Tsakok F H
Ann Acad Med Singap. 1982 Oct;11(4):555-60.
Problems of haemostasis associated with abnormal pregnancy states such as eclampsia, prolonged intrauterine death and amniotic fluid embolism causing maternal death are well recognised. Coagulation problems have been suspected in hydatidiform molar pregnancies previously but because of the rare occurrence, the importance of defective haemostasis in this trophoblastic disorder has not been emphasised. Evidence from clinical course of the disease, from haematological studies and from postmortem findings provide evidence that enhanced coagulation occurs in all hydatidiform molar pregnancies. Secondary fibrinolysis in the intact mole increases during evacuation and could aggravate the coagulation state. If there should already be a moderate degree of intravascular coagulation, it could progress to an irreversible state with evacuation if the coagulation defect are not corrected before the procedure as illustrated by reported maternal deaths. Since the degree of vaginal bleeding does not definitely indicate the degree of coagulopathy, coagulation screening tests are necessary to detect the condition in all hydatidiform moles. The placental proteins with coagulation and fibrinolytic activity found in trophoblastic disease, may be associated with the aetiology of coagulation disorder and may have a prognostic value in detecting subsequent malignancy.
与异常妊娠状态相关的止血问题，如子痫、宫内长期死亡和羊水栓塞导致孕产妇死亡，已得到充分认识。以前曾怀疑葡萄胎妊娠存在凝血问题，但由于其发生率低，这种滋养层疾病中止血缺陷的重要性未得到强调。来自疾病临床过程、血液学研究和尸检结果的证据表明，所有葡萄胎妊娠都会发生凝血增强。完整葡萄胎中的继发性纤溶在排空过程中增加，并可能加重凝血状态。如果已经存在中度血管内凝血，如报告的孕产妇死亡所示，如果在手术前未纠正凝血缺陷，排空时可能会发展为不可逆状态。由于阴道出血程度不能明确表明凝血病的程度，因此有必要进行凝血筛查试验以检测所有葡萄胎中的这种情况。在滋养层疾病中发现的具有凝血和纤溶活性的胎盘蛋白，可能与凝血障碍的病因有关，并且在检测随后的恶性肿瘤方面可能具有预后价值。
