| Spontaneous abortion is the most common adverse reproductive outcome. Risk factors include increasing maternal age, prenatal exposures, and comorbidities such as deficiencies in hemostatic factors. This study was designed to determine if mean differences in hemostatic factors are related to spontaneous abortion.;This study recruited pregnant women aged 14-40 years presenting to the Emergency Department at the Hospital of the University of Pennsylvania. Women with a singleton, intrauterine pregnancy of less than 22 weeks gestation were eligible. At baseline, women completed a questionnaire to collect demographic, past and present medical history, and drug use information. Blood draws measured the level of fibrinogen, factor VII antigen, APC-resistance, protein S, and plasmin-antiplasmin (PAP). Enrolled women not experiencing a spontaneous abortion completed telephone interviews at 16 and 22 weeks gestation to collect information on spontaneous abortion.;This study included 171 women and 57.9% (n = 99) were pregnant at follow-up and classified as a control. The remaining 42.1% (n = 72) had a spontaneous abortion and were classified as a case. Among the cases, 54.2% (n = 39) occurred at enrollment and 45.8% (n = 33) occurred during follow-up. Cases were earlier in gestational age (10 vs. 11 weeks), more likely to report vaginal bleeding since last menstrual period (88% vs. 34%, p =.000), more likely to use cocaine (44.9% vs. 22.0%, p =.002) and a higher percentage of cases reported bacterial vaginosis (19% vs. 3.0%, p =.001). Cases and controls had similar mean levels of APC-resistance and protein S, but cases had significantly lower levels of factor VII antigen (87.9% of normal vs. 108.7% of normal, p =.000), fibrinogen (313.8 mg/dl vs. 367.1 mg/dl, p =.000), and PAP (5.4 nM vs. 6.2 nM, p =.04). Multiple logistic regression analysis controlling for maternal age, prior spontaneous abortion, alcohol and cocaine use, vaginal bleeding, bacterial vaginosis and gestational age continued to find significantly lower levels of fibrinogen (OR =.99, p =.03) and factor VII antigen (OR =.98, p =.002) among the cases.;These results indicate that cases had a reduced coagulation response and lower levels of these coagulation factors may be used to detect a problem pregnancy. |
