A retrospective study to see the correlation between platelet count and coagulation profile in pregnancy induced hypertension

DOI - 10.21276/obgyn.2023.9.2.17 ISSN Print – 2454-2334; ISSN Online – 2454-2342 RESEARCH ARTICLE A retrospective study to see the correlation between platelet count and coagulation profile in pregnancy induced hypertension Swathi A, Sheela HS, Ashwini Neelakanthi, Mounica KSN, Ravi Shree Shivani Corresponding author: Dr. Swathi A, Assistant Professor, Department of Obstetrics and Gynaecology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India; Email: Distributed under Attribution-Non Commercial – Share Alike 4.0 International (CC BY-NC-SA 4.0) ABSTRACT Background: Many of the haemostatic abnormalities occur in hypertensive disorders of pregnancy of which thrombocytopenia being the most common complication which accounts for 20% of patients who have pre-eclampsia. Coagulation failure being one of the most dreaded complications of severe preeclampsia and eclampsia. The Platelet count is one of the simple and costeffective means of assessing haemostatic status compared to a complete coagulation profile. Objective: This study was done to see the correlation between platelet count and coagulation profile in pregnancy induced hypertension. Materials and methods: This was a retrospective study done over a period of 1 year. All the women who were admitted to labour room with diagnosis of hypertensive disorder of pregnancy, details like complete blood count with platelet count and the coagulation profile were all collected from the case records. The data collected is analysed using statistical package for social sciences version 12-0. Results: A total of 150 women were included in the study. Platelets were above 1.5 lakhs (normal) in 84.7% women and in only 15.3% women had platelets less than 1.5lakhs. The prothrombin time was found to be normal in most of the patients (93.3%) and was deranged in about 6.7% women. There was a significant association between thrombocytopenia and prothrombin time. Conclusion: Assessment of only platetet count is sufficient and other coagulation parameters like PT, aPTT and fibrinogen level are recommended in women who have thrombocytopenia which can be cost effective. Keywords: Hypertensive disorders of pregnancy, platelet count, coagulation profile. Hypertensive disorders of pregnancy is associated with various kinds of haemostatic abnormalities of which thrombocytopenia being the most common complication which accounts for 20% of patients who have preeclampsia1. Thrombocytopenia in hypertensive disorders of pregnancy occur due to the thrombotic microangiopathy which is characterized by endothelial injury, followed by platelet aggregation and thrombus formation in the small vessels. Coagulation failure being one of the most dreaded complications of severe preeclampsia and eclampsia. This may be due to primary disease itself or sometime may also arise from its complications such as intrauterine fetal death, abruptio placentae or primary postpartum haemorrhage. Coagulopathy may affect up to 15% of severe preeclampsia cases, and is believed to account for approximately 15% of maternal deaths from the condition 2. In most of the developed countries it is advocated to do more sophisticated tests such as determinations of antithrombin III, thrombin-antithrombin III complex, Ddimer, factor VIII antigen/activity ratio and betathromboglobulin to detect compensated coagulopathy in hypertensive disorders of pregnancy. Despite this, the routine laboratory indicators of disseminated intravascular Received: 15th July 2021, Peer review completed: 4th October 2021, Accepted: 10th October 2021. Swathi A, Sheela HS, Neelakanthi A, Mounica KSN, Shivani RS. A retrospective study to see the correlation between platelet count and coagulation profile in pregnancy induced hypertension. The New Indian Journal of OBGYN. 2023; 9(2): 279 - 82. The New Indian Journal of OBGYN. 2023 (January-June);9(2) coagulation have remained thrombocytopenia, prolonged includes prothrombin time, activated partial thromboplastin prothrombin time, prolonged activated partial thromboplastin time, international normalized ratio were all collected from time and reduction in the concentration of fibrinogen levels 2. the case records. In many institutions, it is common practice to monitor The data collected analysed using statistical package for platelet count, PT, PTT, fibrinogen levels, and fibrin social sciences version 12-0. Descriptive and inferential degradation products closely when a patient is admitted to statistical analysis has been carried out in the present study. labor and delivery with the diagnosis of a hypertensive Results on continuous measurements are presented on mean disorder of pregnancy. The patient thus is evaluated  SD (Min-Max) and results on categorical measurements continuously for development of coagulopathy. In this study are presented in number (%). Significance is assessed at 5 % we would like to know if intial assessment of all patients level of significance. Chi-square/ Fisher Exact test has been with hypertensive disorders of pregnancy can be done with used to find the significance of study parameters on platelets count alone and only those women with categorical scale between two or more groups, nonthrombocytopenia will be subjected to further testing for parametric setting for qualitative data analysis. Fisher exact coagulation abnormalities. This method can be cost-effective test used when cell samples are very small. in low resource setting. Results Materials and methods A total of 150 women were included in the study. Out of This was a retrospective study done in the department of 150, 55 were diagnosed with gestational hypertension, 45 obstetrics and gynaecology over a period of 1 year from women were nonsevere preeclamptic, 31 were severe October 2019 to September 2020 after obtaining institutional preeclamptic and 19 women were eclamptic. Majority of ethical committee clearance. All the women who were women were primigravida (60%), in the age group between admitted to labour room at Vydehi institute of medical 21-30 years (77.3%) all the demographic details are depicted sciences and research centre with blood pressure of systolic in table 1. Table 1: Demographic details more than 140mm of Hg and diastolic more than 90 mm of Variables No. of patients % Hg with or without proteinuria after 20 weeks of gestation Age in years during the study period were all included in the study. 16 10.6  18-20 116 77.3  21-30 Women with preexsisting hypertension, history of hepatic, 18 12.0  31-40 renal disorders, overt diabetes mellitus, auto immune Mean ± SD 25.88±4.55 disorders, idiopathic thrombocytopenic purpura and other Obstetric score 60.0  Primigravida 90 bleeding disorders, recurrent miscarriage, haemoglobin40.0  Multigravida 60 pathies and women on drugs like aspirin and anticoagulants Period of gestation were excluded from the study. Thrombocytopenia was 2 1.3  ≤28.0 11 7.3  28.1-32.0 defined as platelet co (...truncated)