Serial D-Dimer in Pregnancy Women with a History of Fetal Loss Syndrome and Invitro Fertilization

We have reported in abstract P-Th-374 in a 2011 Kyoto ISTH Congress that an increased level of D-dimer in combination with umbilical artery systolic diastolic (UASD) ratio can be used as a timing to start with prophylactic anticoagulants In women with pregnancy failure, regardles of the antibody antiphospholipids (APAs) level, history of fetal loss syndrome or invitro fertilization (IVF).

The question is: Are there any differences of a serial D-dimer level if is compared to the APAs level, history of fetal loss syndrome and IVF?.

A retrospective Cohort study was conducted on a total sampling subjects of pregnancy women who visited two hospitals in Jakarta, Indonesia, at a periode of January 2009 – December 2010. Serial D-dimer using chromogenic assay method (cut off normal level < 500 ng/ml) was tested during antenatal and post partum period. The data were analysed to compare a mean D-dimer with the level of APAs (ACA IgG/IgM, AntiB2GP1 IgG/IgM) tested using ELISA method, a history of fetal loss syndrome and IVF conception

Of 83 pregnant women,19 women with high level of APAs (subgroup 1) showed a mean D-dimer level as follows: Trimester I: 892.15 ± 785.15 ng/ml, trimester II: 782.59 ± 440.53 ng/ml, trimester III:1282.62 ± 601.22 ng/ml, post partum 1367.45 ± 581.19 ng/ml; 31 women with normal APAs (subgroup 2) showed: Trimester I: 666.23 ± 396.24 ng/ml, trimester II: 896.66 ± 396.24 ng/ml, trimester II: 896.66 ± 496.32 ng/ml, trimester III: 1313.45 ± 850.20 ng/ml, post partum: 1991.75 ± 1388.70 ng/ml; 33 women with no data of APAs (subgroup 3) showed: Trimester I: 568.47 ± 482.70 ng/ml, trimester 2: 797.95 ± 934.59 ng/ml, trimester III: 966.89 ± 862.10 ng/ml, post partum: 1078.50 ± 836.29 ng/ml

Of 83 pregnant women, 47 women who have experienced 1 or ≥ 1 abortion or IUFD (subgroup 4) showed D-dimer level as follows: Trimester I:493.09 ± 385.89 ng/ml, trimester II: 740.23 ± 564.99 ng/ml, trimester III: 859.05 ± 549.88 ng/ml, post partum 1342.59 ± 1264.09 ng/ml. Meanwhile, 36 women who have no history of fetal loss (subgroup 5) showed: Trimester I: 892.17± 593.47 ng/ml, trimester II: 930.57± 807.02 ng/ml, trimester III: 1439.71 ± 932.12 ng/ml, post partum 1695.16 ± 1131.56 ng/ml.

Of 83 pregnant women, 10 women who became pregnant after embryo transfer of IVF (subgroup 6) showed: Trimester I: 493.09± 385.895 ng/ml, trimester II: 740.23± 564.99 ng/ml, trimester III:859.05 ± 549.88 ng/ml, post partum 1342.59 ± 1264.09 ng/ml.

Either in subgroup 1, 2, 3,4,5 and 6 mean D-dimer tend to increase from trimester I to trimester II and from trimester II to trimester III, except in subgroup 1 from trimester I to trimester II of pregnancy. Meanwhile, all groups showed a higher mean D-dimer post partum compared to antenatal period.

No relevant conflicts of interest to declare.