Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
J Perinat Med. 2011 Jul;39(4):369-74. doi: 10.1515/jpm.2011.026. Epub 2011 May 31.
Some women exhibit a gradual decrease in antithrombin activity until the time of delivery, with antithrombin activity reaching <65% of the normal level (pregnancy-induced antithrombin deficiency, PIATD). However, the clinical features of such women are not well understood and are unfamiliar to many obstetricians.
PIATD is more likely to occur as the number of fetuses increases (approx. 1.0%, 10%, and 40% for singleton, twin, and triplet pregnancies, respectively) and in women with hypertension, isolated proteinuria and/or edema. However, normotensive women account for 60% of women with PIATD. Antithrombin can escape from the blood into the interstitial space. Women with PIATD suffer from a decreased plasma volume and are more likely to develop liver dysfunction, irrespective of the presence or absence of hypertension. Because antithrombin activity continues to decrease until the time of delivery in women with PIATD, women with unrecognized PIATD may be identified as patients with so-called "acute fatty liver of pregnancy" if delivery is delayed.
Knowledge of AT activity in obstetrical practice may improve management of pregnant women. The determination of AT activity should be considered in women with multifetal pregnancies, hypertension, isolated proteinuria and/or edema.
一些女性在分娩前的一段时间内，抗凝血酶活性逐渐下降，抗凝血酶活性降至正常水平的<65%（妊娠诱导的抗凝血酶缺乏症，PIATD）。然而，这些女性的临床特征尚未得到很好的理解，许多产科医生对此并不熟悉。
PIATD 更可能随着胎儿数量的增加而发生（分别约为 1.0%、10%和 40%，用于单胎、双胎和三胎妊娠），并且在患有高血压、孤立性蛋白尿和/或水肿的女性中更常见。然而，正常血压的女性占 PIATD 女性的 60%。抗凝血酶可以从血液中逸出到间质空间。PIATD 女性的血浆体积减少，更有可能出现肝功能障碍，无论是否存在高血压。由于 PIATD 女性的抗凝血酶活性持续下降直至分娩，因此如果延迟分娩，未被识别的 PIATD 女性可能被诊断为所谓的“妊娠急性脂肪肝”患者。
在产科实践中了解 AT 活性可能会改善对孕妇的管理。在多胎妊娠、高血压、孤立性蛋白尿和/或水肿的女性中应考虑测定 AT 活性。
