Tests during pregnancy - coagulogram: why and when?

APTT stands for activated partial thromboplastin time. This indicator relates to the study of the blood coagulation system and reflects the internal and general path of coagulation, i.e. this is the time required for the formation of a blood clot. This test is part of a study called a coagulogram, which studies the coagulation system in more detail.

Why are pregnant women prescribed an APTT test?

During pregnancy, a number of physiological changes occur in a woman's body. This also applies to blood clotting. A pregnant woman's blood often becomes thicker. The reason to prescribe a coagulogram test is changes in the general blood test, which a woman takes regularly after registering for pregnancy.

If a general blood test shows an increase in the formed elements, this may mean blood thickening, and there is a reason to prescribe a coagulogram, which also includes an APTT analysis. The norm for this indicator for pregnant women is slightly different and is 17-20 s. This is due to a gradual increase in fibrinogen during pregnancy, which by the time of birth reaches a value of 6 g/l, whereas in healthy people it normally ranges from 2.0 to 4.0 g/l.

In the body of a pregnant woman, some processes are not active, this also applies to hemostasis. This is normal, but deviations from the norm still happen. To avoid possible negative consequences for the child and mother, a coagulogram is prescribed.

What is a coagulogram?

A coagulogram (clotting test) is a common blood test that helps examine its ability to clot: whether there are any disorders in the form of increased or decreased coagulation.

It is done without fail, since with its help the hemostasis system is examined, and the tendency of the expectant mother’s body to blood clots and bleeding, which affects the pathological development of the child, difficult or premature births, miscarriages, and other disorders, is also determined. Providing the results of the hemostatic system in graphical form is also called a hemostasiogram.

When analyzing a coagulogram, the main and additional indicators of coagulation are checked (presented in the table below).

Coagulogram

Violations when an extended coagulogram is prescribed

• Varicose veins,
• Multiple pregnancy
• miscarriage,
• Liver pathology,
• Intrauterine fetal death last time,
• Cardiovascular system disorders,
• Genetic blood pathology,
• Condition after surgery,
• Complex form of toxicosis,
• Bad habits in pregnant women
• Pathologies of the urinary and endocrine systems,
• Preeclampsia and placental insufficiency.

Coagulogram norms during pregnancy

A coagulation test is an important diagnostic test for normal pregnancy. The normal coagulogram indicators for a pregnant woman are presented in the table below.

P/n Coagulogram norm during pregnancy table

In the coagulogram table, normal values ​​of indicators, based on the results of a laboratory analysis of coagulation, will give the result of isocoagulation.

Isocoagulation is a definition that means that the state of the coagulation system is normal, and therefore pregnancy proceeds normally, so there is nothing to worry about.

If gestosis or another disorder of pregnancy is confirmed, then coagulation occurs with disturbances, which means that treatment must be started immediately, or intravascular disseminated coagulation syndrome (DIC syndrome) may develop.

This syndrome occurs in stages.

• Hypercoagulation is the 1st stage, during which numerous blood clots occur that interfere with the normal vascular pathway between the mother and the fetus.
• Hypocoagulation is the 2nd stage, when blood clots are destroyed by weakening the factors responsible for coagulation.
• Acoagulation is the last stage at which blood incoagulability occurs and uterine bleeding develops, which is life-threatening for the mother and child.

But remember, even if the test results are far from normal, but the coagulogram was done on time, and treatment is carried out promptly, then many risks can be eliminated.

The need and frequency of testing for coagulation during pregnancy

For pregnant women, a coagulogram is an extremely important analysis. With its help, the balance of the coagulation and anticoagulation systems is monitored.

• The absence of such a balance carries, as mentioned above, consequences that threaten the health of the expectant mother and fetus.
• An imbalance towards the anticoagulation system can cause metrorrhagia, placental abruption, blood loss during and after childbirth in a woman in labor, and towards the coagulation system it thickens the blood, forming blood clots. In this case, a child who receives oxygen exclusively from the placenta experiences oxygen starvation, hypoxia develops, brain pathologies may develop, the woman suffers from leg pain and the development of blood clots, and this can also cause a heart attack, stroke or miscarriage.

The test procedure is as follows: before taking blood, it is better to fast, that is, take the test on an empty stomach. Blood is taken from a vein on the bend of the elbow, and the result of the hemostasiogram is deciphered by your attending physician.

If the indicators are normal, the diagnosis is carried out three times as planned:

• During the registration of a pregnant woman (usually the 1st trimester),
• In the second trimester,
• A week or two before giving birth, which is especially important for women who are preparing to give birth by cesarean section.

In case of complications or abnormal pregnancy, homeostasis is checked much more often in order to respond adequately and prescribe effective treatment.

The normal indicators for a woman during this period, due to changes in physiology, are somewhat different from the indicators before conception, since the female body sets up another blood circulation through the utero-placental-fetal blood flow (insuring itself from significant blood loss). Therefore, only your registered doctor can diagnose the coagulogram results.

Hemostasiogram of indicators during pregnancy and interpretation of the results

What do clotting indicators determine:

Fibrinogen is a special protein, which is the main component of a blood clot, produced in a healthy person by the liver and it is distributed by blood movement throughout all blood vessels.

If there is a damaged area in the vessel, then this protein turns into insoluble fibrin, which becomes the main component of the blood clot that clogs the damaged vessel, thereby stopping the flow of fluid from it.

Such a thrombus, with a normal number of elements, will exist at the site of the lesion until the wound is completely healed.

• Stop bleeding
• If there is a lack of factors 1 and 2, it can cause metrorrhagia, and if they are in excess, unhealthy blood clots will appear - those that break off and wander through the vessels, creating interference with the free vascular path.

The fibrinogen rate is measured in mg/dL or g/L, with g/L leaving mg/dL*0.555/100. Towards the end of the period before childbirth, the value increases slightly. And its reduced value should not fall below 0.5 g/l on the coagulogram, as this is very dangerous for health.

An increase in protein may be the cause:

• Inflammatory diseases
• Pathologies of protein metabolism,
• Surgical intervention before taking diagnostic tests,
• Skin lesions due to high temperature (burn),
• Increased amount of estrogen,
• A small number of hormones that the thyroid gland should produce.

A critical decrease in fibrinogen (below 0.5 g/l) is dangerous:

• Development of DIC syndrome,
• Lack of vitamins C and B12,
• Failure of the heart or liver,
• Postpartum complications,
• Acute promyelocytic leukemia.

What studies are included in a coagulogram?

The coagulogram study can be basic and advanced. The basic study includes the following parameters:

1. Prothrombin (PTI - prothrombin index).
2. INR (international normalized ratio, i.e. standard for determining blood clotting).
3. APTT.
4. Fibrinogen.

If necessary, additional parameters can be assigned:

• Protein C - with its deficiency, the likelihood of thrombosis is high.
• Antithrombin belongs to the anticoagulation system, and its deficiency can also lead to thrombosis.
• D-dimer - released when a blood clot breaks down. Its increased amount indicates the formation of blood clots in the bloodstream.
• Lupus anticoagulant.
• AVR (activated calcification time).
• Plasma recalcification time.
• Plasma tolerance to heparin.
• RFMC (soluble fibrin-monomer complexes).

Increased or decreased clotting

ABP lower than normal during pregnancy is observed when clotting is too rapid, this provokes the occurrence of thrombosis, insufficient oxygen supply to the fetus and developmental delays. There is a high risk of blood clots forming in the vessels located in the placenta, which threatens intrauterine death. The etiological causes of the pathology are often infectious and inflammatory reactions, DIC syndrome and malignant tumors. If aphtv is elevated during pregnancy, then the situation is associated with:

• with congenital anomalies;
• with the presence of DIC syndrome (phase 2 and 3);
• development of autoimmune factors;
• formation of antiphospholipid syndrome;
• renal failure (cirrhosis, hepatitis).

The pathology is dangerous due to the opening of bleeding, since the blood is not able to clot in the prescribed period of time due to an insufficient amount of coagulants or due to the presence of inhibitors. Often, an increase in the clotting period is affected by a lack of vitamin K, which is required for synthesis, so often nutritional adjustments will be enough to normalize the properties of hematopoiesis.

What do the coagulogram indicators indicate?

The aPTT indicator during pregnancy (the norm is 17-20 seconds), fibrinogen and other parameters, especially in the last stages, are of great importance for the prevention of complications. Thus, an increase in PTI (prothrombin) above 150% may indicate placental abruption. This is very dangerous for the life of the expectant mother and her child.

D-dimer should normally be no more than 248 ng/ml. This is in healthy people. During pregnancy, its levels increase. By the end of pregnancy, they can be 3-4 times higher than the initial value. This is the norm. An increase in D-dimer by more than 4 times the initial value may indicate a serious pathology - gestosis, and also occurs in pregnant women with diabetes mellitus or severe kidney disease.

One of the many causes of miscarriage and miscarriages of various periods is APS (antiphospholipid syndrome), which is characterized by the formation of arterial and venous thrombosis. To make such a diagnosis, antibodies to the outer membrane of membranes (phospholipids) are determined, as well as fibrinogen, D-dimer, prothrombin, and APTT. During pregnancy, their norm differs from the normal indicators of healthy people.

Decoding of indicators and norm

The clotting test contains eight leading indicators:

• Fibrinogen is a protein produced by the liver. It is the main element of thrombus formation. Thanks to the uteroplacental circulation, its levels gradually increase as the day of birth approaches. Deviation from the norm indicates an inflammatory process taking place in a woman’s body.

More information about the indicator:

• Activated partial thromboplastin time (aPTT) is the period during which one blood clot forms. In pregnant women, this value decreases slightly, which is normal. A large decrease in level indicates a risk of blood clots, while an increase indicates a predisposition to bleeding.
• Thrombin time (TV) is the period of blood clotting. During pregnancy it increases. Deviation from the norm often occurs when there is a malfunction of the liver.
• Lupus anticoagulant is an indicator of antibody formation. Normally, they should not be found in the blood of a pregnant woman. Their appearance, as a rule, indicates autoimmune diseases, gestosis, and the presence of blood clots in the arteries and veins.
• Platelets are blood cells that take an active part in the coagulation process and are responsible for the state of the hematopoietic system. During pregnancy, their level decreases slightly, and a significant decrease indicates the presence of a progressive disease.

More information about this indicator in pregnant women:

• D-dimer is an indicator of thrombus formation procedure. During pregnancy it increases slightly. A sharp increase indicates the development of diabetes, kidney disease or gestosis.
• Antithrombin III is a protein that slows down the process of blood clotting. A decrease in its amount means a tendency to form blood clots, and an increase in its level means an increased risk of bleeding.
• Prothrombin is a component of blood plasma. An increase in level may indicate placental abruption.

In a normal pregnancy, four coagulogram indicators are usually sufficient:

• APTT;
• prothrombin;
• fibrinogen;
• platelets.

If necessary, a detailed picture of blood clotting is done. Even a slight deviation from the norm can lead to serious consequences.

Interpretation of the results of a coagulogram is carried out only by a doctor, since there are errors in the indicators that may be associated with a woman’s chronic diseases, malnutrition, or taking medications.

Table: coagulogram norm

Thick blood - what to do?

If during pregnancy studies show that the blood is thick, there is no need to panic right away. Most likely, the doctor will prescribe a corrective diet. First of all, salt and all salty foods (sausages, smoked meats, pickles, etc.) should be excluded from the diet. It is also better to avoid fatty foods. Instead, eat more vegetables, berries and fruits of red and orange color. They are richer than others in vitamin C, which can thin the blood.

It is useful to include the following foods in your diet:

• berries (raspberries, black and red currants, mulberries, plums, strawberries, cranberries, sea buckthorn, viburnum), but you should be careful with consuming raspberries and viburnum - these berries cannot be consumed in large quantities by pregnant women;
• citrus fruits (tangerines, oranges, lime, lemon, grapefruit);
• pomegranate;
• dried apricots;
• a pineapple;
• beets;
• tomatoes;
• onion and garlic;
• Birch juice;
• chocolate and cocoa;
• vegetable oils (rapeseed, olive, flaxseed);
• spices instead of salt (turmeric, curry, oregano, paprika, dill, cayenne pepper, ginger, thyme, cinnamon).

Products that can thicken the blood should be completely avoided. These include: bananas, potatoes, buckwheat, all carbonated drinks and alcohol.

You need to drink at least 1.5 liters of water per day. But the water must be potable and without gas.

When APTT increases

APTT is considered elevated if the analysis shows a clotting time of more than 40 seconds, which indicates a decrease in its ability to form blood clots and, therefore, a risk of bleeding.

APTT increases above normal when taking antibiotics, aspirin, heparin and thrombolytic drugs. Before taking the test, you must notify your doctor about this in order to avoid misinterpretation of the results.

An increase in platelet activation time indicates a decrease in blood clotting ability, and occurs in the following pathologies:

• Liver diseases with severe liver failure, including cirrhosis. With these pathologies, the synthesis of coagulation factors in the blood is disrupted;
• Hemophilia A, B, C are hereditary diseases that are a congenital deficiency of coagulation factors and are manifested by the presence of spontaneous bleeding;
• Vitamin K deficiency. Occurs as a result of disturbances in the production of this vitamin in the intestines due to dysbacteriosis and an unbalanced diet;
• Von Willebrand's disease is a hereditary pathology, lack of production of a transport protein that transports coagulation factors;
• Leukemia;
• Disseminated intravascular coagulation syndrome in the stage of consumption coagulopathy. Those. This is a state of the coagulation system when a deficiency of coagulation factors has already developed.

DIC syndrome

DIC syndrome (desseminated intravascular coagulation) is considered one of the most dangerous complications in obstetric practice. At the initial stage, hypercoagulation (increased coagulation) occurs, which is then replaced by hypocoagulation (decreased coagulation ability), which leads to massive blood loss and is life-threatening. DIC syndrome often takes on an uncontrollable course, and then this can lead to the death of the woman herself and her baby.

To avoid such a situation, a coagulogram study is prescribed with the obligatory determination of fibrinogen, PTI, APTT, the norm of which during pregnancy is 17-20 s. Typically, such an examination, if there is no history of complications from previous pregnancies, is prescribed in each trimester. Such studies are carried out unscheduled in cases where:

• At least one of my previous pregnancies ended in miscarriage.
• There are symptoms of gestosis - the presence of protein in the urine, swelling of the extremities, arterial hypertension.
• There is a threat of miscarriage, for example, with uterine hypertonicity.

In what cases is a clotting test indicated?

A planned analysis is carried out three times throughout the pregnancy:

1. When registering with a gynecologist.
2. At 22–24 weeks (II trimester).
3. At 30–36 weeks (III trimester, shortly before birth).

It should be noted that a coagulogram is performed once per trimester only during normal pregnancy . In some cases, additional research is recommended. This happens when a woman is diagnosed or suspected of:

• autoimmune diseases;
• phlebeurysm;
• liver diseases;
• Rh conflict with the child’s father;
• vascular, endocrine pathologies;
• disorders of the circulatory system,
• disorders of the genitourinary system;
• predisposition to bleeding or increased clotting;
• miscarriage of a previous pregnancy;
• multiple pregnancy;
• disorders of the placenta;
• anemia or iron deficiency anemia (more details: https://krasnayakrov.ru/organizm-cheloveka/zhelezodeficitnaya-anemiya.html);
• tendency to thromboembolism, heart attack, stroke.

Bad habits of the expectant mother are also an indication for constant monitoring of blood clotting.

A pregnant woman may be prescribed an extended coagulogram analysis . This happens in the case:

• the presence of any complications in the 1st and 3rd trimester (swelling, increased blood pressure);
• gestosis (toxicosis of the second half of pregnancy);
• multiple pregnancy;
• pregnancy after a long period of infertility;
• woman's predisposition to blood diseases.

If the doctor deems it necessary, a clotting test will be carried out monthly.

How to take a blood test for a coagulogram?

Blood for such a study is donated from a vein in the treatment room in the morning on an empty stomach. Pregnant women do this at the antenatal clinic. For reliable indicators, several simple conditions must be met:

• The last meal should be no later than 10-12 hours before the test.
• It is not recommended to take any medications before donating blood. If the patient is taking medications that affect the coagulation system, this must be indicated in the referral.
• It is not recommended to drink coffee, tea, carbonated drinks, and especially alcohol before donating blood. You are allowed to drink only a glass of clean drinking water.
• Your emotional state can also affect the result, so it’s better to sit in front of the office for a few minutes and calm down.
• Muscle strain can distort the results of the analysis, therefore, immediately before donating blood and the day before, it is not recommended to visit gyms or engage in heavy physical labor.

For the APTT indicator, the norm for women and men is from 25 to 40 s. It does not differ by gender, only during pregnancy it decreases slightly. Interpretation of the research results is carried out only by specialists.

How to take a coagulogram correctly

The result of a coagulogram during pregnancy depends on the correctness of blood sampling and patient preparation. To prepare for the analysis, you need:

• limit the consumption of fatty foods and spices 3 days before the procedure;
• on the eve of the study, exclude physical and emotional stress;
• Take the test on an empty stomach, you can drink a glass of water in the morning.

In addition to a coagulogram, during pregnancy you need a general blood and urine test, and a biochemical analysis. Usually all studies are scheduled for one day.

What does aPTT below normal indicate?

In examining the coagulation system, one of the main parameters is the APTT indicator. Its norm is from 25 to 40 seconds. Let us remind you that this parameter shows the time it takes for the blood to completely coagulate and form a blood clot. If this indicator is below 25 seconds, then this fact may indicate blood thickening and the risk of thrombosis. In pregnant women, the norm for APTT is from 17 to 20 seconds. Typically, this condition does not require treatment during pregnancy and goes away on its own after childbirth. In addition, iron supplements, which are often prescribed to pregnant women with low hemoglobin levels, can thicken the blood somewhat.

Analysis value

The index norm for a pregnant woman is 15-20 seconds.
– blood clots faster. During pregnancy, this type of analysis is performed every trimester. If the results are above or below normal, then close monitoring and drug treatment are necessary.

Elevated index values ​​can provoke the following complications:

• bleeding during pregnancy;
• premature termination of pregnancy - miscarriage;
• bleeding during childbirth;
• large blood loss during the postpartum period;
• in severe cases - death;
• threat of fetal death;
• placental abruption and separation;
• threat of premature birth;
• intrauterine fetal hypoxia;
• thrombosis of the umbilical vein in the fetus.

If the index deviates from the norm, the pregnant woman will need to undergo a full examination in the hospital.

If the index is elevated, it is necessary to stay in the hospital from the third trimester in order to normalize the indicators before childbirth.

What does an increase in APTT indicate?

An aPTT reading higher than normal may indicate that a person has a disease such as hemophilia, serious liver disease such as cirrhosis, or a lack of vitamin K. In addition, an increase in this parameter is observed in the following cases:

• With a lack of blood clotting factors.
• If the patient is treated with anticoagulants, for example, Heparin or Warfarin.
• For hereditary blood pathologies, such as von Willebrand disease.
• With DIC syndrome.

A study of the coagulation system such as a coagulogram is useful not only for pregnant women, but for all people. In case of any deviations from the norm, you should consult a doctor.

What does this indicator mean?

Activated partial thromboplastin time (aPTT) is the most sensitive blood indicator that determines its coagulation. The APTT is determined by the rate of formation of a blood clot during the addition of special reagents.

First, sodium citrate is added to a test tube of blood to neutralize its clotting properties. Then tissue thromboplastin is administered, followed by calcium chloride. As a result, after some manipulations, a clot appears. This period is taken into account in calculating the APTT indicator.

Decreased APTT

A decrease in the indicator is observed at a high speed of the coagulation process. This is a serious risk factor in terms of the development of thrombosis; fetal hypoxia and delayed development of its systems can occur. If blood clots form in the vessels of the placenta, the result will be a disruption of blood flow to the fetus and intrauterine death. Therefore, this condition is treated especially strictly: if a decrease in APTT numbers is detected, corrective drug therapy is necessarily prescribed.

The indicator can decrease for many reasons; the doctor tells the presence of:

• gestosis (toxicosis) – may be complicated by eclampsia;
• early stage of DIC syndrome (increased coagulation, thrombosis of small vessels);
• oncological diseases;
• severe inflammatory and infectious diseases.

A change in APTT may be due to errors during material collection, when the nurse violated the collection technique. In the laboratory, errors sometimes occur with incorrect addition of reagents. If a blood clot formed during a puncture of a vein enters the test tube, this will affect the aPTT level in favor of a decrease.

Laboratory assistant

Blood clotting disorders in pregnant women. Complications and consequences

The balance between the coagulation and anticoagulation systems is maintained through the interaction of platelets, coagulation factors and the process of fibrinolysis. A disorder affecting any of these links can cause serious pregnancy complications. Among these complications, the most dangerous is DIC syndrome (disseminated intravascular coagulation). This syndrome develops due to activation of the coagulation system, on the one hand, and the fibrinolysis system, on the other. DIC syndrome in pregnant women can be caused by various reasons. Among them:

• premature placental abruption - separation of a normally located placenta before the birth of a child. In 80% of cases, this disease is accompanied by bleeding from the genital tract, sometimes a hematoma forms behind the placenta. Bleeding is associated with a decrease in plasma concentrations of coagulation factors, fibrinogen and platelets;
• Amniotic fluid embolism is a rare but dangerous complication that develops during complicated labor and is caused by the entry of amniotic fluid into the mother’s bloodstream and pulmonary vessels, which leads to acute respiratory failure and shock. DIC syndrome develops as a result of massive entry into the bloodstream of tissue thromboplastin, a substance that triggers the blood clotting process;
• endometritis - inflammation of the inner lining of the uterus - which develops after childbirth, can be complicated by the fulminant form of DIC syndrome.

One of the reasons for termination of pregnancy at various stages is antiphospholipid syndrome (APS). APS is a complex of symptoms characterized by venous and arterial thrombosis. Pregnant women with antiphospholipid syndrome are at increased risk of miscarriage and spontaneous abortion due to a violation of the increase in the number of placental vessels with the development of fetoplacental insufficiency - a violation of the basic functions of the maternal placenta, leading to serious disturbances in the intrauterine development of the fetus, as well as due to vascular changes. To make a diagnosis of APS, in addition to increased thrombus formation, antibodies to phospholipids (the outer shell of membranes) are determined.

Nona Hovsepyan, gynecologist, Moscow Article provided by the magazine about pregnancy and childbirth “9 months”, No. 4 2008

Changes in coagulogram parameters by trimester

Normal hemostasis is the key to successful pregnancy and easy childbirth. Therefore, special attention is paid to the quality of blood clotting. During this period, the amount of blood in a woman’s body increases, and any clotting failures are fraught with complications.

If you are taking any medications, tell your doctor about it.

A planned coagulogram is performed for pregnant women every trimester. If the doctor has doubts about the health of the expectant mother, blood should be donated more often. As pregnancy progresses, the normal coagulogram parameters change, which is why the study is carried out at least 3 times during pregnancy. Changes in parameters in a pregnant woman’s body are normal. This is how he prepares for the large blood loss that is inevitable during childbirth. It is important that hemostasis at this stage is high, and any bleeding stops quickly so that it does not threaten the mother and child.

• In the early stages, platelets fibrinogen in the blood of a pregnant woman increase. Shorter clotting periods appear;
• during pregnancy, fibrinogen is increased, and in the third trimester it increases to a level of 6 g/ml;
• D-dimer also increases. If in a healthy woman the level does not exceed 250 ng/ml, then by the 3rd trimester of pregnancy it reaches 1500 ng/ml;
• One coagulogram indicator that should not change throughout 9 months is the prothrombin index. Its increase indicates a developing process of detachment and a serious danger for the child.

Indications for examination

During pregnancy, every woman donates blood to determine coagulogram parameters.

Interesting fact! A standard analysis is carried out twice during pregnancy: at the first visit to the antenatal clinic and at 30 weeks.

Additionally, blood is drawn in the following cases:

1. Complicated obstetric history. Previous pregnancies that ended in miscarriage or abortion, regression, premature birth.
2. Pregnancy that occurs after an in vitro fertilization procedure is a risk factor indicating that a woman was unable to become pregnant naturally due to a somatic or gynecological pathology. Therefore, in order not to lose the long-awaited child, they closely monitor blood counts.
3. Congenital pathologies of the coagulation system. They are asymptomatic when there are only changes in tests, or with a characteristic clinical picture.
4. Complications that arose during the current pregnancy (pathologies of the placenta, gestational diabetes mellitus, gestosis, bleeding).
5. Antiphospholipid syndrome - special antibodies are produced that cause hypercoagulation syndrome (increased blood viscosity, tendency to thrombosis). It is a risk factor for termination of pregnancy at any stage (fetoplacental insufficiency develops with severe disruption of intrauterine development of the fetus).
6. Chronic, acute diseases leading to thrombosis (cardiovascular pathologies, hypertension, problems with the liver, immune system).
7. Preparation for surgical delivery or natural childbirth: the doctor needs to evaluate the functioning of hemostasis in order to prevent the development of possible complications.
8. Monitoring of treatment. The woman may receive anticoagulant therapy.

The list of indications can be expanded at the discretion of the doctor. The individual characteristics of the body and gestational age must be taken into account.

Preeclampsia

When is blood donated again for hemostasis?

A hemostasiogram is always taken by pregnant women. Three tests must be performed in all three trimesters. Additionally prescribed by a doctor in case of a planned operation. This is necessary in order to assess and prevent all life-threatening risks of bleeding or blood clots. This refers to a caesarean section.

Blood is also donated repeatedly and unscheduled for hemostasis if:

• previously had miscarriages;
• gestosis occurs;
• there was injury, which was accompanied by bleeding;
• there is a tendency to form blood clots, varicose veins, thromboembolism;
• history of strokes or heart attacks, arrhythmias, ischemia;
• there are diseases associated with blood vessels and the heart;
• there are liver dysfunctions;
• a woman is being treated with anticoagulants;
• there is anemia, hemorrhagic pathological processes;
• blood was found in the stool or urine;
• pregnancy is accompanied by frequent nosebleeds;
• before this, anabolic drugs, oral contraceptives or glucocorticosteroids were taken.

This study cannot be neglected, as this can lead to fetal loss.