[Thrombophilia and HELLP syndrome in pregnancy - case report and overview of the literature]

Angiotensin-Converting Enzyme (ACE) Insertion/Deletion (I/D) Polymorphism as a Conjoint Regulator of Coagulation, Fibrinolytic, and RAAS Pathway in Infertility and Associated Pregnancy Complications

Despite the increase in assisted reproductive technologies, the high rates of infertility and pregnancy complications are a major concern to infertility specialists worldwide. Infertility may be attributed to pregnancy complications like thrombophilia, preeclampsia and fibrin-induced recurrent pregnancy loss (RPL). Renin-angiotensin-aldosterone system (RAAS) directly or indirectly causes preeclampsia and thrombophilia through the fibrinolytic pathway that ultimately leads to RPL or infertility. The underlying mechanisms of this interaction are still unclear. The present comprehensive review is intended to demonstrate the role and interaction of RAAS and fibrinolytic pathways in pregnancy complications. How this interaction can induce pregnancy complications, and ultimately infertility, is also discussed in the light of current evidence. This study also presents common markers that link RAAS and fibrinolytic processes in developing thrombophilia, preeclampsia and RPL. The common link in these pathways is ACE gene I/D polymorphism. Apart from ACE, PAI-1, VIIa, XIIa, AT1R, AT1AA, and TF are common molecules that can delineate the underlying causes of pregnancy complications and infertility.

The Diagnostic Efficacy of Thrombelastography (TEG) in Patients with Preeclampsia and its Association with Blood Coagulation

Objective

The aim of this study was to investigate the diagnostic efficacy of thrombelastography (TEG) in patients with preeclampsia.

Methods

One hundred and seventeen pregnant women were recruited from Department of Obstetrics and Gynecology of 1^st affiliated Hospital of Fujian Medical University. Of the 117 patients, 59 were normal late gestation (control group), 32 were mild preeclampsia and other 26 cases were severe preeclampsia. All the patients were received thrombelastography (including: K time, Reaction time, Clot angel, MA value, CI value) and blood coagulation examination (including: PT, APTT, Fib, TT, D-dimer and AT-III).

Results

The R time, K time, Coagulation Index value and Clot Angle in preeclampsia group were significant different between control and preeclampsia groups with statistical difference (p<0.05). Moreover, the R and K time value in severe preeclampsia group were significant higher than those of control groups (p<0.05); however, the Coagulation Index value and Clot Angle in severe preeclampsia group were significant higher than those of mild preeclampsia group with statistical difference (p<0.05). Coagulation Index had the highest diagnostic sensitivity [87.93 (76.70-95.01) %] and specificity [83.83 (79.17-96.18)%] compared to other parameters with the AUC of 0.94 (0.90-0.98). The K time and the Coagulation Index had the highest diagnostic sensitivity (96.15%) and specificity (0.75%) respectively with the AUC of 0.68 and 0.75 respectively in differential diagnosis of severe preeclampsia from mild preeclampsia. However, there were no statistical difference in the aspects of platelet count and parameters relevant to coagulation test for the control, mild and sever preeclampsia groups(p>0.05).

Conclusion

TEG provides more accurate information in monitoring the blood coagulation of preeclampsia patients and can be used as a reliable marker for assessing the severity of preeclampsia.