Changes in protein C and free protein S during pregnancy and following hysterectomy.

Two longitudinal studies were undertaken to measure the naturally occurring coagulation inhibitors, protein C and protein S, in females who were either pregnant or who were undergoing hysterectomy. Functional and immunological protein C and free protein S were assayed. During pregnancy, protein C levels remained unchanged except for a small increase in protein C antigen at 28-32 weeks gestation. The free protein S fell significantly and progressively during pregnancy, although only in about one-third of patients did the level fall below the normal range. In the hysterectomy study, a significant fall in protein C occurred on days one and three after surgery but had returned to normal by the time of discharge (days 7-10). A small rise in free protein S was observed at time of discharge, but this factor was otherwise unchanged. We conclude that the changes observed may contribute to the hypercoagulable state which is associated with pregnancy or major surgery.