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A Comparative Study of Coagulation Profiles in Preeclamptic and Normotensive Patients in Relation to Maternal and
Hemant G Deshpande1, Urvashi R Jainani1, Ananya R Kiran1
1Obstetrics and Gynecology, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth (Deemed to be University) Pimpri, Pune, IND.
Insights
Preeclampsia significantly alters coagulation, leading to adverse maternal and infant outcomes. Monitoring these hematological changes is vital for timely intervention and improved health for both mother and baby.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Perinatology
Background:
- Hypertensive disorders in pregnancy, like preeclampsia, are major contributors to maternal and perinatal mortality globally.
- Preeclampsia is characterized by hypertension and proteinuria, often accompanied by significant alterations in the coagulation cascade.
- These hematological changes can impact pregnancy outcomes.
Purpose of the Study:
- To comparatively analyze coagulation profiles in women with preeclampsia versus normotensive pregnant women.
- To evaluate and compare maternal and neonatal outcomes between these two groups.
- To understand the link between coagulation abnormalities and pregnancy complications in preeclampsia.
Main Methods:
- A prospective case-control study involving 74 participants (37 preeclampsia, 37 normotensive) from September 2022 to May 2024.
- Assessment of coagulation parameters: platelet count, bleeding time, clotting time, INR, APTT, PT, fibrinogen, ALP, D-dimer, and FDP.
- Comparison of maternal outcomes (delivery mode, eclampsia, HELLP, PPH) and neonatal outcomes (birth weight, APGAR, NICU stay).
Main Results:
- Preeclampsia group showed significantly lower platelet counts and prolonged bleeding times, INR, APTT, and PT.
- Elevated fibrinogen, ALP, D-dimer, and FDP levels were observed in the preeclampsia group.
- Higher rates of cesarean sections, lower birth weights, increased NICU admissions, low birth weight, intrauterine growth restriction, respiratory distress, and asphyxia were noted in preeclampsia cases.
Conclusions:
- Preeclampsia is strongly associated with significant hematological and coagulation disturbances.
- These changes correlate with adverse fetomaternal outcomes, including increased risks for mothers and newborns.
- Early detection and monitoring of coagulation parameters in preeclampsia are critical for effective management and improved health outcomes.
Abstract:
Background Hypertensive complications during pregnancy play a significant role in the increased rates of maternal and perinatal morbidity and mortality on a global scale. Preeclampsia is characterized by elevated blood pressure levels and the presence of protein in the urine and is associated with diverse hematological alterations, particularly impacting the coagulation cascade. The primary objective of this research was to conduct a comparative analysis of the coagulation profiles and pregnancy outcomes in women with preeclampsia versus those with normal blood pressure during pregnancy. Methods This was a prospective case-control study with 74 participants across two groups, conducted from September 2022 to May 2024. The participants were enrolled and divided into two groups, with 37 in the clinically diagnosed preeclampsia group and 37 in the normotensive group. Coagulation parameters including platelet count, bleeding time, clotting time, international normalized ratio (INR), activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen levels, alkaline phosphatase (ALP) levels, D-dimer levels, and fibrin degradation products (FDP) levels were assessed. Maternal and neonatal outcomes were also compared. In our study, we comprehensively examined both maternal and neonatal outcomes in preeclampsia and normotensive groups. Maternal complications analyzed included mode of delivery, incidence of eclampsia, placental abruption, hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, postpartum hemorrhage (PPH), and peripartum cardiomyopathy (PPCM). For neonatal outcomes, we assessed birth weight, appearance, pulse, grimace, activity, and respiration (APGAR) scores, and the duration of neonatal intensive care unit (NICU) stays. Results The results showed that mean platelet count was significantly lower in the preeclampsia group (151,503 ± 59,875/µL) compared to the normotensive group (245,405 ± 69,021/µL) (p < 0.0001). Bleeding time, INR, APTT, and PT showed significant elevation in the preeclampsia group, indicating a slower coagulation process. Fibrinogen levels, ALP levels, and D-dimer levels were significantly higher in the preeclampsia group (p < 0.0001). The preeclampsia group had a higher rate of cesarean sections (65% vs. 24%) and lower neonatal birth weights (mean 2.3 kg vs. 2.5 kg). APGAR scores were comparable between groups, but a higher number of neonates went to the NICU in the preeclampsia group (64.9% vs. 10.8%). The preeclampsia group also showed higher rates of low birth weight (27%), intrauterine growth restriction (27%), respiratory distress syndrome (10.8%), and asphyxia (5.4%). Conclusion Preeclampsia is associated with significant hematological changes, particularly in coagulation parameters, and adverse fetomaternal outcomes. Early identification and monitoring of these changes are crucial for timely intervention and improving maternal and neonatal health outcomes.
