English 
Italian Interpretazione degli esami relativi all’emostasi in corso di gravidanza
Interpretation of hemostasis tests during physiological pregnancy
AUTORI
1 Synlab Italia, Sezione Ematologia, Castenedolo, Brescia
2 UOC Laboratorio Analisi, AO Ordine Mauriziano, Torino
3 Laboratorio Analisi Chimico-Cliniche, Ospedale Misericordia Grosseto, AUSL Toscana Sudest, Grosseto
4 Dipartimento Di Medicina Sperimentale E Clinica, Malattie Aterotrombotiche, AOU Careggi, Firenze
5 Medicina Di Laboratorio, Aulss 8 Berica, Vicenza
6 Uos Coagulazione, AOU Senese, Siena
7 Servizio Di Medicina Di Laboratorio, Ulss 7 Pedemontana
8 Laboratorio Di Patologia Dell’emostasi, Dipartimento Di Medicina Trasfusionale, Ospedale di Cattinara, Trieste
9 SOD Malattie Aterotrombotiche, Dipartimento Cardiotoracovascolare, AOU Careggi, Firenze
ABSTRACT
Interpretation of hemostasis tests during physiological pregnancy
Pregnancy is associated with significant modifications of the hemostatic system (endothelium, platelets, coagulation and fibrinolysis) resulting in a prothrombotic state. This is mainly due to an increase in the activity of some procoagulant factors and to the decrease of some physiological inhibitors. The plasma concentrations of these hemostatic system components therefore show important modifications during the three trimesters of pregnancy; as a consequence, the clinical laboratory should report specific reference intervals for the three trimesters of pregnancy or at least add a comment to the laboratory report. The screening tests (although very differently) are also influenced by this hypercoagulability condition and therefore also for PT, APTT, fibrinogen, antithrombin and D-dimer, different reference intervals for the three trimesters of pregnancy should be considered. Global tests have been used (viscoelastometric techniques and thrombin generation test) for monitoring the hemostatic imbalance that occurs during pregnancy; these techniques are very promising but, except for the use of viscoelastometry in monitoring post-partum hemorrhagic risk, they are still far from clinical practice.