Preeclampsia as a hemostatic disorder in pregnant women: epidemiological aspects, pathogenetic mechanisms of coagulation changes

Authors

DOI:

https://doi.org/10.14739/2310-1210.2026.3.346835

Keywords:

preeclampsia, hemostasis, laboratory markers, coagulation

Abstract

The review focuses on the laboratory and pathogenetic aspects of preeclampsia, one of the most clinically significant and life-threatening obstetric complications, characterized by multiorgan maternal dysfunction resulting from specific vascular and hemostatic changes.

The aim of the study was to review and critically analyze peer-reviewed publications on coagulation changes in preeclampsia in electronic scientometric databases, including PubMed, Web of Science, Scopus, and Google Scholar.

Materials and methods. A search was conducted for scientific publications using the following queries: “preeclampsia hemostasis abnormalities”, “preeclampsia coagulation disorders pathogenesis”, “coagulation changes in pregnancy”, “preeclampsia mechanisms”, “preeclampsia epidemiology global prevalence”, “endothelial dysfunction and coagulation in preeclampsia”. A retrospective analysis of scientific literature from the past 7 years was conducted using searches in major scientometric databases. Following abstract screening and full-text review, 60 relevant publications were selected. Publication trends on key hemostasis parameters in preeclampsia were tracked in both English and Ukrainian literature, applying “systematic review” filters.

Results. The study revealed a consistent year-on-year increase in publications addressing these search terms across major scientific databases. Disorders of hemostasis play a pivotal role in preeclampsia pathogenesis; thus, evaluating key parameters (platelet count, fibrinogen levels, prothrombin time) enables elucidation of hypercoagulability mechanisms, quantification of endothelial injury, and identification of links between placental hypoperfusion, microthrombosis, and systemic hemostatic alterations. Diagnostic criteria for preeclampsia were established per leading international and Ukrainian guidelines. The analysis highlighted several unresolved challenges in investigating fibrinolysis and coagulation activation markers that warrant further comprehensive research.

Conclusions. Analysis of key parameters of hemostasis in preeclampsia facilitates understanding of its pathogenetic mechanisms, contributes to early diagnosis and risk stratification, and enables assessment of the risk of maternal and perinatal complications.

Author Biographies

R. F. Yeromenko, National University of Pharmacy, Kharkiv

PhD, DSc, Professor of the Department of Clinical Laboratory Diagnostics, Microbiology and Biological Chemistry

O. M. Lytvynova, National University of Pharmacy, Kharkiv

MD, PhD, DSc, Professor of the Department of Clinical Laboratory Diagnostics, Microbiology and Biological Chemistry

H. L. Lytvynenko, National University of Pharmacy, Kharkiv

MD, PhD, Associate Professor of the Department of Clinical Laboratory Diagnostics, Microbiology and Biological Chemistry

N. V. Zaiets, National University of Pharmacy, Kharkiv

Master’s Student at the Department of Clinical Laboratory Diagnostics, Microbiology and Biological Chemistry

References

  1. Beniuk VO, Komar VM, Kovaliuk TV, Lastovetska LD, Shcherba OA, Shapovaliuk OV. [Anamnestic predictors of the risk of preeclampsia development: a contemporary view of the problem]. Reproductive Health of Woman. 2025;(3):104-12. Ukrainian. doi: https://doi.org/10.30841/2708-8731.3.2025.331554
  2. Ma’ayeh M, Costantine MM. Prevention of preeclampsia. Semin Fetal Neonatal Med. 2020;25(5):101123. doi: https://doi.org/10.1016/j.siny.2020.101123
    | |
  3. Phipps EA, Thadhani R, Benzing T, Karumanchi SA. Pre-eclampsia: pathogenesis, novel diagnostics and therapies. Nat Rev Nephrol. 2019;15(5):275-89. doi: https://doi.org/10.1038/s41581-019-0119-6. Erratum in: Nat Rev Nephrol. 2019;15(6):386. doi: https://doi.org/10.1038/s41581-019-0156-1
    | |
  4. Poon LC, Shennan A, Hyett JA, Kapur A, Hadar E, Divakar H, et al. The International Federation of Gynecology and Obstetrics (FIGO) initiative on pre-eclampsia: a pragmatic guide for first-trimester screening and prevention. Int J Gynecol Obstet. 2019;145(Suppl 1):1-33. doi: https://doi.org/10.1002/ijgo.12802
    | |
  5. Yushchenko MI, Duka YM. [Modern view on the etiology and pathogenesis of preeclampsia as the main cause of perinatal losses]. Zdorovia zhinky. 2022;(4):58-68. Ukrainian. doi: https://doi.org/10.15574/HW.2022.161.58
    |
  6. Fox R, Kitt J, Leeson P, Aye C, Lewandowski AJ. Preeclampsia: Risk Factors, Diagnosis, Management, and the Cardiovascular Impact on the Offspring. J Clin Med. 2019;8(10):1625. doi: https://doi.org/10.3390/jcm8101625
    | |
  7. Ives CW, Sinkey R, Rajapreyar I, Tita A, Oparil S. Preeclampsia-Pathophysiology and Clinical Presentations: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;76(14):1690-702. doi: https://doi.org/10.1016/j.jacc.2020.08.014
    | |
  8. Erez O, Romero R, Jung E, Chaemsaithong P, Bosco M, Suksai M, et al. Preeclampsia and eclampsia: the conceptual evolution of a syndrome. Am J Obstet Gynecol. 2022;226(2S):S786- S803. doi: https://doi.org/10.1016/j.ajog.2021.12.001
    | |
  9. Spichak KO, Govsieiev DO. [The role of angiogenic factors in preeclampsia]. Ukrainian Journal of Health of Woman. 2024;(6):4-8. Ukrainian. doi: https://doi.org/10.15574/HW.2024.6(175).48
    |
  10. Pre-eclampsia [Internet]. Who.int. 2025 Dec 10 [cited 2026 Jan 12]. Available from: https://www.who.int/news-room/fact-sheets/detail/pre-eclampsia
  11. Centre for Medical Statistics, Ministry of Health of Ukraine. Stan zdorovia zhinochoho naselennia v Ukraini za 2021 rik [State of health of the female population in Ukraine for 2021]. Kyiv: Centre for Medical Statistics, Ministry of Health of Ukraine; 2022. Ukrainian.
  12. Ministry of Health of Ukraine. Shchorichnyi zvit pro stan zdorovia naselennia Ukrainy ta epidemichnu sytuatsiiu za 2023 rik [Annual report on the health status of the population of Ukraine and the epidemiological situation for 2023]. Kyiv: Ministry of Health of Ukraine; 2024.
  13. Ministry of Health of Ukraine. [Unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care: Hypertensive disorders during pregnancy, labor and postpartum period]. Order dated 2022 Jan 24 No. 151 [Internet]. Available from: https://moz.gov.ua/article/ministry-mandates/nakaz-moz-ukraini-vid-24012022-151-pro-zatverdzhennja-unifikovanogo-klinichnogo-protokolu-gipertenzivni-rozladi-pid-chas-vagitnosti
  14. Roberts JM. Preeclampsia epidemiology(ies) and pathophysiology(ies). Best Pract Res Clin Obstet Gynaecol. 2024;94:102480. doi: https://doi.org/10.1016/j.bpobgyn.2024.102480.
    | |
  15. Cífková R. Hypertension in Pregnancy: A Diagnostic and Therapeutic Overview. High Blood Press Cardiovasc Prev. 2023;30(4):289-303. doi: https://doi.org/10.1007/s40292-023-00582-5
    | |
  16. Opichka MA, Rappelt MW, Gutterman DD, Grobe JL, McIntosh JJ. Vascular Dysfunction in Preeclampsia. Cells. 2021;10(11):3055. doi: https://doi.org/10.3390/cells10113055
    | |
  17. Sharma DD, Chandresh NR, Javed A, Girgis P, Zeeshan M, Fatima SS, Arab TT, Gopidasan S, Daddala VC, Vaghasiya KV, Soofia A, Mylavarapu M. The Management of Preeclampsia: A Comprehensive Review of Current Practices and Future Directions. Cureus. 2024;16(1):e51512. doi: https://doi.org/10.7759/cureus.51512
    |
  18. Martini C, Saeed Z, Simeone P, Palma S, Ricci M, Arata A, et al. Preeclampsia: Insights into pathophysiological mechanisms and preventive strategies. Am J Prev Cardiol. 2025;23:101054. doi: https://doi.org/10.1016/j.ajpc.2025.101054
    | |
  19. Dickerson AG, Joseph CA, Kashfi K. Current Approaches and Innovations in Managing Preeclampsia. J Clin Med. 2025;14(4):1190. doi: https://doi.org/10.3390/jcm14041190
    | |
  20. Rana S, Lemoine E, Granger JP, Karumanchi SA. Preeclampsia: Pathophysiology, Challenges, and Perspectives. Circ Res. 2019;124(7):1094-112. doi: https://doi.org/10.1161/CIRCRESAHA.118.313276
    | |
  21. Pankiewicz K, Szczerba E, Maciejewski T, Fijałkowska A. Non-obstetric complications in preeclampsia. Prz Menopauzalny. 2019;18(2):99-109. doi: https://doi.org/10.5114/pm.2019.85785
    | |
  22. National Institute for Health and Care Excellence (NICE). Hypertension in pregnancy: diagnosis and management. NICE guideline [NG133]. London: NICE; 2021.
  23. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020;135(6):e237-60. doi: https://doi.org/10.1097/AOG.0000000000003891
    | |
  24. Brown MA, Magee LA, Kenny LC, Karumanchi SA, McCarthy FP, Saito S, et al. The hypertensive disorders of pregnancy: ISSHP classification, diagnosis & management recommendations for international practice. Pregnancy Hypertens. 2018;13:291-310. doi: https://doi.org/10.1016/j.preghy.2018.05.004
    | |
  25. Burton GJ, Redman CW, Roberts JM, Moffett A. Pre-eclampsia: pathophysiology and clinical implications. BMJ. 2019;366:l2381. doi: https://doi.org/10.1136/bmj.l2381
    | |
  26. Reese JA, Peck JD, Deschamps DR, McIntosh JJ, Knudtson EJ, Terrell DR, et al. Platelet Counts during Pregnancy. N Engl J Med. 2018;379(1):32-43. doi: https://doi.org/10.1056/NEJMoa1802897
    | |
  27. Temur M, Taşgöz FN, Çift T, Serpim G, Üstünyurt E. Role of platelet indices in prediction of preeclampsia. Ginekol Pol. 2021;92(11):792-6. doi: https://doi.org/10.5603/GP.a2021.0056
    | |
  28. Reese JA, Peck JD, Yu Z, Scordino TA, Deschamps DR, McIntosh JJ, et al. Platelet sequestration and consumption in the placental intervillous space contribute to lower platelet counts during pregnancy. Am J Hematol. 2019;94(1):E8-E11. doi: https://doi.org/10.1002/ajh.25321
    | |
  29. Cines DB, Levine LD. Thrombocytopenia in pregnancy. Blood. 2017;130(21):2271-7. doi: https://doi.org/10.1182/blood-2017-05-781971
    | |
  30. Chermak VІ. Some features of the hemostasis system in pregnant women at risk of developing preeclampsia. Reproductive Health of Woman. 2021;(6):61-5. doi: https://doi.org/10.30841/2708-8731.6.2021.244384
    |
  31. Peng J, Zhao Q, Pang W, Li Y, Dong X. Changes of coagulation function and platelet parameters in preeclampsia and their correlation with pregnancy outcomes. J Clin Hypertens (Greenwich). 2024;26(10):1181-7. doi: https://doi.org/10.1111/jch.14893
    | |
  32. Elawad T, Scott G, Bone JN, Elwell H, Lopez CE, Filippi V, et al. PRECISE Network. Risk factors for pre-eclampsia in clinical practice guidelines: Comparison with the evidence. BJOG. 2024;131(1):46-62. doi: https://doi.org/10.1111/1471-0528.17320
    | |
  33. Kelliher S, Maguire PB, Szklanna PB, Weiss L, Ewins K, O’Doherty R, et al. Pathophysiology of the Venous Thromboembolism Risk in Preeclampsia. Hamostaseologie. 2020;40(5):594-604. doi: https://doi.org/10.1055/a-1162-3905
    | |
  34. Combs DJ, Gray KJ, Schulman S, Bateman BT. Associations of thrombocytopenia, transaminase elevations, and transfusion with laboratory coagulation tests in women with preeclampsia: a cross-sectional study. Int J Obstet Anesth. 2021;46:102972. doi: https://doi.org/10.1016/j.ijoa.2021.102972
    | |
  35. Xu C, Li Y, Zhang W, Wang Q. Analysis of perinatal coagulation function in preeclampsia. Medicine (Baltimore). 2021;100(26):e26482. doi: https://doi.org/10.1097/MD.0000000000026482
    | |
  36. Alemayehu E, Gedefie A, Getu F, Mulatie Z, Walle M, Mohammed O, et al. Fibrinogen and D-dimer protein levels in patients with preeclampsia: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2025;25(1):822. doi: https://doi.org/10.1186/s12884-025-07964-8
    | |
  37. Chen Z, Fang F, Yu X. Urinary protein and coagulation-fibrinolysis indicators in preeclampsia: Expression and significance. J Clin Hypertens (Greenwich). 2024;26(4):374-81. doi: https://doi.org/10.1111/jch.14789
    | |
  38. Zhang J, Liu J, Wang P. The platelet and coagulation function parameters in late pregnancy are associated with preeclampsia and its severity: a single-center retrospective study. PeerJ. 2025;13:e19916. doi: https://doi.org/10.7717/peerj.19916
    | |
  39. Deshpande HG, Jainani UR, Kiran AR, Saha S, Vanrajsinh HV. A Comparative Study of Coagulation Profiles in Preeclamptic and Normotensive Patients in Relation to Maternal and Fetal Outcomes. Cureus. 2024;16(8):e67940. doi: https://doi.org/10.7759/cureus.67940
    |
  40. Alemu N, Teketelew BB, Admas S, Marelgn L, Eyayu Y, Woldu B. Coagulation profiles and platelet parameters among preeclampsia, eclampsia, and normotensive pregnant women attending Comprehensive Specialized Hospital maternity wards, Northwest Ethiopia. PLoS One. 2025;20(7):e0328578. doi: https://doi.org/10.1371/journal.pone.0328578
    | |
  41. Alemayehu E, Mohammed O, Belete MA, Mulatie Z, Debash H, Gedefie A, et al. Association of prothrombin time, thrombin time and activated partial thromboplastin time levels with preeclampsia: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2024;24(1):354. doi: https://doi.org/10.1186/s12884-024-06543-7
    | |
  42. Bhutani N, Jethani V, Jethani S, Ratwani K. Coagulation profile and platelet parameters in pregnancy induced hypertension cases and normotensive pregnancies: A cross-sectional study. Ann Med Surg (Lond). 2022;80:104124. doi: https://doi.org/10.1016/j.amsu.2022.104124
    | |
  43. Kontovazainitis CG, Gialamprinou D, Theodoridis T, Mitsiakos G. Hemostasis in Pre-Eclamptic Women and Their Offspring: Current Knowledge and Hemostasis Assessment with Viscoelastic Tests. Diagnostics (Basel). 2024;14(3):347. doi: https://doi.org/10.3390/diagnostics14030347
    | |
  44. Chaitra H, Ramesh ST, Ahmad R. A comparative study of coagulation profile and haematological parameters in pregnancy induced hypertension (PIH). Trop J Pathol Microbiol. 2021;7(3):150-5. doi: https://doi.org/10.17511/jopm.2021.i03.09
  45. Priya MJ, Ethiraj G, Rangappa SS. A cross sectional study of coagulation profile in term normotensive pregnancy and hypertensive disorders like preeclampsia, eclampsia. Int J Reprod Contracept Obstet Gynecol. 2021;10(11):4258-62. doi: https://doi.org/10.18203/2320-1770.ijrcog20214342
  46. Mintaah S, Anto EO, Boadu W, Sackey B, Boateng LA, Ansah E, et al. Coagulation Factors and Natural Anticoagulants as Surrogate Markers of Preeclampsia and Its Subtypes: A Case-Control Study in a Ghanaian Population. Clin Appl Thromb Hemost. 2023;29:10760296231204604. doi: https://doi.org/10.1177/10760296231204604
    | |
  47. Lefkou E, Van Dreden P, Rousseau A, Gerotziafas GT. Differences in coagulation profile in women with mild and severe preeclampsia. Blood. 2020;136(Suppl 1):15-6. https://doi.org/10.1182/blood-2020-137401
  48. Jin PP, Ding N, Dai J, Liu XY, Mao PM. Investigation of the relationship between changes in maternal coagulation profile in the first trimester and the risk of developing preeclampsia. Heliyon. 2023;9(7):e17983. doi: https://doi.org/10.1016/j.heliyon.2023.e17983
    | |
  49. Li S, Jin Y, Gong Y, Luo X. Preeclampsia complicated with hypofibrinogenemia: 2 case reports and review of the literature. BMC Pregnancy Childbirth. 2023;23(1):631. doi: https://doi.org/10.1186/s12884-023-05965-z
    | |
  50. Shao H, Gao S, Dai D, Zhao X, Hua Y, Yu H. The association of antenatal D-dimer and fibrinogen with postpartum hemorrhage and intrauterine growth restriction in preeclampsia. BMC Pregnancy Childbirth. 2021;21(1):605. doi: https://doi.org/10.1186/s12884-021-04082-z
    | |
  51. Okoye HC, Eweputanna LI, Okpani AO, Ejele OA. Associations between pre-eclampsia and protein C and protein S levels among pregnant Nigerian women. Int J Gynaecol Obstet. 2017;137(1):26-30. doi: https://doi.org/10.1002/ijgo.12085
    | |
  52. Saleh DK, Al Mudallal SS. Evaluation of Protein C and Protein S in Pregnant Females with Preeclampsia. Iraqi Postgraduate Medical Journal. 2021;20(1):46-52.
  53. Jung YW, Park DB, An SJ, Lee JH, Kim HJ, Choi YS, et al. Changes in Protein C and Protein S Activities and the Association with Adverse Pregnancy Outcomes in Pregnant Korean Women. Laboratory Medicine Online. 2024;14(2):82-9. doi: https://doi.org/10.47429/lmo.2024.14.2.82
  54. Neave L, Thomas M, de Groot R, Doyle AJ, Singh D, Adams G, et al. Alterations in the von Willebrand factor/ADAMTS-13 axis in preeclampsia. J Thromb Haemost. 2024;22(2):455-65. doi: https://doi.org/10.1016/j.jtha.2023.10.022
    | |
  55. Gardikioti A, Venou TM, Gavriilaki E, Vetsiou E, Mavrikou I, Dinas K, et al. Molecular Advances in Preeclampsia and HELLP Syndrome. Int J Mol Sci. 2022;23(7):3851. doi: https://doi.org/10.3390/ijms23073851
    | |
  56. Ahmad A, Mustafa G, Mazari N, Naveed MA. Comparison of thrombomodulin, vWF, and ADAMTS13 levels between preeclampsia and normal pregnancy. J Pak Med Assoc. 2024;74(1):124-9. doi: https://doi.org/10.47391/JPMA.7537
    | |
  57. Siennicka A, Kłysz M, Chełstowski K, Tabaczniuk A, Marcinowska Z, Tarnowska P, et al. Reference Values of D-Dimers and Fibrinogen in the Course of Physiological Pregnancy: the Potential Impact of Selected Risk Factors-A Pilot Study. Biomed Res Int. 2020;2020:3192350. doi: https://doi.org/10.1155/2020/3192350
    | |
  58. Tomkiewicz J, Darmochwał-Kolarz DA. Biomarkers for Early Prediction and Management of Preeclampsia: A Comprehensive Review. Med Sci Monit. 2024;30:e944104. doi: https://doi.org/10.12659/MSM.944104
    | |
  59. Tabacco S, Ambrosii S, Polsinelli V, Fantasia I, D’Alfonso A, Ludovisi M, et al. Pre-Eclampsia: From Etiology and Molecular Mechanisms to Clinical Tools-A Review of the Literature. Curr Issues Mol Biol. 2023;45(8):6202-15. doi: https://doi.org/10.3390/cimb45080391
    | |
  60. Varrias D, Spanos M, Kokkinidis DG, Zoumpourlis P, Kalaitzopoulos DR. Venous Thromboembolism in Pregnancy: Challenges and Solutions. Vasc Health Risk Manag. 2023;19:469-84. doi: https://doi.org/10.2147/VHRM.S404537
    | |

Downloads

Additional Files

Published

2026-06-11

How to Cite

1.
Yeromenko RF, Lytvynova OM, Lytvynenko HL, Zaiets NV. Preeclampsia as a hemostatic disorder in pregnant women: epidemiological aspects, pathogenetic mechanisms of coagulation changes. Zaporozhye Medical Journal [Internet]. 2026Jun.11 [cited 2026Jun.11];28(3):274-81. Available from: https://zmj.zsmu.edu.ua/article/view/346835

Issue

Vol. 28 No. 3 (2026): Zaporozhye Medical Journal

Section

Review

License

Copyright (c) 2026 R. F. Yeromenko, O. M. Lytvynova, H. L. Lytvynenko, N. V. Zaiets

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.  Лицензия Creative Commons