Study On The Relationship Between Coagulation Index And Missed Abortion And Its Predictive Value For Recent Complications

Objective: By studying seven items of coagulation and some blood routine indexes in venous blood of patients with normal pregnancy and early and late missed abortion(MA)in Qinghai University Affiliated Hospital,as well as the amount of blood loss in patients with MA at the time of termination of pregnancy,the relationship between the above indexes and MA,the relationship between the above indexes and the gestational weeks of pregnant women with MA,the duration of stopping embryonic development,and the predictive value of short-term complications related to MA were discussed.Methods: According to the inclusion criteria and exclusion criteria of this study,data collected from MA patients attending the Department of Gynecology of Qinghai University Affiliated Hospital from January 1,2015 to January 1,2020 included 123 MA patients(study group)with a mean age of28.24 ± 4.95 years,and 100 normal pregnant women(control group)with a mean age of 26.61 ± 4.25 years.According to the gestational weeks at the time of diagnosis and treatment,the study group was divided into two groups: early MA group(gestational time < 14W)and late MA group(14W≤ gestational time ≤ 27 W / 6d).Patients with early MA were divided into two groups according to the duration of embryo stopping development(i.e.,according to the difference between the gestational weeks of the last menopause and the current embryo size indicated by color ultrasound,hereinafter referred to as the duration of embryo arrest).Patients with early MA were divided into two groups: embryo stop < 4 weeks group(n=37),embryo stop 4 weeks group(n=26),late stage MA patients were divided into 4 weeks group(n=23),4 weeks group(n=22)and ≥ 8 weeks group(n=15).The blood coagulation index,blood routine index and the amount of blood loss before termination of pregnancy were collected.Results :1.Through the analysis of the relationship between the above indexes and MA,the results were as follows:(1)The age and BMI in the MA group were higher than those in the normal pregnancy group,and the difference was statistically significant(P < 0 05).(2)Among the coagulation indexes,PT and APTT in the MA group were shorter than those in the normal pregnancy group,AT-III,Fg and FDP were lower than those in the normal pregnancy group,and DD and PLT were higher than those in the normal pregnancy group.(3)Among the blood routine indexes,the WBC,N% and N of MA group were higher than those of normal pregnancy group,while HB was lower than that of normal pregnancy group.(4)the results of ROC curve analysis showed that some blood coagulation indexes and blood routine indexes had certain predictive value for MA and its short-term complications.2.The results were obtained by analyzing the differences of each index in early and late MA:(1)There was no significant difference in age and BMI between the two groups.(2)Among the coagulation indexes,PT,APTT,TT and AT-III in late MA were shorter than those in early MA,while Fg,FDP,DD and PLT were higher than those in early MA.(3)Among the blood routine indexes,the HB in the late MA group was significantly lower than that in the early MA group,but there was no significant difference in WBC,N% and N between the two groups.3.By analyzing the relationship between each index and the duration of embryo arrest in early MA patients,the results were obtained:(1)There was no significant difference in age and BMI between groups with different embryo arrest duration in early MA(P>0.05);(2)Coagulation indexes Among them,the PT and APTT in the embryo-stop <4w group were shorter than those in the embryo-stop 4-8w group,and the DD and PLT were higher than those in the 4-8w group,and the difference was statistically significant(P<0.05).FDP and TT were higher than those in the embryo-stop<4w group,and there was no significant difference in residual coagulation indexes(P>0.05).<4w increased,and HB was lower than that in the embryostop <4w group,with statistical difference(P<0.05);(4)The bleeding volume at the termination of pregnancy in the embryostop 4-8w group was higher than that in the embryostop<4w group,and the difference was as follows: Statistical significance(P<0.05).4.By analyzing the relationship between each index and the duration of embryo arrest in patients with advanced MA,the results were as follows:(1)There was no significant difference in age and BMI among the groups with different duration of embryo arrest in late MA(P>0.05).(2)Among the blood coagulation indexes,PT and APTT were shorter,DD and PLT were higher,FDP,Fg and TT were higher in the group with embryo stopping for more than 8 weeks than those in the other two groups(P>0.05).(3)Among the blood routine indexes,the WBC,N% and N in the group of embryo stopping >8 weeks were higher than those in the other two groups,while the HB was lower than that in the other two groups(P>0.05).(4)The amount of bleeding at termination of pregnancy in the group of embryo stop > 8 weeks was higher than that in the other two groups,and the difference was statistically significant(P < 0.05).Conclusion :1.The BMI and age of 1.MA patients are higher than those of normal pregnancy group,the blood of MA patients is hypercoagulable,and MA patients are more likely to develop recent adverse complications such as infection and anemia than normal pregnant women.2.With the prolongation of the fetal arrest time,some of the blood routine and coagulation indexes of MA patients changed to varying degrees,and there were statistical differences.The amount of vaginal bleeding and the risk of infection increased when the pregnancy was terminated,and the longer the gestational week,the longer the embryo arrest time.In MA patients,the hypercoagulable state of the blood gradually changes into hyperactivity of the fibrinolytic system,which increases the risk of recent complications and increases the amount of bleeding during pregnancy termination.3.There was a correlation between the above-mentioned blood coagulation,blood routine indexes and the amount of blood loss at the time of termination of pregnancy.The comprehensive detection of the above indexes combined with clinical practice has a certain guiding value for the prediction of MA and its complications.