Objective:To determine whether changes in plasma levels of thrombomodulin from antepartum to postpartum reflect the postpartum regression of preeclampsia.
Methods:Twenty-four preeclamptic women and 34 healthy, normotensive women with singleton pregnancies were studied in the third trimester. Plasma levels of thrombomodulin in the antepartum and postpartum periods were measured by a two-site immunoenzymatic assay. Two-tailed Student t test and paired-comparison t test were used for statistical analyses. The results were expressed as mean ± standard error.
Results:Antepartum plasma thrombomodulin levels in preeclampsia were significantly higher than postpartum levels (71.3 ± 8.5 versus 55.5 ± 5.4 ng/mL; P = .006), which was not seen in the normotensive controls (49.9 ± 3.1 versus 44.2 ± 3.8 ng/mL; P > .05). Antepartum plasma levels of thrombomodulin in preeclamptic women were significantly higher than those in the normotensive controls (P = .01). However, postpartum plasma levels of thrombomodulin in preeclamptic women were not significantly higher than those in the normotensive controls (P > .05).
Conclusions:Significantly decreased postpartum plasma thrombomodulin levels in preeclamptic pregnancies strongly correspond to clinical postpartum regression of preeclampsia.
1. Maruyama I, Bell CE, Majerus PW. Thrombomodulin is found on endothelium of arteries, veins, capillary, and lymphatics, and on syncytiotrophoblast of human placenta. J Cell Biol1985;101:363-371.
2.
2. Malar RA, Kleiss AJ, Griffin JH. Mechanism of action of human activated protein C, a thrombin dependent anticoagulant enzyme. Blood1982;59:1067-1072.
3.
3. Esmon CT. The role of protein C and thrombomodulin in the regulation of blood coagulation. J Biol Chem1989;264:4743-4746.
4.
4. Dittman WA, Majerus PW. Structure and functions of thrombomodulin: A nature anticoagulant. Blood1990;75:329-336.
5.
5. Ishii H, Majerus PW. Thrombomodulin is present in human plasma and urine. J Clind Invest1985;76:2178-2181.
6.
6. Roberts JM, Taylor RN, Musci TJ, Rodger GM, Hubel CA, McLaughlin MK. Preeclampsia: An endothelial cell disorder. Am J Obstet Gynecol1989;161:1200-1204.
7.
7. Rodger GM, Taylor RN, Roberts JM. Preeclampsia is associated with a serum factor cytotoxic to human endothelial cells. Am J Obstet Gynecol1988;159:908-914.
8.
8. Rappoport V, Hirata G, Yap HK, Jordon S.Antivascular endothelial cell antibodies in severe preeclampsia. Am J Obstet Gynecol1990;162:138-146.
9.
9. Khong TY, DeWolf F, Robertson WB, Brosen I.Inadequate maternal vascular response to placentation in pregnancies complicated by pre-eclampsia and by small-for-gestational age infants. Br J Obstet Gynaecol1986;93:1049-1059.
10.
10. Moodley J, Ramsaroop R.Placenta bed morphology in black women with eclampsia. S Afr Med J1989;75:376-378.
11.
11. Hsu CD, Iriye B, Johnson TRB, Witter FR, Hong SF, Chan DW. Elevated circulating thrombomodulin levels in severe preeclampsia. Am J Obstet Gynecol1993;169:149-149. Correction: Am J Obstet Gynecol 1991;171:1165.
12.
12. Hsu CD, Lucas B, Johnson TRB, Hong SF, Chan DW. Elevated urine thrombomodulin/creatinine ratio in severe preeclamptic pregnancies. Am J Obstet Gynecol1994;171:854-856.
13.
13. Hsu CD, Copel JA, Hong SF, Chan DW. Thrombomodulin levels in preeclampsia, gestational hypertension, and chronic hypertension. Obstet Gynecol1995;86:897-899.
14.
14. Hsu CD, Johnson TRB, Hong SF, Chan DW. Altered circulating thrombomodulin and fibronectin levels as evidence for different degrees of vascular endothelial damage between severe and mild preeclampsia. J Matern Fetal Invest1995;5:65-67.
15.
15. Hsu CD, Johnson TRB, Hong SF, Chan DW. Altered circulating thrombomodulin and antithrombin III activities as evidence for varied action of the coagulation cascade in severe versus mild preeclampsia. J Matern Fetal Invest1995;5:140-143.
16.
16. Minakami H, Takahashi T, Izumi A, Tamada T.Increased levels of plasma thrombomodulin in preeclampsia. Gynecol Obstet Invest1993;36:208-210.
17.
17. Bontis J, Vavilis D, Agorastos T, Zournatzi V, Kenstantinidis T, Tagou K.Maternal plasma level of thrombomodulin is increased in mild preeclampsia. Eur J Obstet Gynecol Reprod Biol1995;60:139-141.
18.
18. Kumada T, Dittman WA, Majerus PW. A role for thrombomodulin in the pathogenesis of thrombin-induced thromboembolism in mice. Blood1988;71:728-733.
