Abstract

Preeclampsia, a clinical condition manifested by new onset hypertension (=/> 140/90 mm of Hg) after 20 weeks of gestation with proteinuria with or without evidence of multiorgan involvement. Generalized vasoconstriction that occurs in severe preeclampsia and subsequent multiorgan dysfunction secondary to reduced perfusion, hypoxia, activation of coagulation cascade and loss of endothelial integrity causes characteristic clinical features like hypertension, proteinuria, hypoproteinemia, hemolysis, raised liver enzymes, low platelet count and raised level of urea, creatinine and uric acid. Abnormal values of these parameters are considered as markers of severe preeclampsia which badly affect the course of pregnancy and obstetric outcome though no single marker has been established to have high predictive value.

Materials and Method: This prospective study was carried out for one and half years during the year 2015-16 at a peripheral Medical College of West Bengal, India with Ethical approval. The study population included the antenatal mothers who attended antenatal OPD from the first trimester of pregnancy. The aim of the study was to evaluate the biochemical changes, mainly of liver and kidneys associated with preeclampsia and how it affected the outcome of pregnancy. A total of 100 mothers were taken as case-control study. Group one (n=50) were the mothers having increase systolic pressure >30 mm Hg and diastolic blood pressure >15 mm Hg above their booking blood pressure for two consecutive clinic attendance and presence of  proteinuria by dipstick test, serve as case;  group two (n=50) were the mothers  with normal systolic and diastolic blood pressure throughout  the pregnancy ,serve as control; All biochemical and hematological investigations were done in central pathological lab of the Institution and ultrasonography at the Department of Radiology. All other data collected from Labour Room Record Book, Antenatal Record Book, Logbook, OT Registrar and Bed Head Ticket and data analyzed at the end of the study.

Results & Analysis: According to parity, 42 out of 50 mother in preeclampsia group were primigravida (p value 0.046) rectify nulliparity is a risk factor. There was significant proteinuria among preeclampsia mothers compared to normotensive mothers (P value< 0.05).The study showed preeclampsia group have statistically less Hb% (p value <0.05), less mean total protein (p value< 0.05), less mean albumin (p value< 0.05), abnormal rise of AST (aspartate aminotransferase) (p value< 0.05) and significant rise of blood urea (p value <0.05) at term in comparison to normotensive group. There was higher incidence of LUCS delivery (p value< 0.05) and preterm, IUGR and low birth weight (LBW) babies (p value< 0.05) among preeclampsia mothers than that of normotensive mothers. In evaluation of birth conditions per Apgar score index, relative risk of life expectancy was greater in preeclampsia group (P value< 0.05) than that of normotensive group. In this regard, SNCU admission in preeclampsia group was much higher than normotensive group (P value< 0.05). The duration of hospital stay was more in preeclampsia mother compared to normotensive mother (p value< 0.05) and significant number of mother admitted to ICU in preeclampsia group than that of normotensive group ( P value< 0.05).

Conclusion: In preeclampsia, involvements of multiorgan complicate the course of pregnancy more severely. In this connection, evaluation of different parameters like degree of proteinuria, gestational age, available Hb%, biomarkers like serum total protein, serum albumin, AST, serum urea and creatinine should be justified for the timing delivery in preeclampsia mother and thus a better obstetric outcome could be ascertained.

Keyword:  Preeclampsia, Normotensive, Proteinuria, Aspartate aminotransferase (AST), Low birth weight (LBW).