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Original Article

Evidence of maternal platelet activation, excessive thrombin generation, and high amniotic fluid tissue factor immunoreactivity and functional activity in patients with fetal death

, MD, , , , , , , , , , , , , , , & , MD show all
Pages 672-687 | Received 10 Oct 2008, Accepted 09 Feb 2009, Published online: 19 Aug 2009

Figures & data

Table I.  Demographic and clinical characteristics of patients with normal pregnancies and those with fetal demise.

Table II.  Maternal plasma coagulation parameters of patients with a normal pregnancy and those with a fetal demise.

Figure 1. (a) Maternal plasma tissue factor (TF) concentrations among women with normal pregnancies (median 345.7 pg/ml, range 21.7–2662.2) and patients with a fetal demise with preeclampsia and those without hypertension (with preeclampsia: median 1167.0 pg/ml, range 287.5–1987.0; without hypertension: median 284.2 pg/ml, range 123.6–851.6); (b) Maternal plasma TF activity among women with normal pregnancies (median 9.9 pM, range 0.7–37.6) and patients with a fetal demise with preeclampsia and those without hypertension (with preeclampsia: median 16.2 pM, range 11.6–59.3; without hypertension: median 10.9 pM, range 5.3–57.2).

Figure 1. (a) Maternal plasma tissue factor (TF) concentrations among women with normal pregnancies (median 345.7 pg/ml, range 21.7–2662.2) and patients with a fetal demise with preeclampsia and those without hypertension (with preeclampsia: median 1167.0 pg/ml, range 287.5–1987.0; without hypertension: median 284.2 pg/ml, range 123.6–851.6); (b) Maternal plasma TF activity among women with normal pregnancies (median 9.9 pM, range 0.7–37.6) and patients with a fetal demise with preeclampsia and those without hypertension (with preeclampsia: median 16.2 pM, range 11.6–59.3; without hypertension: median 10.9 pM, range 5.3–57.2).

Figure 2. (a) Maternal plasma tissue factor pathway inhibitor (TFPI) concentration among women with normal pregnancies (median 66.7 ng/ml, range 37.4–86.5) and patients with a fetal demise with preeclampsia and those without hypertension (with preeclampsia: median 72.4 ng/ml, range 45.3–123.7; without hypertension: median 45.6 ng/ml, range 13.6–115.2); (b) Maternal plasma TFPI activity among women with normal pregnancies (median 1.1 unit/ml, range 0.7–2.7) and patients with a fetal demise with preeclampsia and those without hypertension (with preeclampsia: median 1.4 unit/ml, range 1.0–1.7; without hypertension: median 1.15 unit/ml, range 0.8–2.5).

Figure 2. (a) Maternal plasma tissue factor pathway inhibitor (TFPI) concentration among women with normal pregnancies (median 66.7 ng/ml, range 37.4–86.5) and patients with a fetal demise with preeclampsia and those without hypertension (with preeclampsia: median 72.4 ng/ml, range 45.3–123.7; without hypertension: median 45.6 ng/ml, range 13.6–115.2); (b) Maternal plasma TFPI activity among women with normal pregnancies (median 1.1 unit/ml, range 0.7–2.7) and patients with a fetal demise with preeclampsia and those without hypertension (with preeclampsia: median 1.4 unit/ml, range 1.0–1.7; without hypertension: median 1.15 unit/ml, range 0.8–2.5).

Figure 3. Maternal plasma sCD40L concentration among women with normal pregnancies (median 369.5 pg/ml, range 63.5–1848.7) and patients with a fetal demise with preeclampsia and those without hypertension (with preeclampsia: median 732.0 pg/ml, range 271.3–1714.0; without hypertension: median 1213.3 pg/ml, range 118.0–3818.0).

Figure 3. Maternal plasma sCD40L concentration among women with normal pregnancies (median 369.5 pg/ml, range 63.5–1848.7) and patients with a fetal demise with preeclampsia and those without hypertension (with preeclampsia: median 732.0 pg/ml, range 271.3–1714.0; without hypertension: median 1213.3 pg/ml, range 118.0–3818.0).

Figure 4. Maternal plasma thrombin–antithrombin (TAT) III complexes concentration among women with normal pregnancies (median 15.7 μg/l, range 5.2–107, 941.0) and patients with a fetal demise with preeclampsia and those without hypertension (with preeclampsia: median 105.8 μg/l, range 11.2–2002.8; without hypertension: median 28.9 μg/l, range 6.6–61, 256.8).

Figure 4. Maternal plasma thrombin–antithrombin (TAT) III complexes concentration among women with normal pregnancies (median 15.7 μg/l, range 5.2–107, 941.0) and patients with a fetal demise with preeclampsia and those without hypertension (with preeclampsia: median 105.8 μg/l, range 11.2–2002.8; without hypertension: median 28.9 μg/l, range 6.6–61, 256.8).

Figure 5. Maternal plasma prothrombin fragments 1 + 2 concentration among women with normal pregnancies (median 3786.0 pmol/l, range 513.4–486, 310.0) and patients with a fetal demise with preeclampsia and those without hypertension (with preeclampsia: median 8715.4 pmol/l, range 4320.4–18, 954.2; without hypertension: median 5205.4 pmol/l, range 343.4–494, 564.0).

Figure 5. Maternal plasma prothrombin fragments 1 + 2 concentration among women with normal pregnancies (median 3786.0 pmol/l, range 513.4–486, 310.0) and patients with a fetal demise with preeclampsia and those without hypertension (with preeclampsia: median 8715.4 pmol/l, range 4320.4–18, 954.2; without hypertension: median 5205.4 pmol/l, range 343.4–494, 564.0).

Table III.  Placental lesions in patients with a fetal demise according to the presence of hypertensive diseases of pregnancy

Table IV.  Demographic and clinical characteristics of patients with normal pregnancies and those with a fetal demise that had amniocentesis

Supplementary table I. The association between placental lesion and markers for coagulation in women with normal pregnancy.

Supplementary table II. The association between placental lesion and markers for coagulation in women with fetal demise without hypertension.

Supplementary table III. Supplementary The association between placental lesion and markers for coagulation in women with fetal demise with hypertension.

Figure 6. (a) Amniotic fluid tissue factor concentration among women with normal pregnancies (median 3710.4 pg/ml, range 2198.8–6268) and patients with a fetal demise (median 8535.4 pg/ml, range 2208.2–125,990.0); (b) Amniotic fluid tissue factor activity among women with normal pregnancies (median 28.4 pM, range 10.2–84.9) and patients with a fetal demise (median 81.6 pM, range 7.2–1603.4).

Figure 6. (a) Amniotic fluid tissue factor concentration among women with normal pregnancies (median 3710.4 pg/ml, range 2198.8–6268) and patients with a fetal demise (median 8535.4 pg/ml, range 2208.2–125,990.0); (b) Amniotic fluid tissue factor activity among women with normal pregnancies (median 28.4 pM, range 10.2–84.9) and patients with a fetal demise (median 81.6 pM, range 7.2–1603.4).

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