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Thrombin generation in obstetric haemorrhage

Freyer Martins Pereira, Julia 2023. Thrombin generation in obstetric haemorrhage. MPhil Thesis, Cardiff University.
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The haemostatic system undergoes significant changes during pregnancy, particularly at term, leading to alterations in coagulation factors and anticoagulants. These changes result in an increase in procoagulant factors, such as, fibrinogen, factor VIII, and von Willebrand factor, along with reduced levels of anticoagulants like protein S. Consequently, a procoagulable state is established. Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide and may be caused or exacerbated by haemostatic impairment. Current research efforts have primarily focussed on examining coagulation factors and traditional laboratory investigations to monitor PPH and guide replacement of coagulation factors with fresh frozen plasma (FFP). Thrombin generation can be used to measure the integrated effects of procoagulant factors and so give an overview of haemostatic competence. There has been limited research into changes in thrombin generation during PPH and its potential to identify women who might benefit from FFP infusion. This thesis investigated thrombin generation in obstetric patients experiencing PPH and compared the results with non-bleeding pregnant women and non-pregnant participants. The main findings are that thrombin generation confirmed the prothrombotic state at term and remained raised or normal during almost all cases of PPH. This suggests that FFP would not improve haemostasis in most cases of PPH. By examining thrombin generation, a more comprehensive understanding of the haemostatic alterations in PPH can be obtained with the aim to improve individualised treatment.

Item Type: Thesis (MPhil)
Status: Unpublished
Schools: Medicine
Date of First Compliant Deposit: 10 November 2023
Last Modified: 10 Nov 2023 15:12

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