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Umbilical Venous D-dimer Concentrations With and Without Labor

MURTHA AMY P. MD; BOGGESS, KIM A. MD; JIMMERSON, CATHY E.; GREIG, PHILLIP C. MD; HERBERT, WILLIAM N. P. MD
Obstetrics & Gynecology: August 1998
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Objective To determine if labor activates the fetal fibrinolytic system.

Methods A total of 59 umbilical venous blood samples were collecting following vaginal delivery at term (n = 20), cesarean delivery following labor at term (n = 12), vaginal delivery before term (n = 18), and cesarean delivery without labor (n = 9). D-dimer concentrations, a sensitive marker of fibrinolysis, were measured by enzyme-linked immunosorbent assay, and compared between groups by Kruskel-Wallis and Mann Whitney U tests, with significance defined as P < .05.

Results There were no significant differences in median D-dimer concentrations between newborns delivered vaginally or by cesarean after term labor or preterm labor. There were significant differences in median umbilical venous D-dimer concentrations in subjects delivered vaginally or by cesarean after term or preterm labor compared with term subjects without labor delivered by cesarean (427, 773, and 326 versus 87 ng/mL, P = .01)

Conclusion Elevation of umbilical plasma D-dimer concentrations in laboring patients suggests activation of fetal fibrinolysis before delivery.

Address reprint requests to: Amy P. Murtha, MD, Box 3967, Division of Maternal Fetal Medicine, Duke University Medical Center, Durham, NC 27710. E-mail: murth002@mc.duke.edu

© 1998 The American College of Obstetricians and Gynecologists

Fetal fibrinolysis, as reflected by umbilical venous D-dimer concentrations, is activated at birth following labor but not following elective cesarean delivery.