A link between a hemostatic disorder and preterm PROM

A role for tissue factor and tissue factor pathway inhibitor

Offer Erez, Jimmy Espinoza, Tinnakorn Chaiworapongsa, Francesca Gotsch, Juan Pedro Kusanovic, Nandor Gabor Than, Shali Mazaki-Tovi, Edi Vaisbuch, Z. Papp, Bo Hyun Yoon, Yu Mi Han, Debra Hoppensteadt, Jawed Fareed, Sonia S. Hassan, Roberto Romero

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objective. Vaginal bleeding is a risk factor for preterm PROM (PPROM). A disorder of decidual hemostasis has been implicated in the genesis of PROM. Indeed, excessive thrombin generation has been demonstrated in PPROM both before and at the time of diagnosis. Decidua is a potent source of tissue factor (TF), the most powerful natural pro-coagulant. A decidual hemostatic disorder may link vaginal bleeding, PPROM and placental abruption. This study was conducted to determine the behaviour of maternal TF and its natural inhibitor, the tissue factor pathway inhibitor (TFPI) in PPROM. Methods. This cross-sectional study included women with PPROM (n = 123) and women with normal pregnancies (n = 86). Plasma concentrations of TF and TFPI were measured by a sensitive immunoassay. Non-parametric statistics were used for analysis. Results. (1) The median maternal plasma TF concentration was significantly higher in patients with PPROM than in women with normal pregnancies (median: 369.5 pg/mL; range: 3.27-2551 pg/mL vs. median: 291.5 pg/mL; range: 6.3-2662.2 pg/mL respectively, p = 0.001); (2) the median maternal TFPI plasma concentration was significantly lower in patients with PPROM than in women with normal pregnancies (median: 58.7 ng/mL; range: 26.3-116 ng/mL vs. median: 66.1 ng/mL; range: 14.3-86.5 ng/mL respectively, p = 0.019); (3) there was no correlation between the plasma concentration of TF and TFPI and the gestational age at sample collection; and (4) among patients with PPROM there was no association between the presence of intra-amniotic infection or inflammation and median plasma concentrations of TF and TFPI. Conclusions. (1) Patients with PPROM have a higher median plasma concentration of TF and a lower median plasma concentration of TFPI than women with normal pregnancies. (2) These findings suggest that PPROM is associated with specific changes in the hemostatic/coagulation system.

Original languageEnglish
Pages (from-to)732-744
Number of pages13
JournalJournal of Maternal-Fetal and Neonatal Medicine
Volume21
Issue number10
DOIs
Publication statusPublished - 2008

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Hemostatic Disorders
Thromboplastin
Pregnancy
Uterine Hemorrhage
Mothers
Abruptio Placentae
Maternal Behavior
Decidua
Coagulants
Hemostatics
Nonparametric Statistics
Preterm Premature Rupture of the Membranes
lipoprotein-associated coagulation inhibitor
Hemostasis
Immunoassay
Thrombin
Gestational Age
Cross-Sectional Studies
Inflammation

Keywords

  • Coagulation
  • Inflammation
  • Pregnancy
  • Prelabor rupture of membranes
  • Prematurity
  • Preterm delivery
  • Thrombin
  • Thrombosis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynaecology

Cite this

A link between a hemostatic disorder and preterm PROM : A role for tissue factor and tissue factor pathway inhibitor. / Erez, Offer; Espinoza, Jimmy; Chaiworapongsa, Tinnakorn; Gotsch, Francesca; Kusanovic, Juan Pedro; Than, Nandor Gabor; Mazaki-Tovi, Shali; Vaisbuch, Edi; Papp, Z.; Yoon, Bo Hyun; Mi Han, Yu; Hoppensteadt, Debra; Fareed, Jawed; Hassan, Sonia S.; Romero, Roberto.

In: Journal of Maternal-Fetal and Neonatal Medicine, Vol. 21, No. 10, 2008, p. 732-744.

Research output: Contribution to journalArticle

Erez, O, Espinoza, J, Chaiworapongsa, T, Gotsch, F, Kusanovic, JP, Than, NG, Mazaki-Tovi, S, Vaisbuch, E, Papp, Z, Yoon, BH, Mi Han, Y, Hoppensteadt, D, Fareed, J, Hassan, SS & Romero, R 2008, 'A link between a hemostatic disorder and preterm PROM: A role for tissue factor and tissue factor pathway inhibitor', Journal of Maternal-Fetal and Neonatal Medicine, vol. 21, no. 10, pp. 732-744. https://doi.org/10.1080/14767050802361807
Erez, Offer ; Espinoza, Jimmy ; Chaiworapongsa, Tinnakorn ; Gotsch, Francesca ; Kusanovic, Juan Pedro ; Than, Nandor Gabor ; Mazaki-Tovi, Shali ; Vaisbuch, Edi ; Papp, Z. ; Yoon, Bo Hyun ; Mi Han, Yu ; Hoppensteadt, Debra ; Fareed, Jawed ; Hassan, Sonia S. ; Romero, Roberto. / A link between a hemostatic disorder and preterm PROM : A role for tissue factor and tissue factor pathway inhibitor. In: Journal of Maternal-Fetal and Neonatal Medicine. 2008 ; Vol. 21, No. 10. pp. 732-744.
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abstract = "Objective. Vaginal bleeding is a risk factor for preterm PROM (PPROM). A disorder of decidual hemostasis has been implicated in the genesis of PROM. Indeed, excessive thrombin generation has been demonstrated in PPROM both before and at the time of diagnosis. Decidua is a potent source of tissue factor (TF), the most powerful natural pro-coagulant. A decidual hemostatic disorder may link vaginal bleeding, PPROM and placental abruption. This study was conducted to determine the behaviour of maternal TF and its natural inhibitor, the tissue factor pathway inhibitor (TFPI) in PPROM. Methods. This cross-sectional study included women with PPROM (n = 123) and women with normal pregnancies (n = 86). Plasma concentrations of TF and TFPI were measured by a sensitive immunoassay. Non-parametric statistics were used for analysis. Results. (1) The median maternal plasma TF concentration was significantly higher in patients with PPROM than in women with normal pregnancies (median: 369.5 pg/mL; range: 3.27-2551 pg/mL vs. median: 291.5 pg/mL; range: 6.3-2662.2 pg/mL respectively, p = 0.001); (2) the median maternal TFPI plasma concentration was significantly lower in patients with PPROM than in women with normal pregnancies (median: 58.7 ng/mL; range: 26.3-116 ng/mL vs. median: 66.1 ng/mL; range: 14.3-86.5 ng/mL respectively, p = 0.019); (3) there was no correlation between the plasma concentration of TF and TFPI and the gestational age at sample collection; and (4) among patients with PPROM there was no association between the presence of intra-amniotic infection or inflammation and median plasma concentrations of TF and TFPI. Conclusions. (1) Patients with PPROM have a higher median plasma concentration of TF and a lower median plasma concentration of TFPI than women with normal pregnancies. (2) These findings suggest that PPROM is associated with specific changes in the hemostatic/coagulation system.",
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T1 - A link between a hemostatic disorder and preterm PROM

T2 - A role for tissue factor and tissue factor pathway inhibitor

AU - Erez, Offer

AU - Espinoza, Jimmy

AU - Chaiworapongsa, Tinnakorn

AU - Gotsch, Francesca

AU - Kusanovic, Juan Pedro

AU - Than, Nandor Gabor

AU - Mazaki-Tovi, Shali

AU - Vaisbuch, Edi

AU - Papp, Z.

AU - Yoon, Bo Hyun

AU - Mi Han, Yu

AU - Hoppensteadt, Debra

AU - Fareed, Jawed

AU - Hassan, Sonia S.

AU - Romero, Roberto

PY - 2008

Y1 - 2008

N2 - Objective. Vaginal bleeding is a risk factor for preterm PROM (PPROM). A disorder of decidual hemostasis has been implicated in the genesis of PROM. Indeed, excessive thrombin generation has been demonstrated in PPROM both before and at the time of diagnosis. Decidua is a potent source of tissue factor (TF), the most powerful natural pro-coagulant. A decidual hemostatic disorder may link vaginal bleeding, PPROM and placental abruption. This study was conducted to determine the behaviour of maternal TF and its natural inhibitor, the tissue factor pathway inhibitor (TFPI) in PPROM. Methods. This cross-sectional study included women with PPROM (n = 123) and women with normal pregnancies (n = 86). Plasma concentrations of TF and TFPI were measured by a sensitive immunoassay. Non-parametric statistics were used for analysis. Results. (1) The median maternal plasma TF concentration was significantly higher in patients with PPROM than in women with normal pregnancies (median: 369.5 pg/mL; range: 3.27-2551 pg/mL vs. median: 291.5 pg/mL; range: 6.3-2662.2 pg/mL respectively, p = 0.001); (2) the median maternal TFPI plasma concentration was significantly lower in patients with PPROM than in women with normal pregnancies (median: 58.7 ng/mL; range: 26.3-116 ng/mL vs. median: 66.1 ng/mL; range: 14.3-86.5 ng/mL respectively, p = 0.019); (3) there was no correlation between the plasma concentration of TF and TFPI and the gestational age at sample collection; and (4) among patients with PPROM there was no association between the presence of intra-amniotic infection or inflammation and median plasma concentrations of TF and TFPI. Conclusions. (1) Patients with PPROM have a higher median plasma concentration of TF and a lower median plasma concentration of TFPI than women with normal pregnancies. (2) These findings suggest that PPROM is associated with specific changes in the hemostatic/coagulation system.

AB - Objective. Vaginal bleeding is a risk factor for preterm PROM (PPROM). A disorder of decidual hemostasis has been implicated in the genesis of PROM. Indeed, excessive thrombin generation has been demonstrated in PPROM both before and at the time of diagnosis. Decidua is a potent source of tissue factor (TF), the most powerful natural pro-coagulant. A decidual hemostatic disorder may link vaginal bleeding, PPROM and placental abruption. This study was conducted to determine the behaviour of maternal TF and its natural inhibitor, the tissue factor pathway inhibitor (TFPI) in PPROM. Methods. This cross-sectional study included women with PPROM (n = 123) and women with normal pregnancies (n = 86). Plasma concentrations of TF and TFPI were measured by a sensitive immunoassay. Non-parametric statistics were used for analysis. Results. (1) The median maternal plasma TF concentration was significantly higher in patients with PPROM than in women with normal pregnancies (median: 369.5 pg/mL; range: 3.27-2551 pg/mL vs. median: 291.5 pg/mL; range: 6.3-2662.2 pg/mL respectively, p = 0.001); (2) the median maternal TFPI plasma concentration was significantly lower in patients with PPROM than in women with normal pregnancies (median: 58.7 ng/mL; range: 26.3-116 ng/mL vs. median: 66.1 ng/mL; range: 14.3-86.5 ng/mL respectively, p = 0.019); (3) there was no correlation between the plasma concentration of TF and TFPI and the gestational age at sample collection; and (4) among patients with PPROM there was no association between the presence of intra-amniotic infection or inflammation and median plasma concentrations of TF and TFPI. Conclusions. (1) Patients with PPROM have a higher median plasma concentration of TF and a lower median plasma concentration of TFPI than women with normal pregnancies. (2) These findings suggest that PPROM is associated with specific changes in the hemostatic/coagulation system.

KW - Coagulation

KW - Inflammation

KW - Pregnancy

KW - Prelabor rupture of membranes

KW - Prematurity

KW - Preterm delivery

KW - Thrombin

KW - Thrombosis

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