibrinolytic activity is depressed until delivery, mainly due to increased levels of plasminogen activator inhibitors 1 and 2.1 Moderate thrombocytopenia occurs during the last stages of pregnancy and is mainly due to hemodilution.6

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D’Angelo, A. (2009). The microangiopathy of pregnancy. Hematology Meeting Reports (formerly Haematologica Reports), 1(10). https://doi.org/10.4081/hmr.v1i10.346