Original article / research
Comparison Study of Coagulation Profile in Normal Term Pregnancy and Pregnancy Induced Hypertension
Dr. Harendra Kumar
Associate Profeessor, Department of Pathology, Sarojini Naidu Medical Colleege, Agra-282002, Uttar Pradesh, India.
Introduction: Pregnancy Induced Hypertension (PIH) is one of the commonest medical disorders in pregnancy, which is divided into three categories: gestational hypertension, pre-eclampsia and eclampsia. Hypercoagulable state in pregnancy and presence of any provocative factor can easily upset the normal balance culminating into Disseminated Intravascular Coagulation (DIC). In PIH, due to endothelial injury, the delicate haemostatic mechanism is triggered, which leads to coagulation failure.
Aim: To compare the coagulation profile in normal term pregnancy and PIH during third trimester and to diagnose the severity of hypertensive disorders in pregnancy with coagulation parameters, clinical profile and to compare it with healthy controls.
Materials and Methods: The present prospective study included 25 normotensive pregnant women and 80 pregnant women with signs and symptoms of pre-eclampsia and eclampsia in third trimester of gestation, over a period of one year. Study included clinical profile, age wise and parity distribution and coagulation parameters like platelet count, Prothrombin Time (PT), activated Partial Thromboplastin Time (aPTT) and D-dimer in PIH and compared with healthy controls.
Results: Most of the cases (56.25%) were in the age group 20-24 years and most were primipara. Mean systolic blood pressure in mild pre-eclampsia, severe pre-eclampsia and eclamptic patients was 146 mmHg, 164 mmHg and 168 mmHg, while the mean diastolic blood pressure was 94 mmHg, 110 mmHg, 106 mmHg, respectively. The significant proteinuria in mild pre-eclampsia, severe pre-eclampsia and eclampsia was 12 (34.29%), 17 (60.71%), and 09 (52.94%) respectively. Oedema was less severe in mild pre-eclampsia, whereas headache, blurring of vision and right upper abdominal pain were seen in severe cases of PIH. The mean haemoglobin in mild pre-eclampsia, severe pre-eclampsia and eclampsia was 10.8 gm/dL, 11.1 gm/dL, 11.5 gm/dL, respectively, whereas, platelet count was significantly lower than that of healthy pregnant control. There was prolongation of prothrombin time and significant difference between PT, aPTT D-dimer in mild pre-eclampsia, severe pre-eclampsia and eclampsia and that of healthy controls.
Conclusion: The degree of thrombocytopenia increases with severity of disease. Early assessment of severity of PIH can be done to prevent complications and to monitor the disease progression.
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