Published: 2017-03-30

The comparative study of fibrin degradation products in normal pregnancy and pregnancy induced hypertension

Rajani Upadhyaya, Anitha Sannaboraiah, Kasturi V. Donimath


Background: Pregnancy induced hypertension is a multisystem disorder and is characterized by changes in haemostatic system. The assessment of the coagulation parameters of the patients of pre-eclampsia and eclampsia is important because it helps to diagnose the severity of the disease, and to predict the outcome. There is no universal agreement as to the need for further investigations if the platelet count comes normal. Hence in such cases it is always prudent to get the coagulation profile. D dimer of such patients is done to diagnose the cases of coagulation failure early and to manage it efficiently. The objectives of the study to compare the Fibrin Degradation Products in term normal pregnancy, pre eclamptic and eclamptic patients, to assess the severity of pregnancy induced hypertension and to detect coagulation failure early and manage before it worsens.

Methods: This study was conducted in the Department of Obstetrics and Gynaecology at Karnataka Institute of Medical Sciences, Hubli during the period of March 2014 to February 2015 on 100 patients between 37-42 weeks of gestation. 50 controls were well matched with the study population which included a total of 50 patients with pre-eclampsia and eclampsia. Pregnant women with known bleeding disorders, on anticoagulant therapy, with abruptio placentae, with IUD, in labour and with established DIC were excluded.

The blood coagulation parameters which were compared between the control and the study population were Bleeding time (BT), Platelet Count, Clotting time (CT), Prothrombin time (PT), Activated partial thromboplastin time (aPTT) and D-dimer.

Results: The BT, CT, PT, aPTT values were nearly identical in all the groups. The platelet count showed a decreasing trend from normal control to eclampsia group. The D dimer showed an increasing trend from the normal control to eclampsia group. D dimer level was raised in all patients who were in sub clinical and clinical coagulation failure.

Conclusions: This study shows that even with the normal routine coagulation parameters, D dimer was significantly elevated in both subclinical and clinical DIC. So, D dimer can be used as a specific tool in early diagnosis and deciding appropriate management of PIH.


Coagulation profile, D dimer, Eclampsia, Pre-eclampsia

Full Text:



Stirling Y, Woolf L, North WR, Seghatchian MJ, Meade TW. Haemostasis in normal pregnancy, Thromb Haemost. 1984;52:176-82.

Ludwig H. Hemorrhagic disorders in pregnancy. Ther Umsch. 1999;56:608-15.

Bremme KA. Haemostatic changes in pregnancy. Bests Pract Res Clin Haematol. 2003;16(2):153-8.

Gary Cunningham F, Kenneth J. Leveno, Steven L. Bloom, John C. Hauth, Dwight J. Rouse, Catherine Y. Spong. Williams obstetrics- 23rd Edition. New York, NY: McGraw-Hill; 2010:706-56.

Srivastava M, Bali S, Pandey J, Nayar V, Talib VH. Pregnancy Induced Hypertension and Antithrombin-III. Indian J Pathol Microbiol. 1995;38(3):257-60.

Duley L. Maternal mortality associated with hypertensive disordersof pregnancy in Africa, Asia, Latin America and the Caribbean. Br J ObstetGynaecol. 1992;99:547-53.

McKay DG. Hematology evidence of disseminatedintravascular coagulation in eclampsia. Obs and GynSurvey. 1972;27(6):399-417.

Howie PW, Prentice CRM, McNicol GP. Coagulation, fibrinolysis and platelet function in preeclampsia, essential hypertension and placental insufficiency. BJOG: An International Journal of Obstetrics and Gynaecology. 1971;78(11):992-1003.

Lopez - Llera M, Espinosa ML, Lion MD, Linares GR. Abnormal coagulation and fibrinolysis in eclampsia. Am J Obs Gyn. 1976;124(7):681-87.

Agrawal S, Buradkar A. Coagulation studies in toxaemias of pregnancy. J Obstet Gynecol India. 1978;992-96.

Antony T, Suresh H, Kadam S, Shashikala P, Chandrasekhar HR. Coagulation profile in pregnancy induced hypertension (PIH). Ind. J. Hemat. Blood Transf. 1998;16(1):7-11.

Jambhulkar S, Shrikhande A, Shrivastava R, Deshmukh K. Coagulation profile in pregnancy induced Ind. J. Hemat. Blood Transf. 2001;19(1):35.

Kelton JG, Hunter DJS, Neame PB. A platelet functiondefect in preeclampsia. Obs Gyn. 1985;65(1):107-09.

Osmanağaoğlu MA, Topçuoğlu K, Ozeren M, Bozkaya H. Coagulation inhibitors in preeclamptic pregnantwomen. Arch Gynecol Obstet. 2005;271(3):227-30.

Boer KD, Buller HR, Ten Cate JW, Treffers PE. Coagulation studies in the syndrome of haemolysis, elevated liver enzymes and low platelets. Bri J of Obsand Gyn. 1991;98:42-7.

Leduc L, Wheeler JM, Kirshon B, Mitchell P, CottonDB. Coagulation profile in severe pre-eclampsia. Obs Gyn. 1992;79(1):14-8.

Barron WM, Heckerling P, Hibbard JU, Fisher S. Reducing unnecessary coagulation testing in hypertensive disorders of pregnancy. Obs Gyn. 1999;94:364-70.

Bonnar J, McNicol GP, Douglas AS. Coagulation andfibrinolytic systems in preeclampsia and eclampsia. Brit Med Jour. 1971;2:12-6.

Giles C, Inglis TCM. Thrombocytopenia and macrothrombocytosis in gestational hypertension. Bri J of Obs and Gyn. 1981;88:1115-19.

Pritchard JA, Cunningham FG, Mason A. Coagulation changes in pre-eclampsia: Their frequency and pathogenesis. Am J of Gyn Obs. 1976;124(8):855-59.

Trofatter KF, Howell ML, Greenberg CS, Hage ML. Screening of the D-Dimer in screening for coagulation abnormalities in pre-eclampsia. Obs Gyn. 1989;73(3):435-39.

Dekker GA, Sibai BM. Early detection of preeclampsia. Am J Obs Gyn. 1991;165(1):160-75.

Joshi. Platelet estimation: Its prognostic value in pregnancy induced hypertension. Indian J Physiol Pharmacol. 2004;51(2):160-64.

Tacoosian Z, Javadi HE, Farzam S, Javadi A. Evaluation of correlation between pre-eclampsia with D-Dimer. The Journal of Qazvin University of Medical Sciences. 2007;11(1):62-6.

KucukgozGulec U, TuncayOzgunen F, BarisGuzel A, Buyukkurt S, Seydaoglu G, FerhatUrunsak I, et al. An analysis of C-reactive protein, procalcitonin, and D-dimer in pre-eclamptic patients. Am J Reprod Immunol. 2012;68(4):331-7.

Rahman R, Begum K, Khondker L, Majumder NI, Nahar K, Sultana R, Siddika A. Role of D-dimer in determining coagulability status in pre-eclamptic and normotensive pregnant women. Mymensingh Med J. 2015; 24(1):115-20.

Carr JM, McKinney M, McDonagh J. Diagnosis of disseminated intravascular coagulation. Role of D-dimer Am J Clin Pathol. 1989;91(3):280-7.