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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (4): 483-489    DOI: 10.31083/j.ceog.2020.04.5308
Original Research Previous articles | Next articles
High fibrin/fibrinogen degradation product and D-dimer levels for the diagnosis of invasive group A streptococcal infections during pregnancy
N. Matsumoto1, *(), Y. Mori2
1Matsumoto Women’s Health Clinic, Saitama, Japan
2Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
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Abstract  

Objective: Invasive group A streptococcal (GAS) infections during pregnancy are uncommon, and, thus, their early diagnosis remains challenging. The present study was performed to assess fibrin/fibrinogen degradation product (FDP) and D-dimer levels in pregnant women with invasive GAS infections and establish whether they contribute to a diagnosis. Materials and Methods: Laboratory data, including FDP and D-dimer levels, measured between fulmination and just before delivery in 46 cases, consisting of 45 previously published cases and the present case, were examined. Results: Fetal/neonatal and maternal mortality rates were 61 and 28%, respectively. Laboratory data obtained from 24 cases just before delivery were as follows: white blood cell count ≥ 12,000/μL, 46% of cases; platelet count ≤ 100,000/μL, 55% of cases, and C-reactive protein (CRP) level ≥ 10 mg/dL, 40% of cases. These variables showed no sensitivity for the diagnosis of invasive GAS infections. However, 100% of cases were positive for FDP (≥ 10 μg/dL) and D-dimer (≥ 2 μg/dL), the levels of which were extremely high in many cases. Conclusion: FDP and D-dimer levels may contribute to the diagnosis of invasive GAS infections during pregnancy.
Key words:  Antepartum      Disseminated intravascular coagulation      Sepsis      Streptococcus pyogenes      Toxic shock syndrome     
Submitted:  27 June 2019      Accepted:  23 September 2019      Published:  15 August 2020     
*Corresponding Author(s):  N. Matsumoto     E-mail:  research@matsumotoc.org
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Cite this article: 

N. Matsumoto, Y. Mori. High fibrin/fibrinogen degradation product and D-dimer levels for the diagnosis of invasive group A streptococcal infections during pregnancy. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(4): 483-489.

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https://ceog.imrpress.com/EN/10.31083/j.ceog.2020.04.5308     OR     https://ceog.imrpress.com/EN/Y2020/V47/I4/483

Figure 1.  — Histograms of continuous clinical background data from 46 cases of invasive group A streptococcal (GAS) infections during pregnancy. The mean maternal age was 34.5 years, the mean week of pregnancy at fulmination was 36 weeks, and mean parity was 1. (Areas with a deep color indicate maternal death).

Table 1  — Summary of categorical data for clinical background, symptoms, outcomes and therapies from the 46 cases.
Factor n %
Maternal age (y)
Teens 1 2.2
Twenties 9 19.6
Thirties 32 69.6
Forties 4 8.7
Parity
Nulliparous 8 19.4
Multiparous 37 80.6
NA 1
Maternal complications
Yes 10 24.4
No 31 75.6
NA 5
Week of pregnancy at fulmination
Abortion period (< 22 weeks) 5 10.9
Second trimester (22-27 weeks) 4 8.7
Third trimester before term (28-36 weeks) 18 39.1
Term (≥ 37 weeks) 19 41.3
Fulmination period
Antenatal (before the onset of labor) 45 97.8
During labor 1 2.2
Mode of delivery
Emergency cesarean 22 47.8
Vaginal delivery 17 37
Abortion 4 8.7
None (maternal death before delivery) 3 6.5
Mortality
Fetal/neonatal death 28 60.9
Maternal death 13 28.3
Fetal/neonatal asphyxia (including death)
Yes 34 91.9
No 3 8.1
NA 9
Symptoms at fulmination period (some are overlapping)
Fever (> 38 ℃) 44 95.7
Respiratory symptoms 20 43.5
Abdominal pain 32 69.6
Gastrointestinal symptoms 17 37
Abnormally strong uterine contractions 20 43.5
Unconsciousness 5 10.9
Administration of antibiotics
Yes 40 88.9
No 5 11.1
NA 1
Administration of immunoglobulin
Yes 20 44.4
No 25 55.6
NA 1
Blood transfusion
Yes 24 58.5
No 17 41.5
NA 5
Table 2  — Summary of laboratory test values in the 24 available cases whose laboratory tests were carried out during fulmination and just before delivery.
Item n % Median Range
White blood cell count (/μL) 12,490 1,970-45,200
≥ 12,000 11 45.8
< 12,000 13 54.2
NA 0
Hemoglobin concentration (g/dL) 11.4 6.7-13.4
≤ 8 1 7.1
> 8 13 92.9
NA 10
Platelet count (/μL) 96,000 5,000-421,000
≤ 100,000 11 55
> 100,000 9 45
NA 4
AST (U/L) 44.5 15-198
≥ 80 3 37.5
< 80 5 62.5
NA 16
Serum creatinine (mg/dL) 0.87 0.57-1.77
≥ 1.2 4 36.4
< 1.2 7 63.6
NA 13
C-reactive protein (mg/dL) 6.2 0.3-28.2
≥ 10 8 40
< 10 12 60
NA 4
Fibrinogen (mg/dL) 130 18-720
≤ 100 4 44.4
> 100 5 55.6
NA 15
FDP (μg/mL) 352 31-1,920
Strong positive (≥ 40) 6 85.7
Positive (≥ 10) 7 100
Negative (< 10) 0 0
NA 17
D-dimer (μg/mL) 75 2.0-444
Strong positive (≥ 10) 3 60
Positive (≥ 2) 5 100
Negative (< 2) 0 0
NA 19
Figure 2.  — Histograms for laboratory data from 24 available cases in which laboratory tests were performed between fulmination and just before delivery. Positive fibrin/fibrinogen degradation product (FDP) (≥ 10 μg/dL) and positive D-dimer (≥ 2 μg/dL) each had 100% sensitivity. Strong positive FDP (≥ 40 μg/dL) and strong positive D-dimer (≥ 10 μg/dL) had sensitivities of 86 and 60%, respectively. (Each red horizontal bar indicates the cut-off value defined as an apparently abnormal level that needs clinical intervention. Each arrow indicates an abnormal direction. Areas with a deep color indicate maternal death).

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