Screening tests for coagulation and fibinolysis in preeclampsia and placental abruption

number: 
1063
إنجليزية
department: 
Degree: 
Imprint: 
Medicine
Author: 
Bassam M. Hameed
Supervisor: 
Dr.Talal H. Al-Samarai
Dr. Maha Al-Bayati
year: 
2005
Abstract:

Background: Several physiological changes in coagulation and fibrinolysis occur in orrnal pregnancies. On other hand early diagnosis of abruptio-placentae is difficult, because typical symptoms such as, vaginal bleeding, increased uterine tone and tenderness, are often, late manifestation, and early symptoms might be confused with preterm labour. Ultrasonography and standard laboratory measures of coagulation parameters rarely clarify the diagnosis of abruptio-placentae until the process is well advanced. Preeclampsia is the single most common cause of maternal morbidity and mortality and a significant contributor to preterm labour. Coagulation abnormalities in Preeclampsia have been thought to result from endothelial cell injury from vasospasm and high blood pressure; this might result in picture of low grade DIC that remain underestimated. Aim of the study. The study was conducted to evaluate different coagulation and fibrinolytic parameters in normal and complicated pregnancies (preeclampsia, and abroptio-placentae), and these parameters were used as: 1. - Diagnostic markers for early detection of coagulopathies in placental abruption. 2-- Prognostic markers in correlation with clinical severity and outcome in preecalmptic women. Material and methods: This study had been done in AL-Kadhymia Teaching Hospital between January 2004 and October 2004. Fifty (50) cases have been studied and selected according to criteria ngreed uporr;and divided into three groups: • Twenty (20) normal pregnant females as control. - Twenty (20) pregnant women with preeclampsia. Ten (10) pregnancy with abruptio-placentae. For all patients, the following tests have been done: 1- Packed cell volume (PCV), and platelets counts. 2. PT, APTT, Fibrinogen assay, and D- dimer. 3- Biochemical tests include blood urea, serum creatinine, for all groups and uric acid, ALT and AST for preeclampsia. Results Normal pregnancy at term had the following hematological parameters; The PCV mean value was 34.9%, with range 31% -39%. The PT mean value in these ladies was 13.55 sec., and they had PT range 11-16 sec. The APTT mean value was 34.35 sec., and their range 30- 40 sec. The mean platelets counts were 260.75x109/1, with their range 178xl09/l-386x 109/1. The mean fibrinogen level was 394.4gm/l with range 305- 538 gm/1. The D-dimer mean value was 1.2 ug/1, with range of 0-4 ug/1. The renal function tests in these cases represented by blood urea with mean 3.6 mmol/1 and serum creatinine mean value 77.3mmol/l. Patients with Placental abruption had the following hematological parameters; The mean value of PCV in placental abruption was 32.5%, and with range 29-36%. The PT mean value was 14 sec., with range 11-16 sec. , and the difference than that of normal pregnancy was statistically not significant (p>0.05). Out of ten (10) patients six of them 60% had prolonged PT > 14 sec. The mean APTT value was 37.5 sec., with range 34-41 sec., and there was no significant difference from normal pregnancy (p>0.05) The platelets counts mean was 146.4x109/1, with range S2x]09/l -234x109/1, which was significantly lower than platelets in normal pregnancy (p<0.05). The fibrinogen level in abruption is significantly lower than thai of normal pregnancy, by mean 221.8 gm/1 and range 156-392 gm/1. The D-dimer is significantly higher than that of normal pregnancy, (p<0.05), with mean was 4.05 ug/1, and range was 0-8 ug/1. The renal function tests in these cases represented by blood urea with mean value 3.6 mmol/1 and serum creatinine mean value 77.3mmol/l. patients with Placental abruption had the following hematological parameters; The mean PCV value was 34.6%, and their range was 33% -42%. The average time for PT was 13.3 sec., with range 11-16 sec., and there was no statistical difference than that of normal pregnancy (p>0.05) The APTT mean time was 33.75 sec., and range 30-41 sec., and there was no statistical difference than that of normal pregnancy (p>0.05). The platelets counts mean number was 190.45x]09/l, range 72x]09/l-324x]0'Vl, which was significantly lower than that of normal pregnancy. The fibrinogen mean value was 391.25 gm/1, and the range 286-512 gm/1 and there was no statistical difference than that of normal pregnancy (p>0.05) .The D-dimer mean value was 3.05 ug/1, range 0-8 ug/1, which was significantly higher than that of normal pregnancy (p< 0.05) Biochemical tests regarding renal function were blood urea mean value 3,55 mmol/1, and serum creatinine mean value 82.05 umol/1, and liver enzymes were ALT mean value 8.25 u/1, AST mean value 12.65 u/1, and serum uric acid mean value 405.7 umol/1. Conclusions On analyzing findings in this study, several conclusions may jump into mind, all concerning conditions complicating pregnancy. 1 - Many cases presenting with placental abruption to hospital already had laboratory evidence suggestive of disseminated intravascular C0agulation(significant elevation of D-dimer, significantly lower platelets count and lower fibrinogen levels when compared with normal pregnancy). 2- D-dimer tests being easy, simple and highly positive in placental abruption may aid in the diagnosis at early stage of coagulation abnormalities that might be obsereved by performing PT, APTT, and Fibrinogen assay. 3- D-dimer is a good prognostic test in preeclampsia. Recommendations 1- Several studies should be done on complicated pregnancies using factor assay since such studies are lacking in our country. 2- Emergency services are still incompetent, and improvement in the management of obstetrical emergencies demands early diagnosis and rapid access to hospital which require in turn efficient emergency system.