What is a coagulogram during pregnancy, what are the norms and how to decipher the results of the analysis?

Whether the pregnant woman is at risk of bleeding depends on how quickly the blood can clot. If the blood has excessive clotting ability, this is fraught with thrombosis. Both of these conditions can significantly complicate the process of bearing a child and the upcoming birth. To assess the risks, doctors prescribe a coagulogram to expectant mothers - a special analysis. How it is carried out, what it shows and how to decipher it, we will tell in this material.

What it is?

Coagulogram has a second name - hemostasiogram. This is a blood test that allows you to establish at what speed, how quickly the blood coagulates and the processes of hemostasis proceed. This analysis is mandatory and is done three times during pregnancy. The first time it is done when registering in order to assess the prognosis of complications during gestation.

The coagulogram is repeated in the second trimester, at about 22-24 weeks. A hemostasiogram must be prescribed shortly before childbirth or a planned cesarean section, so that doctors can at least approximately predict blood loss, prepare more carefully and, if necessary, involve hematologists in childbirth.

The essence of hemostasis boils down to the fact that when blood vessels are damaged under the influence of special plasma proteins - enzymes - the process of creating a thrombus is triggered, which tightly closes the place of possible "leak". After restoring the integrity of the endothelium in the thrombus, the need disappears, the vessel needs to get rid of it. Hemostasis at this stage ensures the dissolution of the thrombus and the purification of the vessel.

This is how these processes look normal, but sometimes there are violations in the fragile hemostasis system, and it is about them that an analysis such as a coagulogram can tell a lot.

All the nuances of the coagulation and anticoagulation systems and mechanisms are shown by the study, which is considered one of the most "laborious" and difficult in laboratory practice. It requires great precision from the technician and does not tolerate indulgence and inattention.

A person's life depends on the results and their correct interpretation, and in the case of pregnant women, two lives at once.

A blood clotting disorder can be a big problem. So, liquid blood (this is what the people call poor clotting, its insufficiency) can cause placental abruption, bleeding both during pregnancy and in childbirth. It is dangerous in the postpartum period. Thick blood (meaning an increase in hemostasis indicators) can lead to the formation of blood clots, which often becomes the cause of fetal hypoxia.

It is blood clots that are one of the most common causes of maternal mortality - death occurs in a matter of minutes with pulmonary embolism. A blood clotting disorder is also dangerous with the likelihood of premature birth or miscarriage.

Who is assigned?

As already mentioned, all pregnant women must donate blood for a coagulogram three times during pregnancy. However, there are categories of expectant mothers who will have to take this test much more often. These include women with the following complications:

Rh-conflict pregnancy;
a woman's tendency to varicose veins;
various liver diseases in the expectant mother;
diseases of the cardiovascular system;
a history of several miscarriages, recurrent miscarriage;
pathology of the placenta;
multiple pregnancy (twins, triplets);
identified violations of blood clotting factors.

In all these cases, the coagulogram is performed according to the basic scheme. There is also an extended analysis - a detailed hemostasiogram, it is carried out according to special indications for women who suffer from high blood pressure, gestosis with edema in both the first and third trimesters.

An extended analysis will also be prescribed for a pregnant woman if she bears twins or triplets, and also has a predisposition to blood and vascular diseases.

How to get tested?

Preparation for a coagulogram is to follow a diet. For a couple of days, it is undesirable to eat spicy and salty, as well as fatty foods. It is not recommended to eat at all 10-12 hours before donating blood, it is only allowed to drink clean non-carbonated water. The day before the analysis, you should avoid coffee, strong tea, fruit drinks, compotes and any carbonated drinks. You should not drink too much liquid, from this the indicators may be reduced.

Also, in order to prepare for the study, you should protect yourself from stress and emotional outbursts. It has long been proven that the nerve factor has a significant effect on the results of the coagulogram.

Blood is taken from a vein in the morning. The analysis time is approximately 1 day. Depending on the workload of the laboratory, the maximum analysis time is 2 days.

Decoding

As a result of the analysis, several main key indicators that affect blood clotting factors in pregnant women.

APTT. This abbreviation is abbreviated as activated partial thromboplastin time - the length of time required for the formation of a thrombus. In women who are expecting a child, the APTT is always slightly reduced in comparison with non-pregnant women and men. If the APTT is increased relative to normal, this indicates that the blood coagulates slowly and there is a possibility of bleeding. If the APTT is reduced relative to the norm, they speak of "thick" blood and the associated likelihood of blood clots.
Fibrinogen. It is a protein made by the liver. It is necessary for the formation of a blood clot, since when exposed to certain enzymes, it creates the very fibrin threads that tighten the wound site. Without fibrinogen, blood clots would not have been possible. In all pregnant women, with an increase in gestational age, a physiological increase in the concentration of fibrinogen is observed. So the body of a pregnant woman prepares for the upcoming birth.

TV. Behind this reduction lies the time required for clotting, the thrombin time. In pregnant women, even perfectly healthy women, the period of thrombus formation may increase, especially in the first half of pregnancy. This indicator is often violated relative to the norm in women suffering from liver disease.
VA... This indicator stands for lupus anticoagulant. This refers to an indicator that evaluates the formation of antibodies. The norm is the complete absence of lupus anticoagulant in the blood of the expectant mother. If VA is still present, this may indicate the presence of an autoimmune disease, gestosis, thrombosis.
CT. This is the platelet count. It is these platelet cells that take the most active and active part in the process of blood clotting. A high platelet count always indicates a clotting disorder, as well as a decrease in the concentration of these cells in the blood.

D-dimer... This is a protein substance that is formed as a result of the breakdown of blood clots and cleaning of the vessel - fibrinolysis. By the amount of residual substance, one can judge how balanced the second part of hemostasis is - dissolution and removal of blood clots. In all pregnant women, the D-dimer is slightly increased, but a significant increase in its concentration in the blood of the expectant mother is a very alarming phenomenon, characteristic of diabetes mellitus, gestosis, and kidney diseases.
Prothrombin. It is a plasma protein that directly affects the blood clotting process. Determination of prothrombin is considered the most important indicator of the coagulogram. In the last trimester of pregnancy, the concentration of prothrombin may decrease slightly.
RFMK... This refers to soluble fibrin-monomeric complexes, intermediate products of clot decomposition as a result of its dissolution (fibrinolysis). With an increase in the indicator, a tendency to thrombosis, recent injuries associated with blood loss, operations are suspected. RFMK also increases with gestosis, preeclampsia, renal failure.
AT-3. This is another protein, antithrombin-3. Its task is to make the process of coagulation slower, to prevent rapid coagulation. He acts as a regulator. As with most other indicators, the excess or decrease of the AT-3 level relative to the norm is assessed. An increase indicates the risk of thrombosis, and a decrease indicates that the expectant mother has too "liquid" blood.

Coagulogram rates during pregnancy in the table by trimester:

Reasons for deviations

If the coagulogram gave unsatisfactory results, the woman has an increased or low ability to coagulate, this is not a reason for panic, but just the basis for a more detailed examination. If there are significant deviations in one of the trimesters according to the results of the analysis, the doctor may suggest the development of diabetes mellitus in the expectant mother, the presence of gestosis in the late term or severe toxicosis in the early, as well as pathology of the kidneys and liver. It is to identify these reasons that additional examination will be directed.

One of the most important indicators, in addition to APTT, is the definition of lupus anticoagulant. If it is found, then the doctor considers a version of an autoimmune disease in the expectant mother. VA in the blood appears with rheumatoid arthritis, with disorders of cerebral circulation due to ischemic stroke, due to systemic lupus.

During pregnancy, the appearance of a lupus anticoagulant may indicate problems such as placental abruption, placental infarction, intrauterine death of the baby, and blood clots.

An increase in febrinogen in the blood can indicate diseases of the kidneys, heart, the presence of malignant tumors and inflammatory processes of various origins. A decrease in fibrinogen often indicates the presence of disseminated intravascular coagulation syndrome, liver ailments. Antithrombin-3 also increases with inflammatory diseases of the kidneys, liver and with a deficiency of vitamin K in the body of the expectant mother. Antithrombin decreases due to disseminated intravascular coagulation syndrome, coronary heart disease, and thrombosis.

Deviations in the coagulogram can also be caused by a violation of the rules for passing the analysis. If a woman did not warn the laboratory assistant that she was taking any medications, especially coagulant or anticoagulant drugs, in the case of donating blood on a full stomach or with a strong restriction in fluid before the analysis, deviations in her hemostasiogram will be explained only by this.

To eliminate errors, it is recommended to repeat the analysis after receiving unsatisfactory results.

In each specific case, it is required to assess the ratio of all indicators of the coagulogram in order to assign a woman an individual list of tests. Most often, a pregnant woman is given a referral for a biochemical blood test to determine the sugar content, and she should also pass urine to establish whether everything is in order with the kidneys.

Sometimes it is required to additionally conduct an ultrasound of the kidneys and bladder, to consult a cardiologist, therapist, a hematologist, and only after that treatment can be prescribed.

Why are deviations dangerous?

Despite the fact that treatment does not always require serious medication, and sometimes it is quite enough to observe the correct adequate drinking regimen, special recommendations for nutrition and lifestyle, do not underestimate blood clotting disorders, especially during pregnancy. Refusal of treatment and examination, reluctance of the expectant mother to pay due attention to this problem, reluctance to see a doctor - can turn out to be quite dangerous and even lethal consequences.

The most dangerous of them is the occurrence of DIC syndrome. (syndrome of intravascular dessimensional coagulation). With hypercoagulation, many small blood clots form in a woman's body, which can clog the vessels. Such clots contribute to a violation of the blood supply between the mother and her child, the baby begins to receive significantly less nutrients and oxygen, hypoxia - oxygen starvation - can develop.

With hypocoagulation, blood clots do not live long and quickly disintegrate, a woman's blood clots worse and even minor wounds and scratches can lead to severe bleeding. This is especially dangerous in the birth process, at the time of the birth of the placenta, when the bleeding is most intense. With acoagulation, blood does not clot at all... The forecasts for such a pathology are the least favorable - in most cases it is not possible to save the child, because there is profuse uterine bleeding, and the fetus dies.

To reduce the risks when carrying a baby, it is desirable to make a coagulogram for a woman even at the stage of pregnancy planning. This will help to timely identify possible pathologies that a woman who dreams of motherhood does not even know about, undergo treatment and become pregnant with more favorable prognosis for bearing and giving birth to a healthy baby. Also, do not give up a coagulogram during pregnancy.

After all, the fact that a woman has never suffered from liver and kidney diseases, did not complain of heart, does not mean that everything is in order with her blood clotting factors.