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Physiology and Pathology of Coagulation in Pregnancy

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Principles and Practice of Maternal Critical Care

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Abstract

Pregnancy has traditionally been considered a hypercoagulable state; viscoelastic changes suggest as much. However, the traditional coagulation cascade model has been shown to be outdated and out of context in its simplicity. The physiology of coagulation during pregnancy is a different state of balanced clotting and fibrinolysis, both of which are accelerated in the pregnant and postpartum woman compared to the non-obstetric population. The overall changes that occur in normal pregnancy maintain hemostasis during gestation (Sharma SK, Philip J, Whitten CW, et al. Assessment of changes in coagulation in parturients with preeclampsia using thromboelastography. Anesthesiology. 1999;90:385–90). For example, increases in fibrin degradation products (e.g., D-dimer) and plasminogen concentration point to increased fibrinolytic activity during pregnancy. However, acquired and non-acquired coagulopathies in the parturient present both diagnostic and therapeutic challenges, similar to the general population in some ways and unique in other respects.

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Authors and Affiliations

  1. Englewood Health, Englewood, NJ, USA

    Samir N. Patel

  2. Department of Anesthesiology, Critical Care Medicine, Hyperbaric Medicine and Pain Management, Englewood, NJ, USA

    Aryeh Shander

  3. Team Health Research Institute, Englewood, NJ, USA

    Aryeh Shander

  4. Department of Anesthesiology, Medicine and Surgery at Icahn School of Medicine, Mount Sinai, New York, NY, USA

    Aryeh Shander

  5. Department of Anesthesiology at Rutgers New Jersey Medical School, Newark, NJ, USA

    Aryeh Shander

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  1. Samir N. Patel
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Correspondence to Aryeh Shander .

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Editors and Affiliations

  1. Intensive Care Unit, Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Jerusalem, Israel

    Sharon Einav

  2. Division of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Carolyn F. Weiniger

  3. Department of Anesthesiology, Columbia University Medical Center, New York, NY, USA

    Ruth Landau

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Patel, S.N., Shander, A. (2020). Physiology and Pathology of Coagulation in Pregnancy. In: Einav, S., Weiniger, C.F., Landau, R. (eds) Principles and Practice of Maternal Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-030-43477-9_5

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  • DOI: https://doi.org/10.1007/978-3-030-43477-9_5

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