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Title: The study of local fibrinolysis in abortion.
Author: Ikeuchi M.
Journal: Nihon Sanka Fujinka Gakkai Zasshi; 1985 Jul; 37(7):1215-23. PubMed ID: 2411832.
Abstract:
The etiology of abortion, which is still a moot question, is now under intense investigation. The present study discussed the possible role of local fibrinolysis (villous tissue fibrinolysis) in the pathogenesis of abortion by studying tissue fibrinolytic activity in tissue culture as well as blood coagulation, fibrinolysis and the kinin system. Subjects studied include: 1) normal villous tissue (n=46), early pregnancy loss, whose fetal cardiac activity had once been identified (n=22) designated as Group A, and Group B whose fetal cardiac activity had never been identified (n=82). The villous tissues were cultured for 24 hours and then the urokinase (UK) inhibition activity in the medium was determined. 2) Threatened abortion resulted in abortion (poor prognosis, n=42) or the pregnancy continued (good prognosis, n=81). In these patients the following substances in plasma were determined: Prekallikrein, alpha 2-plasmin inhibitor, alpha 1-antitrypsin, alpha 2-macroglobulin, C1-inactivator, antithrombin-III, plasminogen, fibrinogen, fibrin degradation products (FDP). The results are: 1) UK inhibition activity (against UK 2.5 iu), normal villous tissue 26.3 +/- 14.6%, Group A 26.0 +/- 10.3%, Group B 9.6 +/- 10.7%, a significant difference between the normal villous tissue and Group B villous tissue was observed. This suggested that the increased villous tissue fibrinolytic activity due to decreased UK inhibition activity may be one of the causes of abortion. 2) Prekallikrein was significantly reduced in patients with abdominal pain. Also, a significant reduction in plasminogen and elevated C1-inactivator was observed in patients with poor prognosis. The significance of these findings was discussed. This study investigates the possible role of local fibrinolysis (villous tissue fibrinolysis) in the pathogenesis of abortion by studying tissue fibrinolytic activity in tissue culture as well as blood coagulation, fibrinolysis, and the kinin system. Blood was collected by cubital venipuncture. Villous tissues were obtained by intrauterine evacuation from patients suffering from spontaneous abortion and patients with artificial abortion (as control). Patients in both groups had comparable gestational ages. Samples were obtained from patients visiting the outpatient department of the Nagoya City University Medical School during the 1978-82 period. In patients suffering from threatened abortion, serial blood samples were taken from the time symptoms emerged until the end of the disease. Between 1980-82 patients with spontaneous abortion were further separated into 2 groups: group A included those whose fetal cardiac activities had once been identified by ultrasonography. In group b patients, their fetal cardiac activities and never been identified. A tendency of low level of plasminogen was observed in patients with poor prognosis compared to normal control group. Serial samples also revealed a decline of plasminogen levels in this group. A recovery of plasminogen levels was observed in patients with good prognosis. Patients with poor prognosis showed a significant high level of Cl-inactivator compared to normal control group. In patients with good prognosis, a gradual decline of Cl-inactivator was observed like that seen in control group. Serial samples revealed a decrease of serum fibrin degradation products in patients with good prognosis. A significant decrease of fibrinogen was noted in patients with poor prognosis. There was a good correlation between the urokinase inhibition activity in normal villous tissue and the gestational age (6-11 weeks). The increased villous tissue fibrinolytic activity due to decreased urokinase inhibition activity may be 1 of the causes of abortion.

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