During pregnancy, the parturient develops a degree of hypercoagulability, likely as a protective mechanism for delivery of the fetus. Most procoagulants are increased such as 2, 7, 9, 10 but especially fibrinogen or factor 1. In normal patients, fibrinogen levels are 200-400mg/dl but during pregnancy this can rise to greater than 600mg/dl. This rise is gradual and peaks at the time of delivery. During this time there is an increase in the level of fibrinolysis to counteract the degree of hypercoagulability though this is usually to a lesser extent than the rise in fibrinogen activity. Patients often have higher levels of split products or D-dimer than baseline population. As a result, patients who have ROTEM performed during normal pregnancy likely will have a thicker FIBTEM than normal.
References
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