Vergleich von Gerinnungsaktivitäten zwischen Spontangeburt und Sektio-Entbindung unter Berücksichtigung potentieller Einflußgrößen

Abstract

Purpose: To estimate the risk of thrombosis, we determined in this study the degree and time course of thrombin formation and fibrinolysis in women undergoing vaginal delivery or Caesarean section. The patient's history, obstetric risk factors and APC resistance were evaluated. Patients and methods: 96 women were included in the study, 75 with vaginal labour and 21 with primary or secondary Caesarean section. At five time points during delivery and puerperium we determined the plasma concentration prothrombin activation fragments F1 and F2 as marker of coagulation activity and D-Dimers as markers for fibrinolysis. Results: We found a high turnover of coagulation factors in all women. Uterine contracitons during cervical dilatation increased F1 and F2 levels more than the D-Dimer concentration, indicating that they were sufficient to activate clotting. A further increase of prothrombin fragments followed by D-Dimers was seen during detachment of the placenta. D-Dimer levels reached a maximum two hours post partum. All parameters analysed were back on baseline two days after delivery. Surprisingly, thrombin formation was less in women with Caesarean section that in patients with vaginal delivery, while the extent of fibrinolysis was lower in the latter group. Premature rupture of membranes decreased F1 and F2 levels and caused a light increase of the D-Dimer concentration. Parity had no influence on either variable. In patients with prolonged placental separation the degree of coagulation was reduced and fibrinolysis was activated. Women with insufficient anticoagulant response of plasma to activated protein C were found to have low baseline F1 and F2 levels that increased after delivery, while the D-Dimer concentration was elevated at all time points. Conclusion: Coagulation is activated during childbirth. Caesarean section is associated with increased fibrinolysis as compared to vaginal delivery. Our data emphasises the importance of mobilisation as soon as possible after both vaginal and Caesarean delivery to avoid thrombosis or embolism.