Obstet Gynecol Sci.  2017 Nov;60(6):542-548. 10.5468/ogs.2017.60.6.542.

The clinical significance of D-dimer concentrations in patients with gestational hypertensive disorders according to the severity

Affiliations
  • 1Department of Obstetrics and Gynecology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea. sunmin827@hanmail.net
  • 2Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea.
  • 3Department of Obstetrics and Gynecology, Seoul National University Colllege of Medicine, Seoul, Korea.

Abstract


OBJECTIVE
Pregnancy is a major risk factor of thromboembolism, and the patients with preeclampsia (PE) are known to have higher risk of thromboembolic complications than normal pregnant women. D-dimer is a well-established laboratory marker for the screening of venous thromboembolism (VTE), but the concentrations of d-dimer tend to increase physiologically in pregnant women throughout the gestational age. We performed this study to evaluate the clinical significance of d-dimer concentrations in patients with gestational hypertensive disorders (GHD) according to the severity.
METHODS
Retrospective cohort study was performed in one institution. Singleton pregnant women with GHD were enrolled, and their antepartum concentrations of d-dimer were measured as a part of routine evaluation for patients suspected with PE. Patients with multiple gestations, rheumatic diseases, autoimmune diseases, or suspected VTE were excluded. A categorization of severity about PE was based on the general criteria.
RESULTS
In 73.3% of study population, their d-dimer concentrations exceeded the normal range (>0.55 mg/L). A significantly greater proportion of pregnant women had excessive concentrations of d-dimer in the severe GHD than in the non-severe GHD (89.8% vs. 53.7%; P<0.01). Patients with severe GHD had significantly higher median concentrations of d-dimer than those with non-severe GHD (median [range], 2.00 mg/L [0.11 to 7.49] vs. 0.71 mg/L [0.09 to 5.39]; P<0.01) although their earlier gestational ages of sampling.
CONCLUSION
Maternal concentrations of d-dimer were significantly elevated in patients with severe features than those without severe features among those with GHD. Some pregnant women with GHD can have markedly elevated concentrations of d-dimer without any evidence of current VTE.

Keyword

Hypertension, pregnancy-induced; Pre-eclampsia; Fibrin–fibrinogen degradation products, d-dimer; Pregnancy

MeSH Terms

Autoimmune Diseases
Biomarkers
Cohort Studies
Female
Gestational Age
Humans
Hypertension, Pregnancy-Induced
Mass Screening
Pre-Eclampsia
Pregnancy
Pregnant Women
Reference Values
Retrospective Studies
Rheumatic Diseases
Risk Factors
Thromboembolism
Venous Thromboembolism
Biomarkers

Figure

  • Fig. 1 Concentrations of D-dimer according to the severity indicators of gestational hypertensive disorders. The median concentration of d-dimer in patients with pulmonary edema was higher than in those with high blood pressure, but that could not reach statistical significance (P=0.09). BP, blood pressure; HA/VD, headache or visual disturbance; UAP/TE, upper abdominal pain or serum transaminase elevation; OL/CE, oliguria or elevated serum creatinine elevation; FGR, fetal growth restriction.

  • Fig. 2 Receiver operating characteristic (ROC) curve analysis for identification of severe gestational hypertensive disorder. Using ROC curve analysis, a cut-off value of 1.19 mg/L (ROC area under the curve, 0.71; 95% confidence interval, 0.60 to 0.82; P=0.001) for maternal concentration of d-dimer had 63.3% of sensitivity and 65.9% of specificity for the identification of severe gestational hypertensive disorders.


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