The influence of inherited thrombophilia, endothelial activation and fibrinolysis on placental morphology and vasculature and on maternal and fetal outcome, in a low risk primigravid population

Abstract

A number of inherited thrombophilias have been associated with adverse events occurring during pregnancy. A common feature of these abnormalities is their ability to alter endothelial function and to increase thrombin generation. Their effect on low risk pregnancy is controversial. There were three main objectives. The first objective was to assess the role of factor V Leiden (FVL), prothrombin (PT) G20210A, methylenetetrahydrofolate reductase (MTHFR) C667T, plasminogen activator inhibitor type 1 (PAI-1) 4G/5G polymorphism and tumor necrosis factor a G308A (TNFa -308) polymorphism in determining maternal and fetal outcome in a low risk primigravid population and their influence on placental vasculature and morphology. The presence of the cytokines tumour necrosis factor-a (TNFa), interleukin-6 (IL-6) and vascular endothelial growth factor (VEGF) in this group of women was evaulated and their influence on placental vasculature and pregnancy outcome was assessed. A third aim was to evaluate certain circulating pro- and anti- coagulants, protein C, protein S, antithrombin, fibrinogen, and factor VIII, in a sub group of women with an adverse outcome to their pregnancy and in age matched controls.