Hemostatic disorders in pregnant women with undifferentiated connective tissue dysplasia

Aim: to determine the features of the hemostatic profile in pregnant women with undifferentiated connective tissue dysplasia (UCTD) and to evaluate its association with obstetric blood loss, postpartum hemorrhage, and the need for hemostatic interventions. Materials and Methods. A prospective single-center cohort study included 144 pregnant women: 74 with clinical signs of UCTD (main group) and 70 without dysplasia (control group). Standard hemostasis parameters (platelet count, INR, APTT, thrombin time, fibrinogen, D-dimer) were assessed at 32–34 weeks of gestation and before delivery. Thromboelastography (TEG) parameters were evaluated before and in the early postpartum period. Obstetric blood loss, incidence of postpartum hemorrhage, and need for therapeutic interventions were analyzed. Results. Pregnant women with UCTD demonstrated a less pronounced physiological hypercoagulable adaptation, characterized by lower fibrinogen levels (p<0.05), prolonged APTT and thrombin time, and increased MPV. TEG analysis revealed prolonged R and K times, decreased α-angle, and reduced maximum clot amplitude (MA), indicating slower clot formation and reduced clot strength. These abnormalities became more pronounced in the early postpartum period and were accompanied by increased fibrinolytic activity (LY30). The proportion of women with MA <65 mm was significantly higher in the UCTD group. Reduced fibrinogen levels and MA were associated with increased blood loss. Conclusions. Pregnant women with UCTD exhibit a moderate but consistent reduction in hemostatic reserve. Conventional laboratory tests show limited sensitivity, whereas TEG provides a more comprehensive assessment of coagulation potential. Decreased fibrinogen levels and MA may serve as early predictors of postpartum hemorrhage. Individualized management strategies are required for pregnant women with UCTD to reduce the risk of hemorrhagic complications.

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