Abstract
PurposePlasminogen activator activity (PAA) in tears of pregnant women was investigated at various gestation times to assess the availability of plasminogen activator for aiding potential corneal wound healing processes during pregnancy.MethodsPAA was measured by a spectrophotometric method. The analysis used 91 tear samples from pregnant and non-pregnant women, supplemented with 10 additional tear PAA measurements from non-pregnant women obtained in a previous study.ResultsTear levels of PAA in pregnant women formed a bimodal distribution. Either the tear PAA level was zero or non-zero during pregnancy. When non-zero, the tear PAA level was dissociated from gestation time and not different than non-pregnant and post-pregnant levels. The frequency of occurrence of zero level tear PAA increased with gestation: 16%, 17% and 46% had zero tear PAA in samples taken from women in the first, second and third trimester, respectively.ConclusionsOverall, of the tear samples taken from women during pregnancy, a total of 26% were at zero tear PAA. The remaining tear samples had non-zero tear PAA values throughout gestation equivalent to non-pregnant tear PAA values, suggesting local control of the source of PAA in tears. Given the importance of the plasminogen activator system in tears to wound healing in the cornea, and the high occurrence of zero tear PAA in our sample of pregnant women, elective corneal surgery would be contraindicated. If corneal surgery is nevertheless necessary, the tear PAA level would be worth checking and patients with low level should be closely observed during the postoperative period.
Highlights
Major changes in hemostasis are associated with normal pregnancies [1,2]
The frequency of occurrence of zero level tear Plasminogen activator activity (PAA) increased with gestation: 16%, 17% and 46% had zero tear PAA in samples taken from women in the first, second and third trimester, respectively
Of the tear samples taken from women during pregnancy, a total of 26% were at zero tear PAA
Summary
Major changes in hemostasis are associated with normal pregnancies [1,2]. The plasminogen activator/inhibitor system plays a key role. The coagulation activity, the anticoagulation activity, fibrinolytic and anti-fibrinolytic activity are enhanced in normal pregnancy but these activities are balanced despite large changes in blood levels of plasminogen activators and inhibitors [4,5]. This balance and change are needed to control the delivery environment [6,7]. The systemic proteolytic activity needs to be kept under sensitive control to avoid serious complications that may accompany a disturbance of this system [8,9]
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