Review on coagulation in trophoblastic disease.

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.