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COMPARATIVE STUDY OF PLATELET COUNT IN NORMAL PREGNANT WOMAN AND IN PREGNANCY-INDUCED HYPERTENSION.

BACKGROUND

Pregnancy-Induced Hypertension (PIH) is one of the most common and potentially life-threatening complication of pregnancy. It affects 5-8% of all pregnancies and is one of the leading causes of high morbidity for both mother and foetus, especially in developing countries. [1] Thrombocytopenia can be due to idiopathic thrombocytopenic purpura (ITP), which is caused mostly because of the formation of autoimmune antibodies, Letsky and Greaves. [2] Pregnancy-induced hypertension (blood pressure greater than 140/90) occurs before or after 20 weeks of gestation with no proteinuria. The clinical manifestations of maternal preeclampsia are hypertension and proteinuria, with or without coexisting systemic abnormalities involving the kidneys, liver or blood. HELLP syndrome is a severe form of preeclampsia and involves haemolytic anaemia, elevated liver function tests (LFTs) and low platelet count. [3] The aim of this study was to investigate the effect of platelet count in pregnancy-induced hypertension.

Aims and Objectives

To investigate the difference in platelet count in normal pregnant woman and pregnancy-induced hypertension patient.

MATERIALS AND METHODS

Study Area

It is a case control study. Study was conducted in the Department of Physiology in collaboration with Obstetrics and Gynaecology in Kamala Raja Hospital (Gwalior) were studied and platelet count was done in all cases in third trimester of pregnancy from April 2005 to Oct. 2006. Two millilitres of blood sample were drawn aseptically using the S-Monovette vacutainer blood collection system (Sarstedt, Numbrecht, Germany) from the median antecubital vein of all the subjects and control participants into EDTA-anticoagulated tubes. The blood was diluted with the diluent (1%) ammonium oxalate by 1 in 20 dilutions (0.02 mL of blood and 0.38 mL of diluent). Platelets were counted using improved Neubauer ruled counting chamber (Hawksley, UK) and the number of platelets per litre of blood was calculated using the first principle.

Sample Size

Present study was carried out in 100 cases, which was conducted on two groups of pregnant women-

Group 1--Control: 50 normal pregnant women.

Group 2--50 pregnant women (PIH), which was further divided into subgroups of mild PIH and severe PIH.

a. Mild PIH- Is defined by hypertension (blood pressure greater than 140 mmHg systolic or 90 mmHg diastolic) associated with proteinuria > 0.3 g/L in a 24-hour urine collection of 1+ dipstick or greater in random urine collection after 20 weeks of gestation in a previously normotensive woman. [4]

b. Severe PIH- This condition was categorised if systolic blood pressure was > 160 mmHg and diastolic blood pressure was > 110 mmHg. [5]

Inclusion Criteria

All consenting adult (> 18 years) pregnant women who were confirmed to have pregnancy-induced hypertension by an obstetrician constituted the subjects for these subjects.

Exclusion Criteria

Non-consenting, non-adult pregnant women with other pregnancy-related complications were excluded.

Statistical Analysis

The results were analysed statistically to draw comparison between the groups. The statistical data was processed using Microsoft Excel to draw the values of significance for Group II and its subgroups. Tests of significance applied were 'Z' test for statistical analysis to suggest the relation between the observed abnormal value of chosen laboratory tests in the study with hypertensive disorders of pregnancy and its importance in antenatal care.

RESULTS

DISCUSSION

In this study we investigated the platelet count of 100 pregnant women, in which we have 50 cases as normal pregnant and 50 with pregnancy-induced hypertension. We observed a significantly lower platelet count among pregnant women with PIH compared to controls. There seems a significant relationship between low platelet count and PIH. Our finding is consistent with findings from previous study, [6] which observed a low platelet count among PIH patients.

Redman et al reported decreased platelet count in women who developed pre-eclampsia and stated that increased platelet consumption is an early feature of this disorder. [7]

Galton et al claimed that the severity of thrombocytopenia correlates with severity of hypertension. [8]

Romero et al reported that women with pre-eclampsia and thrombocytopenia have higher incidence of maternal and neonatal complications. [9]

In the present study, the mean platelet count falls with increased severity of disease and the count was found to be less in patients with higher blood pressure.

Lower the platelet count, greater the maternal and foetal morbidity and mortality. (Verhaeghe and colleague, 1991 Ledue and co-worker, 1992).

CONCLUSION

The platelet count has an association at prediction of increasing grade of PIH. There is an inverse relationship between the severity of PIH and platelet count.

There is definite statistical difference in values of platelet count, platelet count in PIH groups when compared with normotensive pregnant woman. Therefore, these tests may be considered as screening tests to be routinely performed in antenatal workup of women with PIH. Hence, platelet count can be used as a prognostic indicator in pregnancy-induced hypertension.

REFERENCES

[1] Vanderjagt DJ, Patel RJ, El-Nafaty AU, et al. High-density lipoprotein and homocysteine levels correlate inversely in pre-eclamptic woman in northern Nigeria. Acta Obstet Gynecol Scand 2004;83(6):536-42.

[2] Letsky EA, Greaves M. Guidelines on the investigation and management of thrombocytopenia in pregnancy and neonatal alloimmune thrombocytopenia. Maternal and Neonatal Haemostasis Working Party of the Haemostasis and Thrombosis Task Force of the British Society for Haematology. Br J Haematol 1996;95(1):21-6.

[3] Steegers EA, von Dadelszen P, Duvekot JJ, et al. Pre-eclampsia. The Lancet 2010;376(9741):631-44.

[4] NHBPEP (National High Blood Pressure Education Program) Working group report on high blood pressure in pregnancy. NIH Publication No. 00-3029. Revised 2000:1-38.

[5] Davies JR, Fernando R, Hallworth SP. Hemostatic function in healthy pregnant and pre-eclamptic women: an assessment using the platelet function analyzer (PFA-100) and thromboelastograph. Anesth Analg 2007;104(2):416-20.

[6] Jaremo P, Lindahl LT, Lennnmarken C, et al. The use of platelet density and volume measurements to estimate the severity of pre-eclampsia. Eur J Clin Invest 2000;30(12):1113-8.

[7] Redman CW, Bonnar J, Beilin L. Early platelet consumption in pre-eclampsia. Br Med J 1978;1(6111):467-9.

[8] Galton M, Merritt K, Beller FK. Coagulation studies on the peripheral circulation of patients with toxemia of pregnancy: a study for the evaluation of disseminated intravascular coagulation in toxemia. J Reprod Med 1971;6(2):78-89.

[9] Romero R, Mazor M, Lockwood CJ, et al. Clinical significance, prevalence and natural history of thrombocytopenia in pregnancy-induced hypertension. Am J Perinatol 1989;6(1):32-8.

[10] Dube B, Bhattacharya S, Dube RK. Blood coagulation profile in Indian patients with pre-enclampasia and eclampsia. Br J Obstet & Gynaecol 1975;82(1):35-9.

[11] Agrawal S, Buradkar S. Coagulation studies in toxemia of pregnancy. J Obstet & Gynecol Ind 1978;27:992-6.

[12] Giles C, Inglis TC. Thrombocytopenia and macrothrombocytosis in gestational hypertension. Br J Obstet & Gynaecol 1981;88(11):1115-9.

[13] Kulkarni RD, Sutaria UD. Platelet counts in toxemia of pregnancy. J Obstet & Gynaecol of India 1983;33:3215.

[14] Katz VL, Thorp JM Jr, Rozas L, et al. Natural history of thrombocytopenia associated with pre-eclampsia. Am J Obstet & Gynaecol 1990;163(4 Pt 1):1142-3.

Aruna Singh (1), Brijesh Singh (2), Arun Kumar Patel (3)

(1) Associate Professor, Department of Physiology, S. S. Medical College, Rewa, Madhya Pradesh, India.

(2) Associate Professor, Department of Surgery, S. S. Medical College, Rewa, Madhya Pradesh, India.

(3) Professor, Department of ENT, Jhaiawar Medical College, Jhaiawar, Rajasthan, India.

'Financial or Other Competing Interest': None.

Submission 05-06-2018, Peer Review 20-06-2018, Acceptance 22-06-2018, Published 02-07-2018.

Corresponding Author:

Dr. Aruna Singh, MIG-18, Housing Board Colony, Bodabag, Rewa, Madhya Pradesh, India.

E-mail: drarunassmc@gmaii.com

DOI: 10.14260/jemds/2018/705
Table 1. Distribution of Cases

Sl. No.         Group          No. of Case

1          Normal Pregnant         50
2         Pregnancy with PIH       50

Table 2. No. and Percentage of Cases of
Pregnancy-Induced Hypertension

Sl. No.      Group      No. of Case   Percentage

1.         Mild PIH         40           80%
2.        Severe PIH        10           20%

Table 3. Compression of No. and Percentage of Cases with
Normal, Low, Very Low, Platelet Count in Control and Study
Group

Sl.     Platelet Count     Pregnant   Mild PIH    Severe
No.                        Control                 PIH

1.          Normal         48(96%)    35(87.5%)   1(10%)
      (1.5 - 4 lac/cumm)

2.           Low            2(4%)     5(12.5%)    9(90%)
      (1 - 1.5 lac/cumm)

3.         Very low         0(0%)       0(0%)     0(0%)
         (<lac/cumm)

Table 4. Comparison of Mean Platelet Count between

Sl.   Platelet Count    Normal     Mild PIH     Severe
No.                    Pregnant                   PIH

1     Platelet count      2.1         1.9         1.4
       (lacs/cumm)     lacs/cumm   lacs/cumm   lacs/cumm

1. Normotensive versus Mild PIH in Platelet Count

Normotensive                    Mild PIH

Sample Size          =50         Sample size         =40
[N.sub.1]                         [N.sub.2]

Mean platelet                   Mean platelet
count           2.1 lacs/cumm       count       1.9 lacs/cumm
(lacs/cumm)                      (lacs/cumm)

SD                  .445             SD             .331

SE (d)= .081 by applying Z-test > 2, hence it is significant.

2. Normotensive verses Severe PIH in Platelet Count

Normotensive                    Mild PIH

Sample Size         = 50         Sample Size        = 10
[N.sub.1]                         [N.sub.2]

Mean platelet                   Mean platelet
count           2.1 lacs/cumm       count       1.4 lacs/cumm
(lacs/cumm)                      (lacs/cumm)

SD                  .445             SD             .365

SE (d)= .132 by applying Z-test > 2, hence it is significant.

3. Mild PIH verses Severe PIH in Platelet Count

Mild PIH                    Severe PIH

Sample Size       = 40       Sample Size      = 10
[N.sub.1]                     [N.sub.2]

Mean platelet   1.9 lacs/   Mean platelet   1.4 lacs/
count             cumm          count         cumm
(lacs/cumm)                  (lacs/cumm)

SD                .331           SD           .365

SE (d)= .125 by applying Z-test > 2, hence it is significant.

Comparison of Mean Platelet Count in different Studies

Studies              Normal    Mild   Severe
                    Pregnant   PIH     PIH

                    (Count in lacs/cumm of Blood)

[10] Dube and         2.3      1.9     1.9
Associates (1975)
[11] Agrawal and      2.4      2.1     2.1
Buradkar (1978)
[12] Inglis (1982)    2.6      2.4     2.1
[13] Kulkarni and     2.5      1.84    1.9
Suteria (1983)
[14] Katz (1990)      2.1      1.2     1.2
[7] Our Study         2.1      1.9     1.4
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Article Details
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Title Annotation:Original Research Article
Author:Singh, Aruna; Singh, Brijesh; Patel, Arun Kumar
Publication:Journal of Evolution of Medical and Dental Sciences
Article Type:Report
Geographic Code:9INDI
Date:Jul 2, 2018
Words:1643
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