Coagulation and Fibrinolysis in Twin Pregnancy-Examination of Mother and Cord Blood at the Time of Delivery

Abstract

Aiming at eclucidating the status of blood coagulation and fibrinolysis in twin pregnancy, we measured molecular markers representative of blood coagulation and fibrinolysis in the peripheral and the cord blood obtained from 20 mothers and their babies, respectively, at the time of delivery.Molecular markers determined were antithrombin III (AT-III), thrombin-AT-III complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), D-dimer, tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), t-PA-PAI-1 complex and active PAI-1, Decreased levels of AT-III and increased levels of TAT in blood samples derived from the mothers indicated that the mothers were most likely in the hypercoagurable state. On the contrary, PAI-1 and active PAI-1 in the mothers were found to be increased significantly as compared with those in control, suggesting that fibrinolysis was suppressed in the mothers. The plasma levels of t-PA-PAI-1 complex in the mothers and their babies were found to be decreased significantly as compared with those in control. No significant changes were observed in the levels of PIC, D-dimer and t-PA, however. Similarly, the levels of AT-III in the cord blood was significantly reduced but that of TAT was increased, though in the second baby alone. On the other hand, PAI-1 was significantly elevated. Thus in twin babies, there was also an inclination to the hypercoagulable and hypofibrinolysic state. The observed hypercoagulability and hypofibrinolysis may underlie impared proliferation of placenta leading to growth retardation of the fetus.