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Thromb Haemost 1999; 81(01): 32-34
DOI: 10.1055/s-0037-1614413
Review Article
Schattauer GmbH

Thrombomodulin: A New Marker for Placental Abruption

Urania Magriples
1   From the Departments of Obstetrics and Gynecology, Yale University, New Haven, CT, and Johns Hopkins University School of Medicine, Baltimore, MD, USA
,
Daniel W. Chan
1   From the Departments of Obstetrics and Gynecology, Yale University, New Haven, CT, and Johns Hopkins University School of Medicine, Baltimore, MD, USA
,
Debra Bruzek
1   From the Departments of Obstetrics and Gynecology, Yale University, New Haven, CT, and Johns Hopkins University School of Medicine, Baltimore, MD, USA
,
Joshua A. Copel
1   From the Departments of Obstetrics and Gynecology, Yale University, New Haven, CT, and Johns Hopkins University School of Medicine, Baltimore, MD, USA
,
Chaur-Dong Hsu
1   From the Departments of Obstetrics and Gynecology, Yale University, New Haven, CT, and Johns Hopkins University School of Medicine, Baltimore, MD, USA
› Author Affiliations
Further Information

Publication History

Received05 June 1998

Accepted after resubmission18 September 1998

Publication Date:
08 December 2017 (online)

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Summary

Thrombomodulin (TM), a marker of endothelial cell damage, has been localized to the placental syncytiotrophoblast. A prospective cohort study of twenty-five pregnant women who were admitted with a clinical diagnosis of placental abruption was undertaken. Abruption was confirmed after delivery in eight cases (Group 1). Group 2 consisted of seventeen patients with no clinical or pathologic evidence of placental abruption after delivery. TM was significantly elevated in Group 1 (71.59 ± 5.35 vs. 48.29 ± 3.53 ng/ml, p = 0.001). The sensitivity and specificity of TM ≥60 ng/ml as a marker for abruption was 87.5 and 76.5%, respectively. In comparison, the sensitivity of an abnormal coagulation profile, maternal Kleihauer-Betke and ultrasound in patients with abruption was 0, 16.7 and 28.6%, respectively. TM is a highly sensitive and specific marker for acute placental abruption.

 

  • References

  • 1 Green-Thompson RW. Antepartum hemorrhage. Clin Obstet Gynecol 1982; 9: 479-515.
    PubMedSearch in Google Scholar
  • 2 Eriksen G, Wohlert M, Ersbak V, Hvidman L, Hedegaard M, Skajaa K. Placental abruption. A case-control investigation. Br J Obstet Gynaecol 1991; 98: 448-52.
    CrossrefPubMedSearch in Google Scholar
  • 3 Raymond EG, Mills JL. Placental abruption: Maternal risk factors and associated fetal conditions. Acta Obstet Gynecol Scand 1993; 72: 633-9.
    CrossrefPubMedSearch in Google Scholar
  • 4 Hurd WH, Miodovnik M, Hertzberg V, Lavin JP. Selective management of abruptio placentae: a prospective study. Obstet Gynecol 1983; 61: 467-73.
    PubMedSearch in Google Scholar
  • 5 Emery CL, Morway LF, Chung-Park M, Wyatt-Ashmead J, Sawady J, Beddow TD. The Kleihauer-Betke test. Clinical utility, indication and correlation in patients with placental abruption and cocaine use. Arch Pathol Lab Med 1995; 119: 1032-7.
    PubMedSearch in Google Scholar
  • 6 Pritchard JA, Brekken AL. Clinical and laboratory studies on severe abruptio placentae. Am J Obstet Gynecol 1967; 97: 681-96.
    CrossrefPubMedSearch in Google Scholar
  • 7 Nolan TE, Smith RP, Devoe LD. A rapid test for abruptio placentae: Evaluation of a D-dimer latex agglutination slide test. Am J Obstet Gynecol 1993; 169: 265-9.
    CrossrefPubMedSearch in Google Scholar
  • 8 Katz VL, Chescheir NC, Cefalo RC. Unexplained elevations of maternal serum alpha-fetoprotein. Obstet Gynecol Surv 1990; 45: 719-26.
    CrossrefPubMedSearch in Google Scholar
  • 9 Williams MA, Hickok DE, Zinghelm RW, Zebelman AM. Maternal serum CA 125 levels in the diagnosis of abruptio placentae. Obstet Gynecol 1993; 82: 808-12.
    PubMedSearch in Google Scholar
  • 10 Dahmus MA, Sibai BM. Blunt abdominal trauma: are there any predictive factors for abruptio placentae or maternal-fetal distress?. Am J Obstet Gynecol 1993; 169: 1054-9.
    CrossrefPubMedSearch in Google Scholar
  • 11 Towery R, English TP, Wisner D. Evaluation of pregnant women after blunt injury. J Trauma 1993; 35: 731-5.
    CrossrefPubMedSearch in Google Scholar
  • 12 Maruyama I, Bell CE, Majerus PW. Thrombomodulin is found on endothelium of arteries, veins, capillaries and lymphatics, and on syncytiotrophoblast of human placenta. J Cell Biol 1985; 101: 363-71.
    CrossrefPubMedSearch in Google Scholar
  • 13 Hsu CD, Iriye B, Johnson TR, Witter FR, Hong SF, Chan DW. Elevated circulating thrombomodulin in severe preeclampsia. Am J Obstet Gynecol 1993; 169: 148-9 and Am J Obstet Gynecol 1994; 171: 1165.
    CrossrefPubMedSearch in Google Scholar
  • 14 Gershell DJ, Kraus FT, Riffle MB. Diseases of the placenta. In: Kurman RJ. ed. Blaustein’s pathology of the female genital tract. 3rd ed. New York: Springer-Verlag; 1987: 769-834..
    Search in Google Scholar