TEG Analysis Of Pregnancy Hypertensive Disease Patients And Normal Pregnant Women

Background Thromboelastography can use to monitor clotting factor activity,fibrin function,platelet function,and the hold process of thrombolysis caused by fibrinolysis,the imaging results can understand the whole process of thrombus formation.The function of platelets and fibrinogen could not be reflected by blood routine and traditional clotting tests.The true risk of postpartum hemorrhage in patients with hypertension during pregnancy,and the real-time coagulation status after the bleeding crisis is not adequately understood.But the k-time,angle and MA of TEG can reflect fibrinogen and platelet function in real time.Since the application value of PT and APTT based on the traditional coagulation routine in the diagnosis abnormal coagulation status and perinatal hemostasis intervention is limited,the whole blood test with TEG may have greater advantages.Objective TEG data were obtained from normal women in the third trimester by testing,the95% reference interval of normal pregnant women in the third trimester was calculated in our laboratory,compared with the reference range of non-pregnant normal population,to understand the difference.The TEG results of hypertensive patients during pregnancy and normal pregnant women in the third trimester were compared with conventional blood coagulation routine,and comparison between groups of patients with hypertensive disease,to understand the difference.At the same time,the correlation between TEG and routine coagulation parameters was calculated,to explore the evaluation of TEG in pregnant patients with hypertension and its clinical significance.Method Research group: a total of 148 patients with pregnancy hypertension diagnosed in our hospital were selected,diagnostic criteria refer to the 9th edition of obstetrics and gynecology.According to the severity of the condition,it is divided into group A: gestational hypertension 42 cases,group B: preeclampsia 43 cases,group C:severe preeclampsia 57 cases(early onset severe preeclampsia 15cases).group D: HELLP syndrome 6 cases.Normal pregnancy group,as a control group: 99 cases.The pregnant women in the two group were tested for TEG and coagulation function routine.calculate the correlation between the parameters,set up the regression equation.Find out the difference and relation between TEG and ordinary blood coagulation test.Result The 95% confidence interval of TEG in pregnant women with normal late pregnancy :R(5.09,5.42),K(1.70,1.98),α(64.95,66.76),MA(60.08,62.31),CI(0.27,0.92),it was narrower than the reference range of normal population,The 95%confidence interval for R-time and K-time were significantly closer to the lower values of the reference range for the general population,the 95% confidence interval for Angle and MA were significantly closer to the high values of the reference range for the general population,it suggested that the blood of normal pregnant women in the third trimester was hypercoagulant.Compared with the control group,there was no difference in conventional blood coagulation routine of the study gestational hypertension,the R time and K time of TEG were decreased,and the α,MA,CI and LY30 were increased.Compared with the control group,the D-D of preeclampsia was increased,K-time in TEG was decreased,α,MA and CI were increased.Compared with the control group,D-D of severe preeclampsia increased,APTT prolonged,PLT decreased,K-time in TEG decreased,α,MA,CI and LY30 increased.Compared with the control group,gestational hypertension,preeclampsia and severe preeclampsia showed increased blood hypercoagulability,and TEG detection was more sensitive.Compared with the control group,PLT decreased in HELLP syndrome,K-time was prolonged,α,MA and CI decreased,LY30 increased.Traditional blood coagulation routine can only detect decreased platelet count in patient with HELLP syndrome,while TEG can detect decompensation of platelet function,enhanced fibrinolysis,and low coagulation state of blood.Intergroup comparison in the study group,there was no difference in TEG and routine coagulation index between preeclampsia and gestational hypertension,and between severe preeclampsia and preeclampsia.severe preeclampsia compare with gestational hypertension,D-D and MA increased,It is suggested that when the disease progresses from gestation hypertension to preeclampsia,or from preeclampsia to severe preelampsia,the patient’s clotting status does not change significantly.However,when the disease progresses from gestation hypertension to severe preeclampsia,the function of fibrinolysis and platelet aggregation will be further enhanced.There was no difference between the TEG and conventional coagulation in the early onset and late onset,suggesting that the clotting level of the late onset severe preeclampsia was similar to that of the early onset severe preeclampsia Through the Preason correlation comparison of various parameters,positive correlation include: R-time and APTT(r=0.14),K-time and APTT(r=0.25),αand Fg,PLT(r=0.21,r=0.26),MA and APTT、Fg、PLT(r=0.15,r=0.22,r=0.34).Negative correlations include : K-time and Fg(r=-0.27),α and APTT(r=-0.18),As can be seen from the correlation coefficients,the correlation between R-time,K-time and APTT is weak,it shows that TEG plays a similar role to traditional blood coagulation routine in showing blood clotting state,but they could not substitute each other.Though multiple regression analysis,we found that K-time and α were correlated with APTT and PLT,MA was correlated with Fg,PLT and APTT,the results are basically consistent with Preason correlation coefficient.Conclusion The blood of women with normal third trimester is hypercoagulant and the laboratory should establish a TEG reference range for normal third trimester in this area.Compared with normal third trimester,TEG was more sensitive than conventional coagulation to detect hypercoagulability in hypertensive diseases during pregnancy and hypocoagulability in patients with HELLP syndrome.Traditional coagulation procedures require the combination of TEG to detect an increase in hypercoagulability as the disease progresses from gestational hypertension to severe preeclampsia.TEG was consistent with conventional blood coagulation and found the same level of clotting in late onset severe preeclampsia as in the early onset severe preeclampsia.TEG and traditional blood coagulation routine cannot be substituted with each other,so it should be used in a comprehensive way to evaluate the coagulation status of patients with hypertension during pregnancy,so as to better guide clinical diagnosis and treatment.