The comparative study of fibrin degradation products in normal pregnancy and pregnancy induced hypertension

摘要

Background: Pregnancy induced hypertension is a multisystem disorder and is characterized by changes in haemostatic system. The assessment of the coagulation parameters of the patients of pre-eclampsia and eclampsia is important because it helps to diagnose the severity of the disease, and to predict the outcome. There is no universal agreement as to the need for further investigations if the platelet count comes normal. Hence in such cases it is always prudent to get the coagulation profile. D dimer of such patients is done to diagnose the cases of coagulation failure early and to manage it efficiently. The objectives of the study to compare the Fibrin Degradation Products in term normal pregnancy, pre eclamptic and eclamptic patients, to assess the severity of pregnancy induced hypertension and to detect coagulation failure early and manage before it worsens. Methods: This study was conducted in the Department of Obstetrics and Gynaecology at Karnataka Institute of Medical Sciences, Hubli during the period of March 2014 to February 2015 on 100 patients between 37-42 weeks of gestation. 50 controls were well matched with the study population which included a total of 50 patients with pre-eclampsia and eclampsia. Pregnant women with known bleeding disorders, on anticoagulant therapy, with abruptio placentae, with IUD, in labour and with established DIC were excluded. The blood coagulation parameters which were compared between the control and the study population were Bleeding time (BT), Platelet Count, Clotting time (CT), Prothrombin time (PT), Activated partial thromboplastin time (aPTT) and D-dimer. Results: The BT, CT, PT, aPTT values were nearly identical in all the groups. The platelet count showed a decreasing trend from normal control to eclampsia group. The D dimer showed an increasing trend from the normal control to eclampsia group. D dimer level was raised in all patients who were in sub clinical and clinical coagulation failure. Conclusions: This study shows that even with the normal routine coagulation parameters, D dimer was significantly elevated in both subclinical and clinical DIC. So, D dimer can be used as a specific tool in early diagnosis and deciding appropriate management of PIH.