Perturbed (procoagulant) endothelium and deviations within the fibrinolytic system during the third trimester of normal pregnancy. A possible link to placental function.

Abstract

To evaluate the endothelial cell state and the possible relation to placental function in the third trimester of normal pregnancy by an indirect assessment of endothelial cell function. STUDY-DESIGN. Twenty-six pregnant women entered the study in the 30th week of pregnancy. Von Willebrand Factor, urate and key hemostatic variables were quantified at entry, and during the 33rd and 37th weeks of pregnancy. Levels of von Willebrand Factor, PAI-1 antigen, t-PA antigen; variables produced by the endothelial cell, increased during the third trimester of pregnancy. Serum urate, which is correlated with clinical outcome of pregnancy, increased during the study period and correlated directly with von Willebrand Factor and PAI-1 antigen, respectively. There was an inverse correlation between the concentrations of placenta-derived PAI-2 antigen and urate. In healthy human pregnancy the markers of endothelial related processes of coagulation and fibrinolysis pointed towards a procoagulatory state of the endothelial cell. However, the balance between fibrin formation and resolution seemed to be maintained in uncomplicated pregnancy. Our study indicated an association between this change of endothelial cell function and placental function.