Perinatal determinants of D-dimer levels in a cross-sectional study of low risk pregnant women

Abstract

Background

To examine perinatal determinants of the antenatal levels of D-dimers.

Methods

Cross-sectional study of 760 low risk pregnant women recruited into five gestational groups. Variables examined in antenatal groups included maternal age, body mass index, parity, smoking, family history venous thromboembolism (VTE) and previous use of the oral contraceptive pill (OCP). Onset of labour and mode of delivery were also examined in the post-natal group.

Results

D-dimer levels in group 4 (38–40 + 6) were significantly lower in the women with a history of taking the OCP when compared to those that had not taken it in the past (P = 0.027). In the day 2 post-natal group, the median level of D-dimer was significantly higher in primparous when compared to multiparous women (P = 0.015). The median D-dimer levels were significantly lower in the elective Caesarean section group in comparison to spontaneous onset (P = 0.003) and induction of labour (P = 0.016). When the mode of delivery was examined, the median D-dimer levels were significantly lower in those that had an elective Caesarean section when compared to normal vaginal delivery (P = 0.008) and instrumental vaginal delivery (P = 0.007). Women post elective Caesarean section had a significantly lower D-dimer than those after emergency Caesarean section (P = 0.008).

Discussion

There are some significant differences in D-dimer levels when certain perinatal determinants are examined. This work is potentially beneficial to the future diagnosis of VTE in pregnancy as it supports previously published recommended D-dimer levels for the diagnosis of VTE in pregnancy.

Keywords

D-dimer pregnancy

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References

Heit

Kobbervig

James

. Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study. Ann Intern Med 2005; 143: 697–706.

Knight MKS, Brocklehurst P, Neilson J, et al. (eds.) On behalf of MBRRACE-UK. Saving lives, improving mothers’ care - lessons learned to inform future maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2009–12. Oxford: National Perinatal Epidemiology Unit, University of Oxford, 2014.

Adam

Key

Greenberg

. D-dimer antigen: current concepts and future prospects. Blood 2009; 113: 2878–2887.

Kearon

Julian

Newman

. Noninvasive diagnosis of deep venous thrombosis. McMaster diagnostic imaging practice guidelines initiative. Ann Intern Med 1998; 128: 663–677.

Wells

Anderson

Rodger

. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 2003; 349: 1227–1235.

Bremme

. Haemostatic changes in pregnancy. Best Pract Res Clin Haematol 2003; 16: 153–168.

Murphy

Broadhurst

Khashan

. Gestation-specific D-dimer reference ranges: a cross-sectional study. BJOG 2015; 122: 395–400.

Bozic

Stegnar

. Validation of an automated immunoturbidimetric assay for measurement of plasma D-dimer. Clin Chem Lab Med 2003; 41: 958–962.

Epiney

Boehlen

Boulvain

. D-dimer levels during delivery and the postpartum. J Thromb Haemost 2005; 3: 268–271.

10.

Wiegratz

Stahlberg

Manthey

. Effects of conventional or extended-cycle regimen of an oral contraceptive containing 30 mcg ethinylestradiol and 2 mg dienogest on various hemostasis parameters. Contraception 2008; 78: 384–391.

11.

Stocco

Fumagalli

Franceschini

. Comparative study of the effects of combined oral contraceptives in hemostatic variables: an observational preliminary study. Medicine 2015; 94: e385–e385.

12.

Milne

Redman

Walker

. The pre-eclampsia community guideline (PRECOG): how to screen for and detect onset of pre-eclampsia in the community. BMJ 2005; 330: 576–580.

13.

Bozkurt

Yumru

Sahin

. Troponin I and D-dimer levels in preeclampsia and eclampsia: prospective study. Clinical and Experimental Obstetrics & Gynecology 2015; 42: 26–31.

14.

Han

Liu

. Blood coagulation parameters and platelet indices: changes in normal and preeclamptic pregnancies and predictive values for preeclampsia. PLoS One 2014; 9: e114488–e114488.

15.

Peternel

Terbizan

Tratar

. Markers of hemostatic system activation during treatment of deep vein thrombosis with subcutaneous unfractionated or low-molecular weight heparin. Thromb Res 2002; 105: 241–246.