STATIC DISORDER AND PRETERM PROM? OFFER EREZ, JIMMY ESPINOZA, TINNAKORN CHAIWORAPONGSA, FRANCESCA GOTSCH, JUAN PEDRO KUSANOVIC, NANDOR GABOR THAN, SHALI MAZAKI-TOVI, ZOLTAN PAPP, BO HYUN YOON, DEBRA HOPPENSTEADT, JAWED FAREED, SONIA HASSAN, ROBERTO ROMERO, PerinatologyResearch Branch, NICHD,NIH, DHHS, Detroit, Michigan, Wayne StateUniversity School ofMedicine,Department ofObstetrics andGynecology, Detroit, Michigan, Semmelweis University, 1st Department of Obstetrics and Gynecology, Budapest, Hungary, Seoul National University College of Medicine, Department of Obstetrics and Gynecology, Seoul, South Korea, Loyola University Medical Center, Department of Pathology, Maywood, Illinois OBJECTIVE: Vaginal bleeding is a risk factor for preterm PROM (PPROM). A disorder of decidual hemostasis has been implicated in the genesis of PROM. Indeed, excessive thrombin generation has been demonstrated in PPROM before as well as at the time of diagnosis. Decidua is a potent source of tissue factor, the most powerful natural pro-coagulant. A decidual hemostatic disorder may link vaginal bleeding, PPROM, and abruptio placenta. This study was conducted to determine the behavior of maternal plasma tissue factor (TF), the tissue factor pathway inhibitor (TFPI), its natural inhibitor, as well as the thrombin activatable fibrinolysis inhibitor (TAFI) in PPROM. STUDY DESIGN: This cross-sectional study included women with PPROM (n = 123) and women with normal pregnancies (n = 71). Plasma concentrations of TF, TFPI and TAFI were measured by a sensitive immunoassay. Nonparametric statistics were used for analysis. RESULTS: 1) Maternal TF plasma concentrations were significantly higher in patients with PPROM than in women with a normal pregnancy (median: 369.5 pg/ml; range: 3.27-2551 pg/ml vs. median: 345.7 pg/ml; range: 21.72660.2 pg/ml; p = 0.016, respectively); 2) TFPI plasma concentrations were significantly lower in patients with PPROM than in women with a normal pregnancy (median: 58.7 ng/ml; range: 26.3-116 ng/ml vs. median: 66.7 ng/ml; range: 37.4-86.5 ng/ml; p!0.001, respectively); 3) In contrast, there was no significant difference in the median plasma concentrations of TAFI between patients with PPROM and women with normal pregnancy. CONCLUSION: 1) Patients with PPROM have a higher median plasma concentration of TF and a lower median plasma concentration of TFPI than women with normal pregnancies; 2) However, there were no differences in the concentrations of TAFI; 3) These findings suggest that PPROM is associated with specific changes in the hemostatic/coagulation system.