Study of hematological and clotting parameters in pregnancy induced hypertension(pih)

Abstract

INTRODUCTION Hypertensive disorders of pregnancy affect approximately 10% of all pregnant women worldwide and 5-8% of pregnant women in India. These disorders are characterized by a reduction in systemic perfusion due to vasospasm and the activation of the coagulation system, with thrombocytopenia being the most common presentation observed. The hypercoagulable state in pregnancy associated with Pregnancy-Induced Hypertension (PIH), platelet indices, and coagulation profiles can serve as reliable early indicators of the onset of preeclampsia and eclampsia. A peripheral smear examination is a simple and cost-effective method that can detect red cell abnormalities and quantify platelet abnormalities commonly observed in patients with PIH. These routine tests can be conducted in all hospital settings, helping to reduce maternal and fetal mortality associated with pregnancy-induced hypertension (PIH) and ensuring an effective healthcare system for the population. OBJECTIVES • To evaluate the utility of platelet-count and peripheral smear examination as prognostic indicators in pregnancy-induced hypertension (PIH) and their role in improving maternal and fetal outcomes. • To study the associated changes in peripheral smear, platelet count, prothrombin time (PT), and activated partial thromboplastin time (aPTT). MATERIALS AND METHODS A prospective observational study was conducted at BLDE (Deemed to be University), Shri B. M. Patil Medical College, Hospital and Research Centre, Vijayapura, from April 2023 to March 2024. The study included 305 primigravid women diagnosed with PIH at gestational age ≥28 weeks. Hematological parameters, including platelet count and peripheral smear, were assessed alongside coagulation parameters such as PT, aPTT, and international normalized ratio (INR). Data were analyzed using Stata version 18.0, and statistical significance was determined using appropriate tests. RESULTS The mean age of participants was 24.2 years (SD 3.9). The majority presented with pre-eclampsia with severe features (29.51%), gestational hypertension (22.95%), and pre-eclampsia without severe features (22.95%). The median platelet count was 1,66,000/µL (IQR: 1,00,000 to 1,96,000), with thrombocytopenia observed in 31.15% of cases. PT was prolonged in 39.67% of patients, and aPTT was prolonged in 42.3%. Microscopic hypochromic anemia was the most common peripheral smear finding (44.92%). Platelet counts and coagulation parameters varied significantly across PIH subtypes (p<0.001) CONCLUSION Thrombocytopenia and prolonged coagulation parameters were significant indicators of disease severity in PIH. Peripheral smear examination proved to be a reliable tool in resource-limited settings. Regular monitoring of these hematological indices can aid in early diagnosis, guiding timely interventions to improve maternal and fetal outcomes.