Hemostatic imbalance underlying preterm delivery in COVID-19 convalescent patients
Aim: to study the role of the hemostatic system in pretem delivery in pregnant women who have had COVID-19 in the gestation period from 14 to 16 weeks.Materials and Methods. A prospective single-center observational study was conducted by enrolling 63 pregnant women with verified COVID-19 at 14–16 w...
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IRBIS LLC
2024-03-01
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| Series: | Акушерство, гинекология и репродукция |
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| Online Access: | https://www.gynecology.su/jour/article/view/1842 |
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| author | M. G. Nikolaeva A. V. Korchagina A. P. Momot E. V. Grigoreva |
| author_facet | M. G. Nikolaeva A. V. Korchagina A. P. Momot E. V. Grigoreva |
| author_sort | M. G. Nikolaeva |
| collection | DOAJ |
| description | Aim: to study the role of the hemostatic system in pretem delivery in pregnant women who have had COVID-19 in the gestation period from 14 to 16 weeks.Materials and Methods. A prospective single-center observational study was conducted by enrolling 63 pregnant women with verified COVID-19 at 14–16 weeks of gestation. The main group consisted of 37 patients with preterm birth (PB), comparison group – 26 patients labour activity that occurred at least at gestational age of 37 weeks. Clinical and anamnestic data and dynamic changes in fibrinogen and D-dimer level, activity of tissue factor (TF), tissue factor pathway inhibitor (TFPI), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (t-PA), urokinase plasminogen activator (u-PA) were analyzed; thrombin generation assay (TGA) was performed.Results. It was found that severity of COVID-19 infection did not determine the timing of delivery that depended on patient comorbid condition. All PB observations (37 out of 63, 58.7 %) were caused by decompensated placental function manifested by acute obstetrical complications: increasing intrauterine fetal hypoxia (64.9 %) along with intrauterine growth retardation (51.4 %), severe preeclampsia (13.5 %) and premature abruption of the normally located placenta (5.0 %). In both study groups, COVID-19 experienced at 14–16 weeks of pregnancy was associated with coagulation and fibrinolytic imbalances. At the same time, at least 6 weeks post-COVID-19 infection, patients with PB had higher level of the “Peak thrombin” vs. comparison group (3050 vs. 2527 pmol/L; p = 0.0433). Also, patients with term vs. preterm delivery had TF activity decreased significantly: by 47.1% and 28.1%, respectively (p = 0.0546). Patients in preterm delivery group were characterized by fibrinolytic imbalance. At the first time point, suppressed fibrinolysis (PAI-1 level – 18.4 vs. 12.5 ng/ml in the comparison group; p = 0.0209) was concomitant with elevated level of u-PA (1.5 vs. 0.55 ng/ml in comparison group, p = 0.0015), which suggests a potential prolonged immunoinflammatory response in patients with PB. Magnitude of fibrinogen concentration and D-dimer level during post-COVID-19 follow-up study was within the reference values specific to gestational age.Conclusion. A significant increase in coagulation potential was found and verified by elevated activity of tissue factor and potential to thrombin generation in COVID-19 convalescent patients. In the case of preterm delivery, there was an imbalance in fibrinolysis system revealed by decreased blood fibrinolytic activity elevating along with increasing gestational age. |
| format | Article |
| id | doaj-art-596f7b8f29f44295a4e57accea0c692c |
| institution | DOAJ |
| issn | 2313-7347 2500-3194 |
| language | Russian |
| publishDate | 2024-03-01 |
| publisher | IRBIS LLC |
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| series | Акушерство, гинекология и репродукция |
| spelling | doaj-art-596f7b8f29f44295a4e57accea0c692c2025-08-20T02:53:55ZrusIRBIS LLCАкушерство, гинекология и репродукция2313-73472500-31942024-03-01181233410.17749/2313-7347/ob.gyn.rep.2023.459842Hemostatic imbalance underlying preterm delivery in COVID-19 convalescent patientsM. G. Nikolaeva0A. V. Korchagina1A. P. Momot2E. V. Grigoreva3Altai State Medical University, Health Ministry of Russian Federation; Altay Branch of National Medical Research Center for Hematology, Health Ministry of Russian FederationAltai State Medical University, Health Ministry of Russian Federation; Altai Regional Clinical Perinatal CenterAltai State Medical University, Health Ministry of Russian Federation; Altay Branch of National Medical Research Center for Hematology, Health Ministry of Russian FederationAltai State Medical University, Health Ministry of Russian Federation; Altai Regional Clinical HospitalAim: to study the role of the hemostatic system in pretem delivery in pregnant women who have had COVID-19 in the gestation period from 14 to 16 weeks.Materials and Methods. A prospective single-center observational study was conducted by enrolling 63 pregnant women with verified COVID-19 at 14–16 weeks of gestation. The main group consisted of 37 patients with preterm birth (PB), comparison group – 26 patients labour activity that occurred at least at gestational age of 37 weeks. Clinical and anamnestic data and dynamic changes in fibrinogen and D-dimer level, activity of tissue factor (TF), tissue factor pathway inhibitor (TFPI), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (t-PA), urokinase plasminogen activator (u-PA) were analyzed; thrombin generation assay (TGA) was performed.Results. It was found that severity of COVID-19 infection did not determine the timing of delivery that depended on patient comorbid condition. All PB observations (37 out of 63, 58.7 %) were caused by decompensated placental function manifested by acute obstetrical complications: increasing intrauterine fetal hypoxia (64.9 %) along with intrauterine growth retardation (51.4 %), severe preeclampsia (13.5 %) and premature abruption of the normally located placenta (5.0 %). In both study groups, COVID-19 experienced at 14–16 weeks of pregnancy was associated with coagulation and fibrinolytic imbalances. At the same time, at least 6 weeks post-COVID-19 infection, patients with PB had higher level of the “Peak thrombin” vs. comparison group (3050 vs. 2527 pmol/L; p = 0.0433). Also, patients with term vs. preterm delivery had TF activity decreased significantly: by 47.1% and 28.1%, respectively (p = 0.0546). Patients in preterm delivery group were characterized by fibrinolytic imbalance. At the first time point, suppressed fibrinolysis (PAI-1 level – 18.4 vs. 12.5 ng/ml in the comparison group; p = 0.0209) was concomitant with elevated level of u-PA (1.5 vs. 0.55 ng/ml in comparison group, p = 0.0015), which suggests a potential prolonged immunoinflammatory response in patients with PB. Magnitude of fibrinogen concentration and D-dimer level during post-COVID-19 follow-up study was within the reference values specific to gestational age.Conclusion. A significant increase in coagulation potential was found and verified by elevated activity of tissue factor and potential to thrombin generation in COVID-19 convalescent patients. In the case of preterm delivery, there was an imbalance in fibrinolysis system revealed by decreased blood fibrinolytic activity elevating along with increasing gestational age.https://www.gynecology.su/jour/article/view/1842covid-19 infectionpreterm birthtissue factortfthrombin generation assaytgaurokinase plasminogen activatoru-paplasminogen activator inhibitor-1pai-1 |
| spellingShingle | M. G. Nikolaeva A. V. Korchagina A. P. Momot E. V. Grigoreva Hemostatic imbalance underlying preterm delivery in COVID-19 convalescent patients Акушерство, гинекология и репродукция covid-19 infection preterm birth tissue factor tf thrombin generation assay tga urokinase plasminogen activator u-pa plasminogen activator inhibitor-1 pai-1 |
| title | Hemostatic imbalance underlying preterm delivery in COVID-19 convalescent patients |
| title_full | Hemostatic imbalance underlying preterm delivery in COVID-19 convalescent patients |
| title_fullStr | Hemostatic imbalance underlying preterm delivery in COVID-19 convalescent patients |
| title_full_unstemmed | Hemostatic imbalance underlying preterm delivery in COVID-19 convalescent patients |
| title_short | Hemostatic imbalance underlying preterm delivery in COVID-19 convalescent patients |
| title_sort | hemostatic imbalance underlying preterm delivery in covid 19 convalescent patients |
| topic | covid-19 infection preterm birth tissue factor tf thrombin generation assay tga urokinase plasminogen activator u-pa plasminogen activator inhibitor-1 pai-1 |
| url | https://www.gynecology.su/jour/article/view/1842 |
| work_keys_str_mv | AT mgnikolaeva hemostaticimbalanceunderlyingpretermdeliveryincovid19convalescentpatients AT avkorchagina hemostaticimbalanceunderlyingpretermdeliveryincovid19convalescentpatients AT apmomot hemostaticimbalanceunderlyingpretermdeliveryincovid19convalescentpatients AT evgrigoreva hemostaticimbalanceunderlyingpretermdeliveryincovid19convalescentpatients |