妊娠期孕妇部分相关凝血指标的研究现状

Current status of research on some relevant coagulation indexes of pregnant women during pregnancy

妊娠是一种特殊的生理状态,由于胎儿生长发育的不同时期会引起母体抗凝功能增强及孕妇体内分泌大量激素而导致血液中凝血与纤溶系统功能处于高水平动态平衡状态,特别在妊娠晚期,该生理性高凝状态尤为明显。高凝状态会减少机体出血的风险,对孕妇是一种生理性保护机制,且机体会维持这种高凝状态直至分娩,一旦高凝状态失衡,则会增加妊娠期血栓性疾病和产科疾病的发病率。因此,通过动态监测妊娠期各项凝血指标,可反映孕妇的凝血与纤溶功能变化,对可能出现的产科并发症如血栓形成、产后大出血、弥漫性血管内凝血(DIC)、胎盘早剥、胎儿生长受限及复发性流产等的防治具有重要意义,从而全面提高孕妇分娩的安全性。本文从凝血、抗凝血及纤溶功能、血小板数量与聚集功能及血栓弹力图等方面分析正常妊娠期孕妇部分凝血指标的变化及其对母婴的影响,解析不同孕期的敏感监测指标。

Pregnancy is special physiological state.Due to the different periods of fetal growth and development,the maternal anticoagulant function will be enhanced and the pregnant woman secretes large number of hormones,which leads to high level of dynamic balance between the blood coagulation and fibrinolytic system functions,especially in the third trimester,this physiological hypercoagulable state is particularly obvious.Hypercoagulable state will reduce the risk of body bleeding.It is physiological protection mechanism for pregnant women,and the body will maintain this hypercoagulable state until the birth of the fetus.Once this state is out of balance,it will increase the incidence of thrombotic diseases and obstetrics disease during pregnancy.Therefore,the dynamic monitoring of various coagulation indicators during pregnancy can reflect the changes in the coagulation and fibrinolytic function of pregnant women,and it is great significance on preventing possible obstetric complications such as thrombosis,postpartum hemorrhage,diffuse intravascular coagulation(DIC),premature placenta,fetal growth restriction and recurrent miscarriage,so as to comprehensively improve the safety of pregnant women's delivery.This article analyzes the changes in some coagulation indexes of pregnant women during normal pregnancy and their effects on the mother and child from the aspects of coagulation,anticoagulation and fibrinolysis,platelet number and aggregation function,and thromboelastogram,analyzes the sensitive monitoring indexes of different pregnancy periods.