Every woman is obliged to take care of her health, especially the expectant mother, since her body during the period of expectation of a child is subject to changes in both physiological and hormonal levels. During the initial visit to the antenatal clinic for pregnancy, the gynecologist prescribes a specific list of studies, among which there are. This analysis is the most important among them.

What is this analysis and why is it needed

Nature has created a woman in such a way that even during the formation of a fetus in her womb, another circle of blood circulation is formed, which is responsible for the nutrition of the unborn baby. And in this case, such an analysis becomes very important, since it can be used to identify various organ defects in a timely manner in order to prevent possible diseases of the child and his future mother.

A coagulogram during pregnancy is an analysis to determine the level of blood clotting. This procedure reveals violations and a set of coordinated reactions that ensure the maintenance and restoration of the constancy of the internal environment of the body.

During a decrease in the ability of the human body to self-regulate the hematopoietic system, it manifests itself even due to a small cut, and an excessive increase (hypercoagulation) leads to the formation of thrombosis, heart attacks and strokes.

When to do research

A coagulogram for pregnant women is planned every three months:

during registration for pregnancy;
in the second trimester;
in the third trimester.

Sometimes the gynecologist is obliged to prescribe a coagulogram more often. The reason for this can be various defects, namely:

problems with the heart system;
with renal and hepatic insufficiency;
with varicose veins.

A coagulation test is mandatory for expectant mothers with a negative Rh factor if the future father has a positive Rh factor.

The point is that if future child inherited a positive Rh factor from his father, then the mother's hematopoietic system will perceive the fetus as a foreign body, respectively, the production of antibodies will begin, which, in turn, will begin to fight the immune system.

What are the rules for blood sampling?

In order for the result to be reliable, you must follow some simple rules:

It is undesirable to take the analysis in a stressful state.
Strong physical activity should be excluded.
Be sure to inform the laboratory assistant about taking medications, provided that the expectant mother is undergoing therapy.
The biological fluid is taken from a vein, while the expectant mother should refrain from eating before passing this analysis. More than 8 hours should elapse from the evening meal to the blood sampling for study. Alcohol is not allowed during dinner.
It is recommended to use pure non-carbonated water.
It is forbidden to drink coffee, tea and juice immediately before the analysis.

It is worth noting one very important point, expectant mothers are strictly forbidden to smoke one hour before the test.

How to understand what the analysis showed?

It must be emphasized that a coagulogram during pregnancy is a very complex analysis and only the attending physician should understand the data of the study form for a more accurate diagnosis.

But, curious moms-to-be sometimes can't wait next appointment at the doctor, I want to know what the coagulogram indicators mean during pregnancy.

There are two types of procedure - simple and advanced. A simple form of this study includes the most important indicators of the coagulability of a biological fluid:

APTT;
fibrinogen;
platelets;
Prothrombin;
TV (thrombin time);

What does the APTT indicate?

APTT is an indicator by which blood should clot in a healthy person. The period sufficient for clotting is considered to be about 35 seconds. If the time is reduced to 17-20 seconds, this is not considered a violation.

The decrease serves as a signal of development. Such an indicator may signal an early discharge of the placenta.

blood clotting system

Fibrinogen is a specific protein that is the main element of a blood clot.

The norm is from 2 to 4 g / l. Expectant mothers produce more of an element such as fibrinogen. It is formed in the liver and forms the basis of a blood clot. The increase in fibrinogen values, in expectant mothers, occurs gradually and by the 3rd trimester it reaches 6 g / l. Abnormal indicators signal inflammatory processes that develop in the tissues. The amount of this protein decreases with toxicosis, liver defects and other negative changes.

Platelet level

Platelets are small, scarlet-colored plates of blood that are produced in the bone marrow. The normal number is considered to be 150-400 thousand / μl.

While waiting for the baby, there may be a slight decrease, but if the number of platelets in the blood drops sharply, this can cause blood loss.

The number of platelets may decrease due to:

malnutrition of a woman;
the development of DIC in her;
with toxicosis;
AIDS;
taking certain medications;
leukemia;
with lupus
vitamin B12 and C deficiency.

An increase in platelet values is inherent in pregnant women with inflammatory diseases, tuberculosis, pneumonia and ulcerative colitis.

Prothrombin indicators in the coagulogram

Prothrombin is a clotting factor protein found in blood plasma. This element is the precursor of thrombin, with its assistance, a clot is formed. The usual normal level is considered to be 78-140%. It is from prothrombin that thrombin is formed at the right moment.

By examining the amount of prothrombin, it is possible to establish the density of blood and its ability to rapidly clot. An increase in the number of prothrombin in the blood can lead to fetal loss. Its increase in plasma can be triggered by taking corticosteroid drugs.

Also, an increase provokes thrombosis and oncological diseases. In women suffering from diseases of the gastrointestinal tract, with inherited disorders of the cardiovascular system, leukemia and other blood diseases, a decrease is also observed.

Determination of thrombin time

TT (thrombin time) is the period of time when, under the influence of thrombin, the transformation of fibrinogen into fibrin occurs. The norm of this period is from 12 to 20 seconds.

An increase in the period indicates that the amount or quality of fibrinogen has decreased. These deviations lead to chronic diseases of the liver, pancreas, beriberi, disruption of the gastrointestinal tract.

Parameters of the extended coagulogram

An extended procedure is prescribed for the following indications:

For a long period, it was not possible to get pregnant.
There were miscarriages or fading of the fetus.
Twin pregnancy.
Various blood defects inherited from parents.
Severe forms of hemostasis.

In this type of procedure, additional parameters are specified, such as:

D-dimer is a numerical indicator of the number of small pieces of protein remaining in the blood after the destruction of a blood clot. He is responsible for the formation of blood clots. The norm is about 280 nanograms / ml. By the end of pregnancy, D-dimer increases up to three times. It is worth emphasizing that it is very important in the detection of thrombosis. In the case of pregnancy, its value gradually increases, but at the same time, a very rapid increase will serve as a signal for diabetes, kidney problems, etc.
Antithrombin III is a protein that has the ability to slow down the process of blood clotting. The norm is up to 121%. This indicator must be monitored regularly. Since if the allowable indicators are reduced by at least 50% or more, then this is the first sign of the development of thrombosis.
Lupus coagulant is a set of specific antibodies.

In general, the absence of such indicators is considered the norm.

The importance of a coagulogram during pregnancy

During pregnancy, the mother's blood supply changes. This requires an increase in blood volume, a new placental blood supply is formed. It is necessary for the organization of hemostasis of the unborn child and mother.

For the dynamics of intrauterine development in pregnant women, the gynecologist prescribes a coagulogram analysis every three months. Usually in expectant mothers, clotting is slightly increased. Her body forms protection against possible blood loss, and the fetus from premature miscarriage.

Deciphering the coagulogram during pregnancy will help to identify and prevent the following defects in a timely manner:

limb thrombosis;
the threat of miscarriage;
in time to diagnose the beginning of the process of placental abruption;
prepare for the onset of labor.

Dynamics of coagulogram results during pregnancy

In the primary analysis taken from the expectant mother, an increased number of platelets is diagnosed. Blood clotting often increases, and this can be observed in terms of fibrinogen, which can increase in a pregnant woman, up to 6 g / ml. But the prothrombin index in women in anticipation of a child should remain the same, and if changes are detected against this background, then this is a signal for the onset of placental abruption.

A coagulogram during pregnancy is a mandatory examination for future women in labor. A good level of blood clotting is very important in preparation for childbirth. A timely defined low level of platelets makes it possible to correct them to an acceptable level. This gives a chance to prevent all possible negative consequences and bear a healthy child.

Video: Coagulogram analysis

Every pregnant woman undergoes a series of tests. Some of them are mandatory, while others are subject to certain indications. Blood tests allow you to evaluate the work of the female body and identify possible complications in the course of pregnancy in time. The list of necessary includes a coagulation analysis -.

Why take this test during pregnancy

The state of the circulatory system is an important indicator of the health of a pregnant woman. Deviations from the norm may indicate the development of serious complications. Coagulogram - an analysis that shows the level of blood clotting () in the body. In medicine, it is also called "hemostasiogram". This is a rather complex study that allows you to determine the work of the coagulation and anti-coagulation systems.

Pregnancy involves many changes in the physical and psycho-emotional plane. The work of the circulatory system of a woman is no exception. At this time, hemostasis indicators increase. So female body gradually prepares for the appearance of an additional circle of blood circulation and for the inevitable blood loss during childbirth.

For the expectant mother and baby, any changes in the coagulorogram can mean the development of pathology. With a reduced level of hemostasis, severe blood loss and placental abruption are possible. If the indicator is increased, there is a threat of the formation of blood clots (blood clots), which will inevitably lead to fetal hypoxia. In addition, the tendency to thrombosis can threaten blockage of the vessels of the pulmonary artery. Thrombosis of the veins of the lower extremities and veins of the small pelvis is also possible.

Important! Blood clotting disorders, if not properly monitored and treated, can lead to premature birth or miscarriage.

Video: why blood clotting indicators are important

In what cases is a clotting analysis indicated?

A planned analysis is carried out three times during the entire pregnancy:

When registering with a gynecologist.
At 22–24 weeks (II trimester).
At 30-36 weeks (III trimester, shortly before childbirth).

It should be noted that a coagulogram is performed 1 time per trimester only in the normal course of pregnancy.. In some cases, additional research is recommended. This happens when a woman is diagnosed or suspected of having:

autoimmune diseases;
phlebeurysm;
liver disease;
Rhesus conflict with the father of the child;
vascular, endocrine pathologies;
disorders of the circulatory system,
disorders of the genitourinary system;
predisposition to bleeding or increased clotting;
miscarriage of a previous pregnancy;
multiple pregnancy;
disorders of the placenta;
anemia or iron deficiency anemia (more details:);
tendency to thromboembolism, heart attacks, stroke.

The bad habits of the expectant mother are also an indication for constant control blood clotting.

A pregnant woman may be assigned an extended analysis of the coagulogram. This happens in case:

the presence of any complications in the I and III trimester (edema, increased pressure);
preeclampsia (toxicosis of the second half of pregnancy);
multiple pregnancy;
pregnancy after long infertility;
women's predisposition to blood diseases.

If the doctor deems it necessary, a clotting test will be done monthly.

How to prepare for the procedure

Blood is taken from a vein. Before the study, it is not recommended to eat for 8-12 hours. The analysis is given only in the morning on an empty stomach. You should also not drink coffee, tea, compotes and other drinks. It is allowed to drink only ordinary non-carbonated water.

Before the study, a woman needs to calm down, as it has been proven that tension and stress affect the result.

If a woman is taking any medications, it is imperative to inform the laboratory assistant about this in advance and prescribe the names of the medications in the analysis form.

Video: proper preparation for a blood test

Decoding of indicators and norm

The clotting analysis contains eight leading indicators:

Fibrinogen is a protein produced by the liver. It is the main element of thrombosis. Thanks to the uteroplacental circulation, its indicators gradually increase as the day of delivery approaches. A deviation from the norm indicates an inflammatory process taking place in the body of a woman.

Activated partial thromboplastin time (APTT) is the period during which one blood clot forms. In pregnant women, this value decreases slightly, which is the norm. A large decrease in the level indicates the risk of blood clots, while an increase indicates a predisposition to bleeding.
Thrombin time (TV) - the period of blood clotting. It increases during pregnancy. Deviation from the norm often occurs when there is a malfunction in the liver.
Lupus anticoagulant - an indicator of the formation of antibodies. Normally, they should not be found in the blood of a pregnant woman. Their appearance, as a rule, indicates autoimmune diseases, preeclampsia, the presence of blood clots in the arteries and veins.
Platelets are blood cells that take an active part in the clotting process and are responsible for the state of the hematopoietic system. During pregnancy, their level slightly decreases, and a significant decrease indicates the presence of a progressive disease.

D-dimer is an indicator of the thrombus formation procedure. During pregnancy, it rises slightly. A sharp increase indicates the development of diabetes, kidney disease or preeclampsia.
Antithrombin III is a protein that slows down the process of blood clotting. A decrease in its amount means a tendency to form blood clots, and an increase in its level means an increased risk of bleeding.
Prothrombin is a component of blood plasma. An increase in the level may signal placental abruption.

With a normal pregnancy, four indicators of the coagulogram are usually sufficient:

APTT;
prothrombin;
fibrinogen;
platelets.

If necessary, make a detailed picture of blood coagulation. Even a slight deviation from the norm can lead to serious consequences.

The interpretation of the results of the coagulogram is carried out only by a doctor, since there are errors in the indicators that may be associated with a woman's chronic diseases, malnutrition, and medication.

Table: coagulogram norm

Possible changes by trimester

Indications change somewhat during pregnancy. The fact is that the woman's body is preparing for the upcoming birth and blood clotting increases.

Table: range of acceptable blood clotting values during pregnancy

Index	Norm during pregnancy
	I trimester	II trimester	III trimester
fibrinogen

thrombin time
Lupus coagulant	absent
platelets	120–415 x 10 billion/l
	up to 750 ng/ml
Antithrombin III	the lower limit gradually decreases from 74% to 70% the upper limit is 115–116%
Prothrombin

After passing the first test for blood clotting in a pregnant woman, an increased number of platelets, a slightly increased density of fibrogens, and a shorter period of blood clotting are normally detected, compared with the usual norm for an adult. In addition, D-dimer indicators throughout pregnancy change upwards. This value should be assessed both before pregnancy and throughout the entire process of bearing a baby. But the indicators of prothrombin should not change.

Pathological deviations from the norm

A strong deviation from the norm in the direction of decrease or increase may indicate the development of:

diabetes mellitus of pregnant women;
diseases of the liver, kidneys.

Lack of blood clotting inevitably leads to uterine bleeding and miscarriage, and increased clotting leads to the formation of blood clots, which causes insufficient oxygen supply to the fetus and hypoxia (oxygen starvation).

It should be borne in mind that a change in the values of the coagulogram is also possible with late toxicosis (preeclampsia), which leads to serious consequences:

intrauterine growth retardation;
premature birth;
placental abruption;
heart and kidney failure.

In addition, the doctor pays attention to the indicator of antibody formation (lupus anticoagulant). In the normal course of pregnancy, it is absent. Its appearance indicates the presence in the woman's body of autoimmune diseases. As a rule, the time of formation of one blood clot (APTT) immediately increases.

Detection of lupus anticoagulant occurs when:

rheumatoid arthritis (joint damage);
(malfunction of the immune system, in which inflammation develops in various organs and tissues of the body);
ischemic stroke (impaired cerebral circulation).

A deviation from the norm of this value may indicate:

development of thrombosis of blood vessels;
placental infarction - a sharp cessation of its blood supply;
intrauterine fetal death;
spontaneous abortion.

When treated with heparin, a positive value of the lupus anticoagulant indicator is also observed, this is normal.

If treatment is carried out with anticoagulant drugs (Warfarin, Phenilin), it is necessary to regularly monitor the value of the INR (international normalized ratio). This is the ratio of the actual prothrombin time determined during the analysis and the average value of the prothrombin time. The allowable rate is 2.5.

If the pathology is detected in time, the chances of preventing its further development are very high.

Coagulogram - mandatory research blood clotting, which every pregnant woman goes through. You should not immediately get upset, and even more so panic, if the indicators deviate slightly from the average values. Listen to the recommendations of your doctor in order to correct any unwanted changes in a timely manner.

As soon as a woman becomes pregnant, her whole life becomes different. The body is rebuilt, preparing for the growth of the fetus, the physiology is changing, completely new views on life appear, the emotional state changes.

But another important point is the registration in the antenatal clinic and endless tests, including a coagulogram, which greatly complicates life during gestation.

What kind of analysis is this, how often it needs to be done and why - we will consider below.

What is a coagulogram?

A coagulogram (clotting test) is a common blood test that helps to investigate its clotting ability: are there any violations in the form of increased or decreased clotting.

It is done without fail, since with its help the hemostasis system is examined, the propensity of the future mother's body to blood clots and bleeding, which affects the pathological development of the child, difficult or premature births, miscarriages, and other disorders, is also determined. Presenting the results of the hemostasis system in graphical form is also called a hemostasiogram.

When analyzing the coagulogram, the main and additional indicators of coagulation are checked (presented in the table below).

Coagulogram

Kinds	Indicators

1. Main
	2. Prothrombin, including Mno
	3. APTT
	4. Thrombin time

2. Extended	Basic indicators
	+ additional
	5. Index of antithrombin III (AT3)
	6. D-dimer
	7. Lupus anticoagulant

Violations when an extended coagulogram is prescribed

Coagulogram norms during pregnancy

A coagulation test is an important diagnostic for normal childbearing. The indicators of the norm of the coagulogram for a pregnant woman are presented in the table below.

P / n Coagulogram norm during pregnancy table

	Coagulogram indicators	Significance for pregnant women by trimester
1	Fibrinogen (factor I)	norm	1st trimester
		4-5 g/l	2nd trimester
		6 g/l	3rd trimester
	Protein in the first trimester of a pregnant woman is the same as the norm, and after that it rises
2	thrombin time	11-18 seconds	1st, 2nd and 3rd trimester
	If the thrombin time is lowered, then if the vessels or organs are damaged, it can lead to metrorrhagia, and if it is increased, then to liver dysfunction.
3	Activated partial thromboplastin time (APTT)	17-20 sec
	In a woman in position, the value is too high relative to the norm
4	Prothrombin	78-142 %	throughout pregnancy
	Increasing the value leads to placental abruption
5	prothrombin time	up to 18 seconds	throughout pregnancy
	The value during pregnancy is normal. If there are significant differences, then you need to urgently undergo an examination and eliminate the cause of its change.
6	Lupus anticoagulant	no antibodies
	The number of antibodies should show a zero value, otherwise it indicates an autoimmune complication of pregnancy
7		78-130 units	1st trimester
		85-135 units	2nd trimester
		90-140 units	3rd trimester
	An increase in value indicates that vein thrombosis is possible.
8	Antithrombin III	75-125%	throughout pregnancy
	If antithrombin 3 is lowered, this warns of a possible thickening of the blood and the creation of blood clots, and if it is increased, bleeding
9	D-dimer	0-525 ng/ml	1st trimester
		438-1200 ng/ml	2nd trimester
		888-2085 ng/ml	3rd trimester
	Indicates the formation of blood clots: a slight increase for pregnant women is not terrible, but its sharp increase can be the cause of kidney disease, diabetes and other complications.

In the coagulogram table, the normal values of the indicators, according to the results of a laboratory analysis of coagulability, will give the result of isocoagulation.

Isocoagulation is a definition that means that the state of the coagulation system is normal, and therefore the pregnancy proceeds normally, so there is nothing to worry about.

If preeclampsia or another violation of the course of pregnancy is confirmed, then coagulation occurs with violations, then treatment should be started immediately, or intravascular disseminated coagulation syndrome (DIC) may develop.

This syndrome occurs in stages.

Hypercoagulability- Stage 1, in which numerous blood clots occur that interfere with the normal vascular pathway between the mother and fetus.
Hypocoagulation- Stage 2, when blood clots are destroyed due to the weakening of the factors responsible for clotting.
Acoagulation- the last stage, at which blood incoagulability occurs, uterine bleeding develops, which is dangerous for the life of the mother and child.

But remember, even if the results of the analysis are far from normal, but the coagulogram was done on time, and the treatment is performed promptly, then many risks can be eliminated.

The need and frequency of testing for clotting during pregnancy

For pregnant women, a coagulogram is an extremely important analysis. With its help, they monitor the balance of the coagulation and anticoagulation systems.

The absence of such a balance carries, as mentioned above, consequences that threaten the health of the future mother and fetus.
An imbalance in the direction of the anticoagulant system can induce metrorrhagia, placental abruption, blood loss during and after childbirth in a woman in labor, and in the direction of the coagulation system, it thickens the blood, forming blood clots. At the same time, a child who receives oxygen exclusively from the placenta experiences oxygen starvation, hypoxia develops, brain pathologies may develop, a woman suffers from pain in her legs and the development of thrombosis, and this can also cause a heart attack, stroke or miscarriage.

The procedure for passing the test is as follows: before taking blood, it is better to starve, that is, take the test on an empty stomach. Blood is taken from a vein at the elbow bend, your attending physician deciphers the result of the hemostasiogram.

With normal indicators, diagnostics are done as planned three times:

During the registration of a pregnant woman (usually 1 trimester),
In the second trimester
A week or two before childbirth, which is especially important for women who are being prepared for childbirth with a caesarean section.

In case of complications or abnormal course of pregnancy, homeostasis is checked much more often in order to adequately respond and prescribe effective treatment.

The norm indicators for a woman during this period, due to changes in physiology, are somewhat different from those before conception, since the female body sets up another blood circulation through the utero-placental-fetal blood flow (insurance against significant blood loss). Therefore, the diagnosis of the results of the coagulogram can only be done by your accounting doctor.

Hemostasiogram of indicators during pregnancy and interpretation of the results

What determines the coagulability indicators:

- This is a special protein, which is the main component of a blood clot, produced in a healthy person by the liver and it is distributed by the movement of blood through all blood vessels. If there is a damaged place in the vessel, then this protein turns into insoluble fibrin, which becomes the main component of the thrombus that clogs the damage to the vessel, thereby stopping the outflow of fluid from it. Such a thrombus, with a normal number of elements, will exist at the site of the lesion until the wound is completely healed.

Stop bleeding

In case of a lack of factors 1 and 2, it can cause metrorrhagia, and if they are in excess, then unhealthy blood clots will appear - those that break off and wander through the vessels, interfering with the free vascular path.

The rate of fibrinogen is measured in mg/dl or g/l, with g/l leaving mg/dl*0.555/100. By the end of the period before childbirth, the value increases slightly. And its reduced value should not fall over 0.5 g / l according to the coagulogram, since this is very dangerous for health.

An increase in protein may be the cause of:

inflammatory diseases,
Pathologies of protein metabolism,
Surgical intervention before taking tests for diagnostics,
Skin lesions by action high temperature(burn),
Increased amount of estrogen
A small number of hormones that the thyroid gland must produce.

A critical decrease in fibrinogen (below 0.5 g/l) is dangerous:

The development of DIC
Lack of vitamins C and B12,
Failure of the heart or liver
postpartum complications,
Acute promyelocytic leukemia.

It requires thrombolytic treatment.

thrombin time- this is the period during which plasma combines with thrombin to create a thrombus.

APTT- the time period for the creation of a blood clot, which checks how well the coagulation system works and the sufficiency of plasma factors in the blood.

The lengthening of the time period indicates the presence of a pregnant woman:

DIC-syndrome of the 2nd or 3rd stage,
Hemophilia A, B, C,
Accelerated production of antibodies to phospholipids.

A shortened gap may be the cause of:

DIC-syndrome of the 1st stage,
Thrombosis,
Injury to the vein during sampling.

Prothrombin(factor 2) a complex protein, one of the main factors of homeostasis that determines the quality of blood clotting, which is produced by the liver with the help of vitamin K.

According to the coagulogram, its increase is dangerous:

thrombus formation,
Damage to the heart muscle
thromboembolic syndrome.

clot formation

A decrease in prothrombin indicates:

A low number of fibrinogens in the blood and the development of hypofibrinogenemia,
A low content of vitamin K in children manifests itself as hemorrhagic diathesis,
Deficiency of prothrombin causing metrorrhagia.

Prothrombin also rises and falls due to the fact that a woman in a position takes drugs that slow down or enhance the action of coumarin.

INR(prothrombin time)- this is the period of time when a thrombin clot is created when Ca and tissue factor enter the blood.

Lupus anticoagulant- These are antiphospholipid antibodies of Ig class M, G, which, in the case of pathologies of the immune system, are produced to disrupt the impermeability of platelet membranes. Its presence is dangerous with complications and miscarriage.

Soluble fibrin monomeric complex (SFMK)- this is an intermediate consumption that appears as a result of the splitting of fibrin lumps, which are very difficult to determine due to their rapid elimination from the plasma. It is allowed to increase the rate of Rfmk in the 2nd trimester and until the end of the term.

Antithrombin III is a protein whose main task is to prevent hemostasis and the appearance of clots.

D-dimer- this is the period of creation of a thrombus and splitting of fibrin. This number gradually increases during pregnancy.

conclusions

The hemostasiogram is of great importance, both for the life and health of a pregnant woman with her unborn child. And if the coagulogram is normal, then there is nothing to worry about, respectively, there is no danger to the health of the mother and fetus. But if the indicators are outside the normal range, then you need to contact your doctor for advice as soon as possible.

The main thing is not to panic, but to go through all the examinations that your doctor prescribes, so that, if necessary, you can adjust the treatment to get good results.

The work of the circulatory system is perhaps the most important indicator of health. During pregnancy, she requires increased attention. reveals violations of hemostasis - a system that is responsible in our body for the liquid state of blood in the norm and for blood clotting to stop bleeding. If the indicators of hemostasis are lowered, a person has large blood loss even due to a minor cut. Too high (hypercoagulability) leads to thrombosis, heart attacks and strokes.

According to doctors, the danger of both anomalies is that in Everyday life they may not show up at all. But during an operation or childbirth, they threaten the development of a critical situation.

The hemostasis system during pregnancy undergoes some changes. Therefore, the coagulogram before pregnancy and during it is different. Nature provides for such a natural restructuring. In the process of bearing a child in a woman's body, a third circle of blood circulation occurs, which is called the uteroplacental. There is a preparation for an increase in the amount of circulating blood. This is important, among other things, because of the inevitable blood loss during childbirth.

Blood clotting test: when and how?

Usually, a coagulogram is carried out once a trimester. Sometimes more often. This need arises when varicose veins veins, hepatic, vascular and immune diseases, before or after surgery.

The risk group also includes pregnant women with a negative Rh factor. In this case, during the gestation of the fetus, it fights with its own antibodies, since it perceives them as foreign.

If a woman is predisposed to increased blood clotting or the first coagulogram showed deviations, the study will have to be repeated periodically. Blood is taken from a vein. Before the analysis, you can not eat for eight hours.

If it turns out that the patient has poor blood clotting, but this was not detected in time, there is a high risk or even brain dysfunction in the fetus.

Coagulogram: interpretation of the results

Remember that only a doctor should decipher all test results, since many of them can change in one direction or another. For example, if a woman has chronic diseases, then some data sometimes do not meet the norm, while the pregnancy proceeds safely.

The coagulogram includes eight main indicators. Even small deviations can be detected from them.

fibrinogen A protein that makes up the bulk of a blood clot when it clots. The norm is 2-4 g / l. In pregnant women - up to 6 g / l. Its increase indicates a tendency to thrombosis. A decrease can be observed with toxicosis. Due to the uteroplacental circulation, the fibrinogen level increases with each month of pregnancy and reaches a maximum by the time of delivery.

APTT- activated partial thromboplastin time. This is the gap in which the blood coagulates. In a healthy person, it stops within 24-35 seconds. In pregnant women, due to an increase in fibrinogen, this interval is reduced to 17-20 seconds.

thrombin time is the duration of the last stage of blood clotting. Normally, it is 11-18 seconds. Since the amount of fibrinogen in the blood is higher in pregnant women, the thrombin time is longer. Deviations may indicate a violation of the liver.

Prothrombin- a protein in blood plasma, a precursor of thrombin, is involved in the formation of clots. Its concentration determines the thickness of the blood and its ability to coagulate in a timely manner. Optimal - 78-142%. An increase in this factor in pregnant women is one of the symptoms.

platelets- elements of blood that are formed in the bone marrow. During pregnancy, there may be a slight decrease. But if the indicator is significantly below the norm, this is a sign of the disease. Platelet deficiency is caused by malnutrition or the development of DIC in a pregnant woman - damage to the hemostasis system.

D-dimer responsible for the process of thrombosis. The indicator is important for the timely diagnosis of thrombosis. In a pregnant woman, it should gradually grow. But a rapid jump indicates the presence of diabetes, kidney disease.

Antithrombin III A protein that slows down blood clotting. If the expectant mother takes drugs aimed at reducing it, its level will have to be constantly monitored. When the deviation is 50%, the development of thrombosis is not excluded.

Group of specific antibodies- indicates the presence of lupus anticoagulant. Normally, they shouldn't be. If, nevertheless, they are detected, the doctor must exclude autoimmune diseases and Rhesus conflict. The presence of antibodies in the blood can also speak of preeclampsia - a pathology in which the condition of the mother and child worsens.

Comment on the article "Tests during pregnancy - coagulogram: why and when?"

Coagulation system during pregnancy

APTT - activated partial thromboplastin time. This indicator is measured in the laboratory and means the readiness of the blood to clot. After the addition of reagents to the blood, the triggering of the mechanism of thrombus formation in response to bleeding is simulated.

Normally, for an ordinary person, this indicator ranges from 28 to 40 seconds. An increase or decrease in this time indicates a violation of the ratios of coagulation and anticoagulation components of blood plasma.

During pregnancy, the APTT changes, this is a natural adaptation mechanism of the woman's body. Already from the end of the first trimester of pregnancy, there is a gradual decrease in the time of thrombus formation.

These changes are due to two factors:

in the body of a woman, another circle of blood circulation is added - uteroplacental. The placenta has a large number of vessels through which, even with a small area of detachment, significant blood loss can occur. An episode of placental abruption can occur with an increase in the tone of the uterus - the threat of termination of pregnancy.
a decrease in the time of thrombus formation is necessary in childbirth as a compensatory mechanism. After the birth of a child during the separation of the placenta, a woman simultaneously loses up to 400 ml of blood. With such rapid and massive blood loss, the coagulation system must be prepared to quickly form blood clots and prevent further blood loss.

APTT during pregnancy decreases, and its norm is in the range of 17-20 seconds.

When to take a blood test for APTT

If the pregnancy proceeds without complications, blood for APTT is routinely examined when a woman is registered (up to 12 weeks), at a period of 20-22 and 32-36 weeks.

A blood test is taken on an empty stomach, after 8 hours of fasting. Before taking the analysis, it is recommended to refrain from fatty foods, since an excess amount of lipids can distort the test results. The result may also be affected by taking iron supplements to treat anemia.

A blood test for APTT during pregnancy is examined additionally in various conditions.

If pregnancy occurs after prolonged infertility;
In cases where previous pregnancies ended in spontaneous abortion;
If there were complications during previous pregnancies and childbirth: preeclampsia (late toxicosis), placental abruption, bleeding during childbirth and the early postpartum period;
If during a previous pregnancy IUGR (restricted intrauterine development of the fetus) was diagnosed, associated with placental insufficiency;
With multiple pregnancy;
After in vitro fertilization;
In the presence of liver diseases;
With varicose veins;
With periodic nosebleeds, bleeding gums and a tendency to form hematomas even with minor injuries;
With previously diagnosed blood diseases;
With pathology of the endocrine system;
With diseases of the cardiovascular system;
With chronic processes in the genitourinary system;
In case of autoimmune diseases.

Blood on APTT is examined according to indications in cases where a complication of pregnancy develops - preeclampsia, or late toxicosis. With this disease, edema occurs, an increase in blood pressure and protein appears in the urine. This is a serious complication of pregnancy that poses a threat to the life of the mother and child.

Determination of APTT in preeclampsia

The danger of preeclampsia lies in the fact that under the influence of a number of factors that are still being studied, multiple damage to the vascular walls occurs in a woman's body. As a result, a biologically active substance, fibronectin, is released into the blood, and a whole cascade of reactions is triggered. There is a generalized vasospasm, increased blood pressure, impaired uteroplacental blood flow. Intrauterine fetal hypoxia begins, which over time leads to developmental delay or, in severe cases, to the death of the child.

Pathological mechanisms that develop in a woman's body with late toxicosis affect the state of the coagulation system. The anticoagulant properties of the blood decrease. Together with oxygen starvation and generalized vasospasm, these processes lead to the development of disseminated intravascular coagulation syndrome.

With DIC syndrome, multiple formation of microthrombi occurs both in the vascular bed of a woman and in the uteroplacental circle. As a result, the blood supply to all organs of a pregnant woman worsens. The fetus also experiences constant oxygen starvation. In addition, prolonged processes of thrombus formation lead to the depletion of the coagulation system, and by the time of childbirth, the woman's body loses its readiness for blood loss. As a result, bleeding during childbirth can lead to the death of a woman.

DIC occurs in 2 stages: the phase of accelerated thrombus formation and the coagulopathy of consumption following it, when the blood practically loses its ability to form fibrin clots.

An increase in APTT is a significant indicator of the severity of coagulation system disorders in preeclampsia. Therefore, this blood test for complicated pregnancy is performed several times according to indications.

When does APTT rise?

APTT is considered elevated if the analysis shows a clotting time of more than 40 seconds, which indicates a decrease in its ability to form blood clots and, therefore, the risk of bleeding.

APTT rises above normal when taking antibiotics, aspirin, heparin, and thrombolytic drugs. Before passing the analysis, it is necessary to notify the attending physician about this in order to avoid incorrect interpretation of the results.

An increase in platelet activation time indicates a decrease in blood coagulation, and occurs with the following pathologies:

Liver diseases with severe liver failure, including cirrhosis. With these pathologies, the synthesis of coagulation factors in the blood is disrupted;
Hemophilia A, B, C - hereditary diseases that are congenital deficiency of coagulation factors and are manifested by the presence of spontaneous bleeding;
Vitamin K deficiency. Occurs as a result of violations of the production of this vitamin in the intestine during dysbacteriosis, an unbalanced diet;
Willebrand's disease is a hereditary pathology, lack of production of a transport protein-carrier of clotting factors;
Leukemia;
Syndrome of disseminated intravascular coagulation in the stage of consumption coagulopathy. Those. such a state of the coagulation system, when a deficiency of coagulation factors is already developing.

When the APTT goes down

A decrease in this coagulation indicator indicates an increased readiness for thrombosis. This is fraught with the development of vascular microthrombosis, followed by oxygen starvation of the tissues of the mother and fetus. APTT is considered lowered if the analysis shows a time of less than 17 seconds.

Shortening the time of thrombus formation can develop:

after inflammatory diseases, as a result of damage to the vascular walls by toxins of bacteria and viruses;
In the first phase of DIC - when there is an acceleration of the process of thrombus formation;
With blood loss immediately before the test, in this case, the acceleration of blood clots has a compensatory mechanism;
In the presence of malignant tumors.

The value of other indicators of the coagulogram in pregnant women

In addition to ATCV during pregnancy, other indicators of the coagulogram are examined.

Fibrinogen is a protein component of blood plasma that is directly involved in the formation of a blood clot. The norm of the indicator ranges from 2 to 4 g / liter. If fibrinogen is increased by more than 6 g / liter, this may indicate past infectious diseases. If the indicator is below the norm in combination with an increase in APTT, then there is a high probability of developing DIC.

Lupus anticoagulant. The norm during pregnancy is the absence of this component in the blood plasma. The determination of lupus anticoagulant in conjunction with an increase in APTT means that the risk of developing DIC is increased.

thrombin time. The norm during pregnancy is from 11 to 18 seconds. At the last stage of blood coagulation, their fibrinogen is converted to fibrin, this process is due to the action of thrombin. Since an increase in fibrinogen is the norm during pregnancy, a prolongation of thrombin time is also considered a natural reaction.

Prothrombin. The norm of this indicator of the coagulation system during pregnancy ranges from 77 to 142%. The ratio is measured in percent, as it determines the state of activity of the prothrombin complex in relation to the control plasma. This indicator of the coagulogram characterizes the state of the second stage of blood coagulation. An elevated level of prothrombin is determined in pregnant women with placental abruption.

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