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. 2024 Aug 27;16(8):e67940.
doi: 10.7759/cureus.67940. eCollection 2024 Aug.

A Comparative Study of Coagulation Profiles in Preeclamptic and Normotensive Patients in Relation to Maternal and Fetal Outcomes

Hemant G Deshpande  1 , Urvashi R Jainani  1 , Ananya R Kiran  1 , Shrestha Saha  1 , Hada V Vanrajsinh  1
Affiliations

A Comparative Study of Coagulation Profiles in Preeclamptic and Normotensive Patients in Relation to Maternal and Fetal Outcomes

Hemant G Deshpande et al. Cureus. .

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.

Keywords: coagulation; fetal outcome; maternal outcome; normotensive; pre-eclampsia.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Sub-Committee, Dr. D Y Patil Medical College, Hospital and Research Centre, Dr. D Y Patil Vidyapeeth (Deemed to be University) Pimpri issued approval IESC/PGS/2022/131. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Bar graph representation comparison of mean platelet count
*** indicates p-value<0.0001 calculated using t-test
Figure 2
Figure 2. Comparison of bleeding time
*** indicates p-value<0.0001 calculated using t-test
Figure 3
Figure 3. Comparison of clotting time
ns indicates p-value>0.05, indicating non-significant. Calculated using t-test.
Figure 4
Figure 4. Comparison of international normalized ratio
** indicates p-value<0.001 calculated using t-test
Figure 5
Figure 5. Comparison of activated partial thromboplastin time
* indicates p-value<0.05 calculated using t-test
Figure 6
Figure 6. Comparison of prothrombin time
*** indicates p-value<0.0001 calculated using t-test
Figure 7
Figure 7. Comparison of fibrinogen level
*** indicates p-value<0.0001 calculated using t-test
Figure 8
Figure 8. Comparison of alkaline phosphatase levels
*** indicates p-value<0.0001 calculated using t-test
Figure 9
Figure 9. Comparison of D-dimer level
*** indicates p-value<0.0001 calculated using t-test
Figure 10
Figure 10. Comparison of fibrin degradation products level
*** indicates p-value<0.0001 calculated using t-test
See this image and copyright information in PMC

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