Prospective Study Of Obstetric And Perinatal Outcomes In Severe Preeclampsia With Altered Biochemical And Haematological Parameters Amongst Pregnant Women

Abstract

Hypertensive diseases during pregnancy includes gestational hypertension (without proteinuria), preeclampsia (with proteinuria), and eclampsia (preeclampsia with convulsions). Pregnancy termination reverses the clinical manifestations of the disease, suggesting that trophoblastic invasion plays a central role in the pathogenesis of preeclampsia. A recent study revealed that excessive placental secretion of soluble fms-like tyrosine kinase-1 may contribute to endothelial dysfunction, hypertension, and proteinuria in preeclampsia.2 In a multicenter study, approximately 30% of HDP cases were due to chronic hypertension, while 70% were due to gestational hypertension/preeclampsia.3
For the conceptus, the most common consequences associated with hypertensive diseases are the restriction of intra-uterine growth, low birth weight, prematurity, stillbirth and intrauterine death.4,5 Predicting the onset of these complications could aid in timely interventions such as increased surveillance, treatment of symptoms, transfer to higher care facility and delivery when necessary, which could reduce morbidity and mortality from the HDPs.6
The most common immediate maternal complications are eclampsia, oligohydramnios, accidental hemorrhages, disseminated intravascular coagulation, and hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome. Remote complications include residual hypertension, recurrent preeclampsia, and chronic renal failure7. Many hematological changes are seen in association with HDP, thrombocytopenia being the most common8,9. Changes are also seen in peripheral smear, coagulation profile, and liver enzymes. In such cases, definitive therapy can be initiated to prevent maternal and neonatal morbidity and mortality. From the standpoint of prevention, preeclampsia has remained a challenge for obstetricians. Various strategies have been proposed to reduce the perinatal effects of preeclampsia. This can be achieved by early diagnosis of preeclampsia simply via assessment of blood coagulation profile10,11 , complete blood count, urine examination, and liver function tests performed to identify platelet abnormalities, red cell abnormality, and to detect progression to HELLP syndrome.
Thus, the present study is an attempt to analyse maternal and perinatal outcome in severe preeclampsia with altered biochemical and hematological parameters and to find the usefulness of these tests as predictors of maternal outcome. It will aid clinicians in early detection, monitoring, and management of cases with HDPs, especially severe preeclampsia.