Value of haematological and serum biochemical parameters in the prediction of perinatal outcome in preeclampsia
Abstract
Preeclampsia is a serious disorder characterized by a generalized maternal inflammatory response associated with diffuse endothelial cell dysfunction. Preeclampsia has a long preclinical phase before it manifests. The possibility of predicting complications in preeclampsia is clinically very significant, as it could contribute to the reduction of maternal and neonatal morbidity and mortality. The aim of this study is to examine whether haematological and serum biochemical parameters may be of use in predicting more severe clinical picture and worse perinatal outcome in preeclampsia.
The prospective observational study included the study group consisted of 30 singleton pregnancies with preeclampsia completed by caesarean section (CS). This study group was divided into two subgroups with respect to severity of preeclampsia (mild and severe). The control group consisted of 20 healthy pregnant women delivered by elective CS. Clinical characteristics of pregnant women, haematological and serum biochemical parameters, as well as perinatal outcome were analyzed. In preeclampsia, reported were the higher values of hematocrit and hemoglobin, and lower platelet count, as well as the higher values of aspartate aminotransferase (AST), alanine aminotransferase, lactate dehydrogenase (LDH), gamma-glutamyl transferase, cholesterol, triglycerides, uric acid, urea and creatinine. Laboratory parameters associated with a severe clinical picture of preeclampsia in our study, as well as with a worse perinatal outcome were thrombocytopenia and increased AST and LDH levels. However, despite being indicators of a poorer outcome, they cannot be used with absolute certainty and in isolation from other indicators to predict poor perinatal outcome in preeclampsia. Deciding the delivery time in relation to an expectative approach should be based on a comprehensive consideration of gestational age, fetal condition, clinical and laboratory maternal indicators.
References
Akhlag M, Nagi AH, Yousaf AW. Placental morphology in pre-eclampsia and eclampsia and likely role of NK cells. Indian J Pathol Microbiol 2012;55:17-21. [CrossRef][PubMed]
Amburgey OA, Ing E, Badger GJ, Bernstein IM. Maternal hemoglobin concentration and its association with birth weight in newborns of mothers with pree-clampsia. J Matern Fetal Neonatal Med 2009;22:740-4. [CrossRef][PubMed]
Aviram R, Shental B, Kidron D. Placental aetiologies of foetal growth restriction: Clinical and pathological differences. Early Hum Dev 2010;86:59-63. [CrossRef][PubMed]
Baksu B, Baksu A, Davas I, Akyol A, Gulbaba G. Lipoprotein(a) levels in women with pre-eclampsia and in normotensive pregnant women. J Obstet Gynaecol Res 2005;31:277-82. [CrossRef][PubMed]
Baschat AA, Gembruch U, Reiss I, Gortner L, Weiner CP, Harman CR. Absent umbilical artery end-diastolic velocity in growth-restricted fetuses: a risk factor for neonatal thrombocytopenia. Obstet Gynecol 2000; 96:162-6. [CrossRef][PubMed]
Benoit J, Rey E. Preeclampsia: should plasma albumin level be a criterion for severity? J Obstet Gynaecol Can 2011;33:922-6. [CrossRef][PubMed]
Bramham K, Poli-de-Figueiredo CE, Seed PT, Briley AL, Poston L, Shennan AH, et al. Association of proteinuria threshold in pre-eclampsia with maternal and perinatal outcomes: a nested case control cohort of high risk women. PloS ONE 2013; 8:e76083. doi: 10.137/journal.pone.0076083. [CrossRef][PubMed]
Bukan N, Kandemir O, Nas T, Gulbahar O, Unal A, Cayci B. Maternal cardiac risks in pre-eclamptic patients. J Matern Fetal Neonatal Med 2012; 5:912-4. [CrossRef][PubMed]
Dong M, He J, Wang Z, Xie X, Wang H. Placental imbalance of Th1- and Th2- type cytokines in preeclampsia. Acta Obstet Gynecol Scand 2005;84: 788-93. [CrossRef][PubMed]
Egbor M, Ansari T, Morris N, Green CJ, Sibbons PD. Pre-eclampsia and fetal growth restriction: how mor-phometrically different is the placenta? Placenta 2006; 27:727-34. [CrossRef][PubMed]
Eskild A, Romundstad PR, Vatten LJ. Placental weight and birth weight: does the association differ between pregnancies with and without preeclampsia? Am J Obstet Gynecol 2009; 201:595.e1-5. doi:10.1016/j.ajog.2009.06.003. [CrossRef][PubMed]
Fanshawe AE, Ibrahim M. The current status of lipoprotein(a) in pregnancy: a literature review. J Cardiol 2013;61:99-106. [CrossRef][PubMed]
Gangaram R, Naicker M, Moodley J. Accuracy of the spot urinary microalbumin:creatinine ratio and visual dipsticks in hypertensive pregnant women. Eur J Obstet Gynecol Reprod Biol 2009;144:146-8. [CrossRef][PubMed]
Jaiswar SP, Gupta A, Sachan R, Natu SN, Shaili M. Lactic dehydrogenase: a biochemical marker for preeclampsia-eclampsia. J Obstet Gynaecol India 2011;61:645-8. [CrossRef][PubMed]
Jeremiah Z, Oburu J. Pattern and prevalence of neonatal thrombocytopenia in Port Harcourt, Nigeria. Pathol Lab Med Int 2010;2:27-31. [CrossRef]
Koopmans CM, van Pampus MG, Groen H, Aarnoudse JG, van den Berg PP, Mol BWJ. Accuracy of serum uric acid as a predictive test for maternal complications in preeclampsia: Bivariate meta-analysis and decision analysis. Eur J Obstet Gynecol Reprod Biol 2009; 146:8-14. [CrossRef][PubMed]
Korkmaz A, Teksam O, Yurdakok M, Yigit S, Tekinalp G. Fetal malnutrition and its impacts on neonatal outcome in preterm infants. Turk J Pediatr 2011; 53:261-8. [PubMed]
Kozic JR, Benton SJ, Hutcheon JA, Payne BA, Magee LA, von Dadelszen P, et al. Abnormal liver function tests as predictors of adverse maternal outcomes in women with preeclampsia. J Obstet Gynaecol Can 2011;33:995-1004. [CrossRef][PubMed]
Kumar N, Singh AK. Maternal serum uric acid and calcium as predictors of hypertensive disorders of pregnancy: A case control study. Taiwanese J Obstet Gynecol 2019;58:244-50. [CrossRef][PubMed]
Kumari A, Chakrawatry A, Singh A, Sigh R. Maternofoetal complications and their association with proteinuria in a tertiary care hospital of a developing country. J Pregnancy 2014;2014:431837. doi:10.1155/2014/431837. [CrossRef][PubMed]
Laskin S, Payne B, Hutcheon JA, Qu Z, Douglas MJ, Ford J, et al. The role of platelet counts in the assessment of inpatient women with preeclampsia. J Obstet Gynaecol Can 2011;33:900-8. [CrossRef][PubMed]
Livingston JR, Payne B, Brown M, Roberts JM, Cote AM, Magee LA, et al. Uric acid as a predictor of adverse maternal and perinatal outcomes in women hospitalized with preeclampsia. J Obstet Gynaecol Can 2014;36:870-7. [CrossRef][PubMed]
Madazli R, Somunkiran A, Calay Z, Ilvan S, Aksu MF. Histomorphology of the placenta and the placental bed of growth restricted foetuses and correlation with the Doppler velocimetries of the uterine and umbilical arteries. Placenta 2003;24:510-6. [CrossRef][PubMed]
Mello G, Parretti E, Cioni R, Lagazio C, Mealli F, Pratesi M. Individual longitudinal patterns in biochemical and hematological markers for the early prediction of the pre-eclampsia. J Matern Fetal Neonatal Med 2002; 11:93-9. [CrossRef][PubMed]
Milosevic-Stevanovic J, Krstic M, Radovic-Janosevic D, Stefanovic M, Antic V, Djordjevic I. Preeclampsia with and without intrauterine growth restriction – two pathogenetically different entities? Hypertens Pregnancy 2016;35(4):573-82. doi:10.1080/10641955.2016.1212872. [CrossRef][PubMed]
Morris RK, Riley RD, Doug M, Deeks JJ, Kilby MD. Diagnostic accuracy of spot urinary protein and albumin to creatinine ratios for detection of significant proteinuria or adverse pregnancy outcome in patients with suspected pre-eclampsia: systematic review and meta-analysis. BMJ 2012; 345:e4342. doi:10.1136/bmj.e4342. [CrossRef][PubMed]
Nadkarni J, Patne SK, Kispotta R. Hypoxia as a predisposing factor for the development of early onset neonatal thrombocytopenia. J Clin Neonatol 2012; 1:131-4. [CrossRef][PubMed]
Paula LG, da Costa BE, Poli-de-Figueiredo CE, Antonello IC. Does uric acid provide information about maternal condition and fetal outcome in pregnant women with hypertension? Hypertens Pregnancy 2008;27:413-20. [CrossRef][PubMed]
Powers RW, Bodnar LM, Ness RB, Cooper KM, Gallaher MJ, Frank MP, et al. Uric acid concentration in early pregnancy among preeclamptic women with gesta-tional hyperuricemia at delivery. Am J Obstet Gynecol 2006;194:160. [CrossRef][PubMed]
Redman CW, Sargent IL. Placental debris, oxidative stress and preeclampsia. Placenta 2000;24:597-602. [CrossRef][PubMed]
Redman CWG, Sargent IL. Immunology of pre-eclampsia. Am J Reprod Immunol 2010;63:534-43. [CrossRef][PubMed]
Report of the National High Blood pressure Education Program Working Group on High Blood Pressure in Pregnancy. Am J Obstet Gynecol 2000;183:S1-22. [CrossRef][PubMed]
Roberts DJ, Post MD. The placenta in pre-eclampsia and intrauterine growth restriction. J Clin Pathol 2008; 61:1254-60. [CrossRef][PubMed]
Roberts JM, Bodnar LM, Lain KY, Hubel CA, Markovic N, Ness RB, et al. Uric acid is as important as proteinuria in identifying fetal risk in women with gestational hypertension. Hypertension 2005;46: 1263-9. [CrossRef][PubMed]
Roberts JM. Pregnancy related hypertension. In: Creasy RK, Resnik R, Iams JD, editors. Maternal-fetal medicine. 5th ed. USA: Saunders, Elsevier Inc; 2004. p. 859-897.
Saito S, Sakai M, Sasaki Y, Nakashima A, Shiozaki A. Inadequate tolerance induction may induce pree-clampsia. J Reprod Immunol 2007;76:30-9. [CrossRef][PubMed]
Schneider S, Freerksen N, Maul H, Roehrig S, Fisher B, Noeft B. Risk groups and maternal-neonatal com-plications of preeclampsia – current results from the national German Perinatal Quality Registry. J Perinat Med 2011;39:257-65. [CrossRef][PubMed]
Sibai B, Dekker G, Kupferminc M. Pre-eclampsia. Lancet 2005;365:785-99. [CrossRef][PubMed]
Spracklen CN, Smith CJ, Saftlas AF, Robinson JG, Ryckman KK. Maternal hyperlipidemia and the risk of preeclampsia: a meta-analysis. Am J Epidemiol 2014; 180:346-58. [CrossRef][PubMed]
Steegers EA, Svon Dadelszen P, Duvekot JJ, Pijnenborg R. Preeclampsia. Lancet 2010;376:631-44. [CrossRef][PubMed]
Stefanovic M, Vukomanovic P, Milosavljevic M, Kutlešić R, Popovic J, Tubic-Pavlovic A. Insulin resistance C-reactive protein in preeclampsia. Bosn J Basic Med Sci 2009;9:235-8. [CrossRef][PubMed]
Stevens DU, Al-Nasiry S, Bulten J, Spaanderman ME. Decidual vasculopathy and adverse perinatal outcome in preeclamptic pregnancy. Placenta 2012;33:630-3. [CrossRef][PubMed]
Thangaratinam S, Coomarasamy A, O'Mahony F, Sharp S, Zamora J, Khan KS, et al. Estimation of proteinuria as a predictor of complications of pree-clampsia: a systematic review. BMC Med 2009;7:10. doi:10.1186/1741-7015-7-10. [CrossRef][PubMed]
Thangaratinam S, Ismail KM, Sharp S, Coomarasamy A, Khan KS, Tests in prediction of pre-eclampsia severity review group. Accuracy of serum uric acid in predicting complications of preeclampsia: A systematic review. BJOG 2006;113:369-78. [CrossRef][PubMed]
von Dadelszen P, Payne B, Li J, Ansermino JM, Broughton Pipkin F, Cote AM, et al. Prediction of adverse maternal outcomes in pre-eclampsia: Deve-lopment and validation of the full PIERS model. Lancet 2011;377:219-27. [CrossRef][PubMed]
von Tempelhoff GF, Heilmann L, Rudig L, Pollow K, Hommel G, Koscielny J. Mean maternal second-trimester hemoglobin concentration and outcome of pregnancy: a population based study. Clin Appl Thromb Hemost 2008;14:19-28. [CrossRef][PubMed]
Williams KP, Galerneau F. The role of serum uric acid as a prognostic indicator of the severity of maternal and fetal complications in hypertensive pregnancies. J Obstet Gynaecol Can 2002;24:628-32. [CrossRef][PubMed]
Xiong X, Buekens P, Pridjian G, Fraser WD. Pregnancy-induced hypertension and perinatal mortality. J Rep-rod Med 2007;52:402-5. [PubMed]