Title: Biochemical findings in patients with severe preeclampsia & eclampsia: A study from North Indian tertiary health care institution

Authors: Rohit Dogra, Anu Bala Chandel

 DOI: https://dx.doi.org/10.18535/jmscr/v8i6.62

Abstract

Introduction: Hypertensive disorders of pregnancy comprising of pre-eclampsia and eclampsia are a major cause of adverse pregnancy outcomes.

Methods: The study was conducted among 65 antenatal women diagnosed with pre-eclampsia and eclampsia at gestational age >20 weeks in the Department of Obstetrics and Gynaecology, Kamla Nehru State Hospital for Mother and child IGMC Shimla. Clinical signs and symptoms and Laboratory test were recorded for study purpose.

Results: The mean age of subjects in the study was 25.03±5.6 yrs, majority of subjects were between 20-29 years. 75% subjects were booked and 25% were unbooked. Majority (58%) of subjects were primigravidae and 40% were multigravidae, a single patient was admitted with postpartum eclampsia. 51(78.4%) subjects had severe preeclampsia and 14(21.5%) subjects had eclampsia. Majority of subjects had significant proteinuria. Hematocrit, LDH, serum uric acid  ApTT and 24 hrs urinary protein were significantly higher with  abnormal RBC morphology

Conclusion: Indicators of endothelial dysfunction i.e. abnormal RBC morphology, elevated LDH, deranged renal function tests were significantly higher in these patients.. We conclude that the brain edema in patients with preeclampsia-eclampsia syndrome is primarily associated with the laboratory based evidence of endothelial damage

Keywords: Antenatal women, Pregnancy induced hypertension, Biochemical tests.

References

  1. Report of the National High Blood Pressure Education Program Working Group on high blood pressure in pregnancy. Am J Obstet Gynecol 2000;183:S1–22
  2. World Health Organization. WHO Recommendations for Prevention and Treatment of Pre-Eclampsia and Eclampsia. Geneva, Switzerland: World Health Organization; 2011
  3. Gabbe SG, Niebyl JR, Simpson JL, Landon MB, Galan HL, Jauniaux ERM et al. Obstetrics: Normal and problem pregnancies: Hypertension. 6th edition Philadelphia. Saundars An imprint of Elsevier Publications; 2013, 779-824
  4. Cunnighum FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL. Williams obstetrics: Hypertensive disorders in pregnancy. 24th Newyork: McGraw-Hill Education; 2014. Chapter no. 10 : 1508-6135
  5. Patil Mithil M. Role of Neuroimaging in Patients with Atypical Eclampsia. J of Obstet & Gynecol of India 2012; 62 (5): 526-30
  6. Razia S, Selina A, Nasima S, Fazlul Karim S M, Farhana A. Association of serum uric acid with preeclampsia: a case control study, Delta Med Col J, 1(2), 2013, 46-50.
  7. Akter S, Sultana S, Dabee S R. Association of hyperuricaemia with perinatal outcome in pregnancy induced hypertension, Journal of Bangladesh College of Physicians and Surgeons, 32(3), 2014, 124-129.
  8. Madazli R, Benian A, Gumustas K, Uzun H. Lipid peroxidation and antioxidants in preeclampsia, Europian Journal of Obstetrics and Gynecology, 85(2), 1999, 205-208.
  9. James J, Walker. Severe pre-eclampsia and eclampsia, Baillie Á re's Clinical Obstetrics and Gynaecology, 14(1), 2000, 57-71
  10. Lowe S A, Bowyer L, Lust K, McMahon L, Morton M R, North R A, Paech M. Said J. The SOMANZ guideline for the management of hypertensive disorders of pregnancy, Society of Obstetric Medicine of Australia and New Zealand (SOMANZ), 2014, 3-22.
  11. Redman C W, Beilin L J, Bonnar J, Wilkinson R H. Plasma urate measurements in predicting fetal death in hypertensive pregnancy, Lancet, 1(7974), 1976, 1370-1373.
  12. Rizwana Habib Kant, Nousheen Mir, Safeena Sarwar3, Shruti Gupta, Rukhsana Najeeb. Role of Maternal Serum Lactate Dehydrogenase as a Biochemical Marker in Pre-Eclampsia, Journal of Dental and Medical Sciences (JDMS), 14(7), 2015, 12-19.
  13. Paneri S, Panchonia A, Varma M, Yadav S. Evaluation of RFTS, LFTS and ascorbic acid in pre-eclampsia among women of Indore, Indian Journal of Fundamental and Applied Life Sciences, 1(4), 2011, 312-315.
  14. Basima S. Alghazali, Alaa M S, Nabras N H. The role of trace elements (zinc, copper, magnesium and calcium) in pregnant women with preeclampsia in third trimester and fetal cord blood after delivery, Medical Journal of Al-Muthanna, 1(1), 2014, 16-26.
  15. Remero R, Vizoso J, Emamian M, Duffy T, Riely C, Halford T et al. Clinical significance of liver dysfunction in pregnancy induced hypertension, Am J Perinatol, 5(2), 1988, 146- 1451.
  16. Leela K V, Lakshmi Kantham A, Kasibabu A. Evaluation of biochemical parameters in HELLP syndrome cases of pregnancy induced hypertension and eclampsia, J of Evidence Based Med and Hthcare, 2(26), 2015, 3914- 3923.
  17. Swain S, Ohha KN, Prakash A. Maternal and perinatal mortality due to eclampsia. Indian Pediatr 1993 Jun; 30(6):771-73.
  18. Schwartz RB, Mulkern RV, Gudbjartsson H and Jolesz F: Diffusion-Weighted MR Imaging in Hypertensive Encephalopathy: Clues to Pathogenesis. AJNR Am J Neuroradiol 1998;19:859–62
  19. Schwartz RB, Feske SK, Polak JF, De Girolami U, Iaia A and Beckner KM: Preeclampsia-eclampsia: clinical and neuroradiographic correlates and insights into the pathogenesis of hypertensive encephalop-athy, Radiology. 2000 No34v;217(2):371-6.

Corresponding Author

Dr Anu Bala Chandel

Department of Obstetrics and Gynaecology, Regional Hospital, Bilaspur, Himachal Pradesh, India