Clinical Significance Of Combined Detection Of D-dimer And Coagulation In The Third Trimester Of Pregnancy

Objective:1.To investigate the serum levels of D-dimer and clotting items(APTT,PT,FIB,TT)in high-risk pregnant women and normal pregnant women in the third trimester of pregnancy,to assess the risk of thrombosis in women with gestational diseases and pregnancy complications,and to explore the clinical value of monitoring D-dimer and clotting items in the third trimester of pregnancy.2.To investigate the predictive effect of D-dimer and coagulation monitoring on postpartum hemorrhage in women with low risk of vaginal delivery.Methods:1.Selection in December 2018-December 2019 in northern Subei people’s hospital of obstetrics regular prenatal and hospital childbirth aged 22 to 34 years old,pregnant weeks pregnant women more than 28 weeks,medical history collection,selection of pregnancy complications and complications of the single child healthy pregnant women,150 cases as control group,and 72 cases of twin pregnancy women,sheep water abnormal pregnant women 43 cases,preeclampsia women 40 cases,32 cases of severe preeclampsia women,placenta previa,24 cases of pregnant women,intrahepatic cholestasis during pregnancy(ICP)pregnant women 40 cases,100 cases of gestational diabetes mellitus(GDM)in pregnant women as a group.The levels of D-dimer and clotting items in each high-risk pregnancy group and control group were compared.2.The second part is a retrospective study.The low-risk pregnant women with postpartum hemorrhage during vaginal delivery in the subei people’s hospital of Jiangsu province from December 2018 to December 2019 were analyzed as the experimental group,and the healthy pregnant women with a smooth pregnancy and vaginal delivery during the same period were selected as the control group.(1)D-dimer and clotting items levels were detected and compared between the two groups of pregnant women after labor;(2)draw ROC curve for the indicators with significant statistical differences in(1)and analyze the diagnostic value;(3)correlation analysis was conducted between the statistically significant indicators in(2)and the amount of postpartum bleeding.Result:1.The level of D-dimer in the twin pregnancy group,preeclampsia group,placenta previa group were higher than that in the normal control group,and the level of APTT was lower than that in the normal control group,with significant difference(p<0.05).There was no significant difference in PT,FIB,and TT between the groups(p>0.05).2.The level of D-dimer and TT in the severe preeclampsia group was higher than that in the normal control group.In contrast,the level of APTT was lower than that in the normal control group,with a significant difference(p<0.05).There was no significant difference in PT and FIB levels between the two groups(p>0.05).The D-dimer level in the severe preeclampsia group was higher than that in the preeclampsia group.3.The level of D-dimer in ICP group,GDM group were significantly higher than that in the control group(p<0.05).There was no significant difference in APTT,FIB,PT,and TT between the groups(p>0.05).4.There was no difference in D-dimer,APTT,TT,FIB,and PT levels between the abnormal sheep water volume group and the normal control group(p>0.05).5.The level of D-dimer in the postpartum hemorrhage group was significantly higher than that in the normal delivery group,and the level of PT and TT was lower than that in the control group(p<0.05).There was no significant difference in APTT and FIB between the two groups.6.Prenatal D-dimer level changes associated with the occurrence of postpartum hemorrhage,optimal diagnostic critical value of 2.11 mg/l,the sensitivity was 57%,specificity of 77%,positive prediction rate 57.14%,negative prediction rate 76.92%,show that low-risk pregnant women in labor before D-dimer level below 2.11 mg/1 occurs when the probability of postpartum hemorrhage is small,when the plasma D-dimer rose,incidence of postpartum hemorrhage increased significantly.7.When postpartum hemorrhage occurs,there is a linear relationship between the level of D-dimer before labor and the amount of postpartum hemorrhage Postpartum hemorrhage=941.68+93.56× D-dimer level.Conclusion:1.Women with preeclampsia,severe preeclampsia,twin pregnancy,ICP,GDM,and placenta previa have higher blood coagulation status than women with a normal single pregnancy,and face a higher risk of thrombosis.2.D-dimer combined with blood coagulation in the third trimester of pregnancy is helpful for screening out pregnant women with high risk,which is of great significance in mastering the condition,improving the pregnancy outcome,grasping the time of delivery and preventing maternal thrombosis.3.D-dimer has medium predictive value for postpartum hemorrhage in pregnant women after labor.4.When postpartum hemorrhage occurs,there is a linear relationship between d-dimer level and postpartum blood loss in pregnant women.