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Assessment of severity of pregnancy induced hypertension by estimation of platelets, liver enzymes and early detection of hellp syndrome

Author: 
Dr. P. Kumudha, Dr. R. Vinodha and Dr. D. Bobby
Subject Area: 
Health Sciences
Abstract: 

Introduction: In any community mother and children constitute a priority group. They comprise approximately 71.14 percent of the Population of the developing countries. Hypertensive disorders complicating pregnancy contribute greatly to maternal morbidity and Mortality. The present study was undertaken to assess the severity of pregnancy induced hypertension in the antenatal mothers at Government Raja Mirasudhar Hospital, Thanjavur. Aim and Objectives: To study early assessment of severity of pregnancy induced hypertension by estimating platelets, liver enzymes, peripheral smear and haematocrit values and early detection of HELLP syndrome. Materials and Methods: The study design was cross sectional study. This study was carried out in the Department of Physiology Thanjavur Medical College, Thanjavur. The study was carried out in 40 normotensive pregnant women, as control and 40 pregnancy induced hypertensive women, as study group. Both groups were correlated with age, parity and period of gestation. The subjects were collected from antenatal clinic, in patients ward and labour room from Department of obstetrics & Gynaecology, Raja mirasdhar Hospital, Thanjavur. The subjects were categorized as normotensive control, mild pregnancy induced hypertension and severe pregnancy induced hypertensive group by the presence of varying degrees of blood pressure and proteinuria. The presence of associated features of HELLP syndrome (Hemolysis, elevated liver enzymes – SGOT, SGPT > 70 U/L, LDH > 600 U/L) was assessed in patients in all the three classes of Thrombocytopenia. Results: Statistical analysis was done by using the Statistical Package for Social Sciences (SPSS) X version. The results were analyzed by the Chi - Square test and ANOVA study. The mean age of control group ,study group was 24.95  3.55 yrs,24.78  3.59 yrs respectively. The mean gestational age in the control group, study group was 34.45  3.37 wks. 35.45  3.71 wks respectively. In normotensive control, the mean systolic & diastolic BP was 116.70  6.19, 75.80  5.04 mmHg respectively. In mild PIH, the mean systolic & diastolic BP was 144.21  6.24, 94.41  4.35 mmHg respectively. In severe PIH, the mean systolic & diastolic BP was 168.55  12.62, 113.64  6.38 mmHg respectively. In severe PIH the mean platelet count was 1.3900  0.5909 lakhs / mm3.The test results has shown significant reduction in platelet count in the mild & severe PIH (P < 0.0005). The mean difference in the SGOT, SGPT, LDH value in the normotensive control, mild & severe PIH were significant (P < 0.0005). The mean SGOT, SGPT, LDH in normotensive were 27.58  9.28, 18.12  7.03, 322.20  84.46 U/L respectively. The mean SGOT, SGPT, LDH in mild PIH were 32.42  17.64, 23.61  14.61, 560.72  224.50 U/L respectively. The mean SGOT, SGPT, LDH in severe PIH were, 90.60  122.62, 76.85  82.64, 801.73  281.38 U/L respectively. These liver enzymes were markedly elevated in severe PIH. In the Haematocrit estimation the mean difference between these groups were significant (P < 0.0005). Hct % were raised in mild PIH, reduced in severe PIH, with normal results in control group. The mean Hct % in normotensive, 35.65, in mild PIH, 36.27  4.5%. In severe PIH, 29.18  4.75%. The peripheral smear study for hemolysis was significantly present in PIH when compared with normotensives (P = 0.011). The platelet estimation between control, mild PIH & severe PIH were statistically significnat (P value = 0.013). All degrees of thrombocytopenia were present in severe PIH & mild thrombocytopenia was present in mild PIH. Out of 10 cases of thrombocytopenia 6 cases were present with features of HELLP syndrome. Conclusion: The progression of PIH from mild to life threatening diseases cannot be predicted. The aim of this study to draw attention to the life threatening complication such as hepatic dysfunction, haematological abnormalities and HELLP syndrome that may occur in cases of preeclampsia. The early diagnosis and early assessment of severity by platelet estimation, peripheral smear study, liver enzyme assays & urine analysis for proteinuria would be the most effective approach to enhance both maternal and fetal well being, as well as the successful outcome of pregnancy.

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