The Value Of D-dimer Level During The Second Trimester To Predict The Adverse Pregnancy Outcomes

Chapter1 The value of D-dimer level during the second trimester to predict the adverse pregnancy outcomesObject: 1 To discuss the value of D-dimer level during the second trimester to predict the adverse pregnancy outcomes. 2 To establish the reference range of D-dimer level which adapt to the women in second trimester preliminary.Method: In May to December 2015, singleton pregnancy women with 24-28 weeks who take their antenatal examination regularly and will deliver in the first affiliated hospital of Ji Nan University were selected as the research object to implement a prospective study. The following circumstances were excluded: hypertension; diabetes mellitus; fetal growth restriction; coagulation disorders; the history of thromboembolic disease; taking drugs that may affluence the coagulation and fibrinolysis system; the history of abnormal pregnancy; anemia; cardio-cerebrovascular disease; hepatic disease and renal disease; thyroid disease; autoimmune disease; got infection in 30 days and the temperature was higher than 37.5C; had surgery or trauma in 30 days; had blood transfusion in half year; in a stress state the day before blood collection; malignant tumor. Signed the consent form with the objects and collect 2ml peripheral blood into 3.2% sodium citrate anticoagulation(109mmol/L) vacuum tubes. Reverse the tubes immediately to make blood and sodium citrate anticoagulation fully mixed. Detect the D-dimer level in 2 hours. Follow up the cases until delivery to collect their age, gravidity and parity, reexamination of the D-dimer level and treatment, HC、AC、FL、PI、RI of the three-dimensional ultrasound during the early、middle、late trimester, complications, gestational age, deliver mode, volume of postpartum hemorrhage in 2、24 hours, characteristics of the amniotic fluid, neonatal birth weight, Apgar score.Result: 1 Comparison of general data There is no significant difference between different D-dimer levels during the second trimester in age, gravidity, parity, gestational age(days) and deliver mode(P>0.05). 2 The D-dimer level during the second trimester and adverse pregnancy outcomes 2.1 The D-dimer level during the second trimester and hypertensive disorders complicating pregnancy(1) Linear correlation analysis: There is a negative relationship between the D-dimer level during the second trimester(ug/L) and the incidence of hypertensive disorders complicating pregnancy(r s=-0.14,P<0.05).(2) Rank-sum test: There is no significant difference between different D-dimer levels during the second trimester in the incidence of hypertensive disorder complicating pregnancy(P>0.05).(3) Non-conditional logistic regression: In the multivariate regression analysis, the incidence of hypertensive disorder complicating pregnancy is regarded as the dependent variable, the D-dimer level during the second trimester has not been introduced into the model. 2.2 The D-dimer level during the second trimester and gestational diabetes mellitus(1) Linear correlation analysis: There is no relationship between the D-dimer level during the second trimester(ug/L) and the blood glucose(mmol/L) of OGTT(rFasting=-0.07,P>0.05;r1h after meal=-0.01,P>0.05;r2h after meal=0.00,P>0.05).(2) Rank-sum test: There is no significant difference between different D-dimer levels during the second trimester in the blood glucose of OGTT(P>0.05). 2.3 The D-dimer level during the second trimester and fetal growth restriction(1) Linear correlation analysis: There is a positive relationship between the D-dimer level during the second trimester(ug/L) and the neonatal birth weight(kg)(r=0.18,P<0.05).(2) Rank-sum test: The cases whose D-dimer levels during the second trimester are lower have a lower neonatal birth weight than whose D-dimer levels during the second trimester are higher(P<0.05).(3) Multiple linear regression analysis: In the multiple linear regression analysis, neonatal birth weight is regarded as the dependent variable, the D-dimer level during the second trimester has been introduced into the model. 3 The D-dimer level during the second trimester and other outcomes of maternal and neonatal There is no significant difference in the D-dimer level during the second trimester between the occurrence of adverse pregnancy outcomes such as premature rupture of membranes, premature delivery, fetal distress, abnormal delivery, postpartum hemorrhage or not(P>0.05). 4 The multiple linear regression analysis of the factors that may influence the D-dimer level during the second trimester In the multiple linear regression analysis, the D-dimer level during the second trimester is regarded as the dependent variable, PAPP-A during the first trimester and RI of uterine artery during the second trimester have been introduced into the model. 5 The percent of the D-dimer level during the second trimester in normal pregnancy P2.5:501.25;P25:822.50;P50:1040.00;P75:1352.50;P97.5:2526.25.Conclusion: 1 The D-dimer level during the second trimester is not an appropriate indicator to predict the incidence of hypertensive disorders complicating pregnancy and gestational diabetes mellitus. 2 There is a negative relationship between the D-dimer level during the second trimester and the incidence of hypertensive disorders complicating pregnancy, a positive relationship between D-dimer and neonatal birth weight, a positive relationship between D-dimer and PAPP-A during the first trimester, a negative relationship between D-dimer and RI of uterine artery during the second trimester, which indicate that the D-dimer level during the second trimester may have a relationship with uterine spiral artery remodeling. 3 The reference range of D-dimer level during the second trimester we preliminarily establish is(501.25,2526.25)ug/L.Chapter2 The relationship between the D-dimer level during the second trimester, pregnancy outcome and placenta pathological changeObject: To discuss whether the D-dimer level during the second trimester can predict the placenta exchange function before delivery, thus can predict the adverse pregnancy outcomes.Method: Divided the cases into four groups according to the D-dimer level during the second trimester: 0-999ug/L(122cases) 、 1000-1999ug/L(150cases) 、3:2000-2999ug/L(21cases)、4:>3000ug/L(17cases). Select 10 cases from each group randomly and cut about 1.5*1.5cm full layer tissue from placenta immediately after delivery. Wash with physiological saline and put into formaldehyde solution 48 h. Then dehydrated, waxed, embedded in paraffin, perhaps for HE stain, CD34 immunohistochemistry stain and caspase-3 immunohistochemistry stain.Result: 1 Observation of the placental tissue slice with HE stain 2 The relationship between the D-dimer level during the second trimester, pregnancy outcome and the stereology of placental micro-vascular 2.1 The relationship between the D-dimer level during the second trimester and the stereology of placental micro-vascular(1) Linear correlation analysis: There is no relationship between the D-dimer level during the second trimester(ug/L) and Lv、Vv of the placental micro-vascular(r=0.18,P>0.05;r=-0.03,P>0.05).(2) Rank-sum test: There is no significant difference between different D-dimer levels during the second trimester in Lv、Vv of the placental micro-vascular(P>0.05). 2.2 The relationship between pregnancy outcome and the stereology of placental micro-vascular(1) Linear correlation analysis: There is positive relationship between the incidence of adverse pregnancy outcomes and Lv of the placental micro-vascular(r s=-0.53,P<0.05). There is no relationship between the incidence of adverse pregnancy outcomes and Vv of the placental micro-vascular(r s=-0.25,P>0.05).(2) T test: The cases who with adverse pregnancy outcomes have a lower Lv of the placental micro-vascular than that who without(P<0.05). There is no significant difference between the cases who with and without adverse pregnancy outcomes in Vv of the placental micro-vascular(P>0.05). 3 The relationship between the D-dimer level during the second trimester, pregnancy outcome and the mean optical density value of apoptotic placental cells 3.1 The relationship between the D-dimer level during the second trimester and the mean optical density value of apoptotic placental cells(1) Linear correlation analysis: There is no relationship between the D-dimer level during the second trimester(ug/L) and the mean optical density value of apoptotic placental cells(r=0.09,P>0.05).(2) Rank-sum test: There is no significant difference between different D-dimer levels during the second trimester in mean optical density value of apoptotic placental cells(P>0.05).3.2 The relationship between pregnancy outcome and the mean optical density value of apoptotic placental cells(1) Linear correlation analysis: There is positive relationship between the incidence of adverse pregnancy outcomes and the mean optical density value of apoptotic placental cells(r s=0.74,P<0.05).(2) T test: The cases who with adverse pregnancy outcomes have a higher mean optical density value of apoptotic placental cells than that who without(P<0.05).Conclusion: 1 The cases who with adverse pregnancy outcomes have a lower Lv of the placental micro-vascular、a higher mean optical density value of apoptotic placental cells than that who without, which indicate that adverse pregnancy outcomes may have a relationship with descend of the placenta exchange function. 2 There is no significant difference between different D-dimer levels during the second trimester in Lv、Vv of the placental micro-vascular, mean optical density value of apoptotic placental cells, which indicate that the D-dimer level during the second trimester is not an appropriate indicator to predict the placenta exchange function before delivery.