COAGULATION PROFILE AS IMPORTANT MARKERS IN PREECLAMPSIA AND ECLAMPSIA

1. Assistant Professor, Department of Pathology, Darbhanga Medical College, Darbhanga. 2. Senior Resident, Department of surgery, Darbhanga Medical College, Darbhanga. 3. Professor and H.O.D, Department of Pathology, Darbhanga Medical College, Darbhanga. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


Introduction:-
Preeclampsia and eclampsia are disorders of pregnancy characterized by high blood pressure and proteinuria. Preeclampsia is defined as hypertension that occurs in pregnancy for the first time after 20weeks of gestation and disappears following delivery.
There are marked changes in the coagulation and fibrinolytic system occurs during normal pregnancy leading to hypercoagulable state. These changes are more magnified during eclampsia and preeclampsia. Coagulation activation probably represents a secondary event consequent upon endothelial activation and damage. Antithrombin which binds and inactivates thrombin correlates inversely with the level of proteinuria and subsequent renal dysfunction.
Early assessment of severity of pre-eclampsia and eclampsia is necessary to prevent complications like HELLP syndrome and increased maternal and fetal morbidity and mortality. These disorders are an important cause of severe morbidity, long-term disability and death among both mothers and their babies.

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Hence, this study was undertaken with the aim to compare the coagulation parameters of women with pre-eclampsia and eclampsia with normal women so as to identify the correlation of coagulation parameters with severity of preeclampsia and eclampsia.

Material and Methods:-
Material:-140 pregnant women between 17yrs to 30 yrs age were included in the study. The women were selected from among those who presented in Darbhanga Medical College and Hospital for antenatal care and also those who presented in emergency with eclamptic fits.
These women were Divided in three groups:-Normal pregnant control -40 women Preeclampsia -68 women Eclampsia -32 women Total -140 women A detailed obstetric history including past and present history regarding associated medical disorders and bleeding diathesis was taken. In the physical examination blood pressure and presence or absence of edema was particularly taken note of.
In the control group healthy pregnant women of same age and gestation period were taken. Care was taken to rule out women with any underlying disease.
In this study the coagulation parameters studied were: bleeding time, clotting time, prothrombin time, thrombin time, activated partial thromboplastin time, plasma fibrinogen and platelet count. These tests were carried out in the Hematology lab under Department of Pathology, Darbhanga Medical College by using SYSMEX XS 3 part hematology analyzer and SYSMEX CA-500 series Coagulometer.

Statistical Calculation:-
The values of coagulation parameters was statistically analyzed by determining the mean, standard deviation (S.D), Standard Error of Mean (S.E.M), t value, p value . All statistical tests were 2-sided and a < 0.05was recognized as the statistically significant.

Observation and Results:-
The study group included 140 pregnant women between 17yrs to 30 yrs age. Among these 68 women presents with preeclampsia, 32 women with eclampsia and 40 healthy pregnant women in third trimester of pregnancy were taken as control.  Hence it was seen that majority of preeclamptic women were nulliparous (52.9%) indicating higher incidence of pregnancy being complicated with preeclampsia in primigravida. This trend was not seen in eclamptic group where only 25% were primigravida. In the study group all the patients except 4 were in the third trimester of pregnancy. 47% of preeclamptic and 37.5% of eclamptic women were in early third trimester of pregnancy. Four eclampsia cases (12.5%) were in 24 weeks of gestation.

Summary:-
The present work "coagulation profile as important markers in preeclampsia and eclampsia" was done retrospectively on 140 women of which 68 were preeclamptic, 32 were eclamptic and 40 were normal pregnant women in third trimester of pregnancy.