{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T17:45:55Z","timestamp":1790703955711,"version":"4.1.0"},"reference-count":90,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Semin Thromb Hemost"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The hemostasis system is composed of procoagulant, anticoagulant, and fibrinolytic proteins that interact with endothelial and blood cells and with each other in a complex system of checks and balances to maintain blood flow while preventing both hemorrhage and thrombosis. Pregnancy is a unique physiological state in which biological alterations predispose both mother and fetus to both bleeding and clotting. The placenta is a vascular interface for maternal and fetal blood exchange which predisposes the mother to hemorrhage. Maternal hemostasis presents a compensatory hypercoagulability including elevated factor VIII, von Willebrand factor, fibrinogen and thrombin generation, decreased thrombin regulation with resistance to activated protein C and decreased free protein S, and decreased fibrinolysis with increased plasminogen activator inhibitors. The placental vascular surface is of fetal trophoblastic origin that derives many characteristics of endothelium but differs in that tissue factor is constitutively expressed. Ontogeny of fetal hemostasis is characteristic. Platelets, von Willebrand factor, factor VIII, and fibrinogen are expressed and mature early in gestation, while vitamin K\u2013dependent and contact factors exhibit delayed development. The fetal hemostatic system has a decreased capacity to generate or regulate thrombin, resulting in a fragile balance with little capacity to compensate under stress conditions, particularly in the infant born prematurely. Dysfunction of the maternal\/placental\/fetal unit gives rise to gestational disorders including preeclampsia, fetal growth restriction, placental abruption, and premature delivery. Knowledge of normal hemostasis levels and function are critical to evaluate bleeding or clotting syndromes in the pregnant woman and her fetus or newborn infant.<\/jats:p>","DOI":"10.1055\/s-0042-1760332","type":"journal-article","created":{"date-parts":[[2023,2,7]],"date-time":"2023-02-07T19:12:50Z","timestamp":1675797170000},"page":"319-329","source":"Crossref","is-referenced-by-count":30,"title":["Hemostasis in the Pregnant Woman, the Placenta, the Fetus, and the Newborn Infant"],"prefix":"10.1055","volume":"49","author":[{"given":"Beth Boulden","family":"Warren","sequence":"additional","affiliation":[{"name":"University of Colorado Hemophilia and Thrombosis Center, Aurora, Colorado"},{"name":"Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Genevieve C.","family":"Moyer","sequence":"additional","affiliation":[{"name":"University of Colorado Hemophilia and Thrombosis Center, Aurora, Colorado"},{"name":"Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilyn J.","family":"Manco-Johnson","sequence":"additional","affiliation":[{"name":"University of Colorado Hemophilia and Thrombosis Center, Aurora, Colorado"},{"name":"Department of Pediatrics, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2023,2,7]]},"reference":[{"issue":"07","key":"ref1","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1055\/s-0036-1592303","article-title":"Classic and global hemostasis testing during pregnancy and during pregnancy complications","volume":"42","author":"F I Ataullakhanov","year":"2016","journal-title":"Semin Thromb Hemost"},{"issue":"08","key":"ref5","doi-asserted-by":"crossref","first-page":"3173","DOI":"10.1182\/blood-2005-10-4111","article-title":"Fetomaternal cross talk in the placental vascular bed: control of coagulation by trophoblast cells","volume":"107","author":"R Sood","year":"2006","journal-title":"Blood"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1054\/blre.1999.0114","article-title":"Interaction of the protein C\/protein S anticoagulant system, the endothelium and pregnancy","volume":"13","author":"P Clark","year":"1999","journal-title":"Blood Rev"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1056\/NEJMoa1802897","article-title":"Platelet counts during pregnancy","volume":"379","author":"J A Reese","year":"2018","journal-title":"N Engl J Med"},{"issue":"06","key":"ref8","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1111\/aji.12433","article-title":"Platelet adhesion and thrombus formation in whole blood at arterial shear rate at the end of pregnancy","volume":"74","author":"M-C Val\u00e9ra","year":"2015","journal-title":"Am J Reprod Immunol"},{"issue":"01","key":"ref9","first-page":"132","article-title":"Enhanced thrombin generation and fibrinolytic activity in normal pregnancy and the puerperium","volume":"80","author":"K Bremme","year":"1992","journal-title":"Obstet Gynecol"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1055\/s-0038-1661167","article-title":"Haemostasis in normal pregnancy","volume":"52","author":"Y Stirling","year":"1984","journal-title":"Thromb Haemost"},{"issue":"04","key":"ref11","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1160\/TH09-10-0704","article-title":"Haemostatic reference intervals in pregnancy","volume":"103","author":"P B Szecsi","year":"2010","journal-title":"Thromb Haemost"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1159\/000299596","article-title":"Studies on blood coagulation and fibrinolysis in pregnancy, during delivery and in the puerperium. 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