Coagulation and Fibrinolysis in Pregnancy
Summary
In pregnancy, complex adjustments in blood clotting and clot breakdown ensure maternal and foetal health. Normally, pregnancy induces a hypercoagulable state to prevent haemorrhage at delivery, driven by elevated fibrinogen, prothrombotic clotting factors and enhanced platelet activation, balanced against regulated fibrinolytic activity. Plasminogen activators are downregulated while inhibitors such as plasminogen activator inhibitor-1 rise, reducing clot dissolution. This equilibrium supports placental perfusion and minimises bleeding risk. Disruption of these processes underlies major obstetric complications: excessive coagulation promotes placental microthrombi, contributing to preeclampsia and intrauterine growth restriction, whereas impaired clot breakdown may exacerbate postpartum haemorrhage. Elucidating these pathways informs risk assessment, monitoring and targeted interventions globally.
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Coagulation and Fibrinolysis in Pregnancy publication trend
The graph below shows the total number of articles in coagulation and fibrinolysis in pregnancy across all publications each year (not limited to Nature Index journals).
Technical terms
Coagulation: The cascade of enzymatic reactions leading to fibrin clot formation to prevent bleeding.
Fibrinolysis: The enzymatic breakdown of fibrin clots, primarily mediated by plasmin.
Hypercoagulable state: A physiological condition of increased clotting tendency, common in pregnancy, elevating thrombotic risk.
D-dimer: A degradation product of cross-linked fibrin, used clinically to indicate clot formation and lysis.
Thromboelastography (TEG) / Thromboelastometry (ROTEM): Point-of-care tests measuring the viscoelastic properties of blood during clot formation and dissolution.
References
- Quantitative Proteomics of Maternal Blood Plasma in Isolated Intrauterine Growth Restriction. International Journal of Molecular Sciences (2023).
- Serum D-dimer is not predictive of placenta-mediated complications in pregnancy at high risk: The multicentric prospective cohort AngioPred study. Frontiers in Cell and Developmental Biology (2023).
- Hemostasis in Pre-Eclamptic Women and Their Offspring: Current Knowledge and Hemostasis Assessment with Viscoelastic Tests. Diagnostics (2024).
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