DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20213667

Determination of coagulopathy complicating severe preeclampsia and eclampsia with platelet count

Venkata Jayashree, Lakshmi Renuka

Abstract


Background: Preeclampsia is a dangerous complication which occurs potentially in pregnancy and is characterised by high blood pressure. It effects maternal and perinatal health and is complicated by abnormalities of coagulation. The aim of the study was to determine platelet count which predicted coagulopathy in patients with severe preeclampsia and eclampsia.

Methods: Prospective cohort study done in all patients were admitted with diagnosis of severe preeclampsia and eclampsia and admitted for stabilisation.  Blood samples were collected from all patients for detecting bleeding, clotting time, electrolytes, urea and creatinine, liver functions tests, full blood count, platelet count, prothrombin time, activated partial thromboplastin time and plasma fibrinogen level in 100 patients in total. Using chi square test, univariate analysis was conducted.

Results: Out of 100 women patients, 70 (70%) patients had severe preeclampsia and 30 (30%) patients had eclampsia out of which 15 patients had thrombocytopenia. The incidence of thrombocytopenia among patients was 16.6%. Biochemical coagulopathy was noted in 7%. Patients with severe preeclampsia had platelet count of 185000±61289 per µl, PT was 13.52±1.48 sec, APTT was 34.52±2.49 sec and fibrinogen was 3.16±0.22 g/dl. Patients with eclampsia (with thrombocytopenia) had platelet count of 79528±14897 per µl, PT was 19.25±5.28 sec, APTT was 37.08±5.33 sec and fibrinogen was 2.67±0.53 g/dl. Thrombocytopenia was complicated with eclampsia and it was associated with biochemical coagulopathy which made the condition more severe.

Conclusions: 80000 cells/µl is the thrombocytopenia level which is considered to be critical in severe preeclampsia and eclampsia. This will help to reduce maternal and perinatal mortality and morbidity rates.


Keywords


Thrombocytopenia, Prothrombin time, APTT, Fibrinogen

Full Text:

PDF

References


Jahromi BN, Rafiee SH, Coagulation factors in severe pre-eclampsia. IRCMJ. 2009;11:321-4.

Kay AP, Berg CJ, Atrash HK. Pregnancy-related mortality from preeclampsia and eclampsia. Obstet Gynecol. 2001;97(4):533-8.

Cunningham GF, Leveno JK, Bloom LS, Hauth CJ, Gilstrap L, Westrom DK. Hypertensive disorders in pregnancy. Willaims Obstetrics. 22nd ed. New York, NY: McGraw Hill; 2005: 761-808.

Perry KG, Martin JN. Abnormal hemostasis and coagulopathy in preeclampsia and eclampsia. Clin Obstet Gynecol. 1992;35(2):338-50.

Mammen EF. Disseminated intravascular coagulation (DIC). Clin Lab Sci. 2000;13(4):239-45.

Ugwu EO, Dim CC, Okonkwo CD, Nwankwo TO. Maternal and perinatal outcome of severe pre-eclampsia in Enugu, Nigeria after introduction of Magnesium sulfate. Niger J Clin Pract. 2011;14(4):418-21.

Ebeigbe PN, Aziken ME. Early onset pregnancy-induced hypertension/eclampsia in Benin City, Nigeria. Niger J Clin Pract. 2010;13(4):388-93.

Onuh SO, Aisien AO. Maternal and fetal outcome in eclamptic patients in Benin City, Nigeria. J Obstet Gynaecol. 2004;24(7):765-8.

Barker P, Callander CC. Coagulation screening before epidural analgesia in pre-eclampsia. Anaesthesia. 1991;46(1):64-7.

Awolola OO, Enaruna NO. Determination of coagulopathy complicating severe preeclampsia and eclampsia with platelet count in a University Hospital, South-South, Nigeria. Trop J Obstet Gynaecol 2016;33:179-84.

Sharma SK, Philip J, Whitten CW, Padakandla UB, Landers DF. Assessment of changes in coagulation in parturients with preeclampsia using thromboelastography. Anesthesiology. 1999;90(2):385-90.

Pritchard JA, Cunningham FG, Mason RA. Coagulation changes in eclampsia: their frequency and pathogenesis. Am J Obstet Gynecol. 1976;124(8):855-64.

Enaruna NO, Osemwenkha AP. Clinical Correlates of Laboratory Abnormalities in Patients with Severe Pre‑eclampsia at the University of Benin Teaching Hospital. J Med Biomed Res. 2013;12:81‑90.

Rahim R, Nahar K, Khan IA. Platelet count in 100 cases of pregnancy induced hypertension. Mymensingh Med J. 2010;19(1):5-9.

Jambhulkar S, Shrikhande A, Shrivastava R, Deshmukh K. Coagulation Profile in Pregnancy Induced Hypertension. Indian J Hematol Blood Transfus. 2001;19:3-5.

Barron WM, Heckerling P, Hibbard JU, Fisher S. Reducing unnecessary coagulation testing in hypertensive disorders of pregnancy. Obstet Gynecol. 1999;94(3):364-70.

Leduc L, Wheeler JM, Kirshon B, Mitchell P, Cotton DB. Coagulation profile in severe preeclampsia. Obstet Gynecol. 1992;79(1):14-8.

Fitz GMP, Floro C, Siegel J, Hernandez E. Laboratory findings in hypertensive disorders of pregnancy. J Natl Med Assoc. 1996;88(12):794-8.

Prieto JA, Mastrobattista JM, Blanco JD. Coagulation studies in patients with marked thrombocytopenia due to severe preeclampsia. Am J Perinatol. 1995;12(3):220-2.