Soluble fibrin in plasma as a sign of activated coagulation in patients with pregnancy complications.
Ostlund E. Bremme K. Wiman B.
Department of Woman and Child Health, Karolinska Hospital/Karolinska Institute, Stockholm, Sweden.
BACKGROUND: Disseminated intravascular coagulation (DIC) is a frequently observed complication in pregnant women. The laboratory diagnosis of DIC is difficult but the development in the detection of circulating soluble fibrin has improved the possibility. METHODS: A number of pregnant women (n= 175) with obstetric complications e.g. preeclampsia, hypertension, intrauterine growth retardation (IUGR) and intrahepatic cholestasis was examined for plasma soluble fibrin and subjected to some routine hemostatic tests, mainly during the third trimester of pregnancy. RESULTS: Of these patients, 57 of 175 (33%) had an elevated concentration of soluble fibrin (above 23 nmol/L) as compared with a healthy group of women sampled in the third trimester. Eighteen patients (10%) had highly increased levels, above 100 nmol/L. In comparison, none of the 23 healthy, pregnant women investigated had a value above 40 nmol/L. CONCLUSIONS: Hemostatic abnormalities, including increased concentrations of soluble fibrin, are quite frequently observed in women with obstetric complications, most likely as a sign of a systemic activation of coagulation. Although a higher concentration of plasma soluble fibrin was observed in many of the women, no clear correlation to the outcome of the pregnancy was obtained. Whether or not plasma soluble fibrin is of any value, either diagnostically or the treatment of patients with pregnancy complications, remains to be shown.
Objective methods cannot predict anal incontinence after primary repair of extensive anal tears.
Goffeng AR. Andersch B. Andersson M. Berndtsson I. Hulten L. Oresland T.
Department of Obstetrics and Gynecology, Sahlgrenska Universitetssjukhus, University of Goteborg, Sweden.
BACKGROUND: An increased awareness of anal incontinence after delivery tears has developed during the last years. The aim of this study was to compare complaints with the results of physiological methods in women with complete sphincter ruptures primarily repaired at delivery. METHODS: Twenty-seven women, 16 with total rupture of the external anal sphincter and 11 who also had a ruptured internal anal sphincter were studied. Interviews on pelvic floor function, investigation with recto-anal manometry, single fiber EMG and anal endosonography were performed at 11.9 (2.5) months after delivery. Fifteen women vaginally delivered without sphincter rupture served as controls. RESULTS: Pelvic floor dysfunction was admitted in 74%, in particular gas incontinence (59%). Maximum squeeze pressure was significantly reduced (p