Biochemical Changes In Women With Pre-Eclampsia

Biochemical Changes In Women With Pre-Eclampsia
Abstract
The aim of this study was to evaluate the biochemical changes which occur in the serum of pregnant women with pre-eclampsia including renal functions (urea, creatinine, sodium, potassium, anduric acid), liver functions (total protein, albumin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase), and complete blood count(CBC).Blood samples were collected from 120 pregnant women with pre-eclampsia beside75 normal pregnant women which served as control group. Serum urea, creatinine, uric acid, total protein, albumin, ALT, AST, ALP) were measured using automated chemical analyzer (Mindary BS – 210).Serum sodium and potassium were measured using (ion selective electrode). Complete blood count (CBC) was done using full automated hematology analyzer (Sysmex). Data were analyzed using IBM SPSS (version 20).The study revealed that the mean age of the women with pre-eclampsia was (28.1±6.5years), while in the women with normal pregnancy was (29. 2±6.4 years). The mean weight in the pre-eclampsic women was (79.3±9.0 Kg), while in the control group was (77.4±5.8Kg). The study observed a significant increase {P value (0.000)} in the mean of both diastolic and systolic blood pressure in the pre- eclampsic women, which were (152.3±17.7mmHg) and (106.5±11.5 mmHg), versus (122.8±5.6 mmHg) and (78.9±3.3 mmHg) respectively for the control group. Serum creatinine level was significant increased in pre-eclampsic women when compared to the control group (0.7±0.4mg/dl) versus (0.4±0.3mg/dl) with Pvalue (0.000). Serum uric acid in the women with pre-eclampsia was (7.0±2.1mg/dl) versus 5.0±1.4mg/dl) in the women with normal pregnancy; there was a significant increase with P. value (0.000). The mean of serum ALP in the women with pre-eclampsia was (130.7±46.1 U/L) versus (83.9±17.7U/L) in the women with normal pregnancy, there was a significant increase with P. value (0.000). The mean of serum AST in the women with pre-eclampsia was (63.9±112.2 U/L) versus (29.6±12.1 U/L) in the women with normal pregnancy; there was a significant increase with P.value (0.01). The mean of serum ALT in the women with pre-eclampsia was (32.1±49.9 U/L) versus (18.2±8.6 U/L) in the women with normal pregnancy there was significant increase with P.value (0.003). The mean WBCs in the women with pre-eclampsia was (9.4±4.2) versus (8.2±2.8) in the women with normal pregnancy; there was a significant increase with P.value (0.015). The mean of PLTs in the women with pre-eclampsia was (211.2±93.1) versus (245.4±66.0) in the women with normal pregnancy; there was a significant decrease with P.value (0.003).
It was concluded that in pre-eclampsic Sudanese women; serum creatinine, uric acid, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and white blood cell count significantly increase, while platelets count significantly decrease.
Chapter One
Introduction
1.1 Background to the Study
Eclampsia is a Greek; means “shining forth” is an acute and life-threatening complication of pregnancy, characterized by the appearance oftonic–clonic seizures, usually in a patient who has developed pre-eclampsia. Pre-eclampsia and eclampsia are collectively calledhypertensive disorder of pregnancy and toxemia of pregnancy. Eclampsia includes seizures and coma that happen during pregnancy but are not due to preexisting or organic brain disorders (Chesley, 1971).
Eclampsia refers to the occurrence of one or more generalized convulsions and/or coma in the setting of pre-eclampsia and in the absence of other neurologic conditions. The clinical manifestations can appear anytime from the second trimester to the puerperium. In the past, eclampsia was thought to be the end result of preeclampsia, however; it is now clear that seizures should be considered merely one of several clinical manifestations of severe pre-eclampsia, rather than a separate disease. Despite advances in detection and management, pre- eclampsia/eclampsia remains a common cause of maternal death (Douglas and Redman, 1994).
An eclamptic seizure occurs in 2 to 3 percent of severely pre-eclamptic women not receiving anti-seizure prophylaxis; the seizure rate is estimated to be between 0 and 0.6 percent in women with mild pre-eclampsia (Sibai, 2004). The incidence of eclampsia has been relatively stable at 1.6 to 10 cases per 10,000 deliveries in developed countries (Douglas and Redman, 1994; Tan et al, 2006). In developing countries, however, the incidence varies widely: from 6 to 157 cases per 10,000 deliveries (Miguilet al, 2008).
Pre-eclampsia is a medical condition characterized by high blood pressure and significant amounts of protein in the urine of a pregnant woman. If left untreated, it can develop into eclampsia, the life-threatening occurrence of seizures during pregnancy (Chesley, 1971).
There are many different causes for the condition. It appears likely that there are substances from the placenta that can cause endothelial dysfunction in the maternal blood vessels of susceptible women. While blood pressure elevation is the most visible sign of the disease, it involves generalized damage to the maternal endothelium, kidneys, and liver, with the release of vasoconstrictive factors being a consequence of the original damage. An outdated medical term for pre-eclampsia is toxemia of pregnancy, since it was thought that the condition was caused by toxins (Sibai, 2004).The pathophysiologic processes underlying this disorder are described as occurring in two stages (Roberts and Hubel, 1999).
The first stage ischaracterized by reduced placental perfusion, possibly related to abnormal placentation, with impaired trophoblast invasion and inadequate remodeling of the uterine spiral arteries. The second stage refers to the maternal systemic manifestations characterized by inflammatory, metabolic, and thrombotic responses that converge to alter vascular function, which can result in multiorgan damage (Roberts and Gammill 2005; Steegerset al, 2010).
Many factors have been associated with an increased risk of developing preeclampsia including prior history or family history of preeclampsia, nulliparity, multigestational pregnancy, long time interval between pregnancies, obesity, age>40 years, diabetes mellitus, and preexisting history of other medical conditions such as chronic hypertension and renal disease, among others(Duckitt and Harrington 2005; Van Rijn et al, 2006).
Pre-eclampsia may develop from 20th week of gestation (it is considered early onset before 32 weeks, which is associated with an increased morbidity). Its progress differs among patients; most cases are diagnosed before labor typically would begin. Pre-eclampsia may also occur up to six weeks after delivery. Apart from Caesarean section and induction of labor (and therefore delivery of the placenta), there is no known cure. It is the most common of the dangerous pregnancy complications; it may affect both the mother and fetus (Sibai, 2004).
The hypertensive disorders during pregnancy affect up to 8.0% of all pregnancies (Sullivan and Martin, 1995).
Over the years, a lot of interest has been directed at studies on the role of serum uric acid, urea and creatinine in the pathogenesis of pregnancy induced hypertension (Egwuatu, 1986;Mustaphi, et al, 1996). At the same time hypertensive disorders account for 21% (Mustaphiet al, 1999) of cases of thrombocytopenia in pregnancy and the risk of anemia may also increase with the severity of hypertensive disorders(Mustaphi and Ananth, 2009). Thus; though the roles of serum urea, uric acid and creatinine have been studied by many researchers, there is a constant ongoing search for better predictors and prognostic factors to assess the progress and severity of the disease, hematological parameters being one among them (Mustaphi and Nanda, 2013 ;Sivakumaret al, 2007).
1.2 Statement of the Problem
Worldwide, 10 to 15 percent of direct maternal deaths (i.e., resulting from obstetric complications of pregnancy) are associated with preeclampsia/eclampsia (Duley, 2009).Inthe United states, preeclampsia/eclampsia is one of four leading causes of maternal death, along with hemorrhage, cardiovascular conditions, and thromboembolism (Chang et al, 2003, Mackay et al, 2011).Pre-eclampsia is responsible for 15 percent of all preterm births in the USA. Infants of mothers suffering from pre-eclampsia have a five times higher risk of dying than those of mothers without pre-eclampsia, mainly because of preterm birth (Lain and Robert, 2002).Women with pre-eclampsia are at an increased risk for life-threatening events, including placental abruption, acute renal failure, cerebral hemorrhage, hepatic failure or rupture, pulmonary edema, disseminated intravascular coagulation, and progression to eclampsia (Duley,2009).There is approximately one maternal death due to pre-eclampsia-eclampsia per 100,000 live births, with a case-fatality rate of 6.4 deaths per 10,000 cases (Livingston et al, 2003, Mackay et al, 2001). In the Netherlands between 1993 and 2005, pre-eclampsia was the most common cause of maternal death, with 3.5 maternal deaths per 100,000 live births (Schutteet al, 2010).
1.3 Objective of the Study
The main objective of this study is to determine the biochemical changes in women with pre-eclampsia. Specifically, the Objectives of this study are:
- To determine blood pressure of subjects under study.
- To evaluate renal function (urea, creatinine, uric acid, sodium, potassium).
- To evaluate liver function(total protein, albumin, ALP, ALT, AST).
- To evaluate (White blood cells, hemoglobin and platelets, PCV, MCH, MCHC, and MCV).
1.4 Scope of the Study
The aim of this study on the Biochemical Changes In Women With Pre-Eclampsia was to evaluate the biochemical changes which occur in the serum of pregnant women with pre-eclampsia including renal functions (urea, creatinine, sodium, potassium, anduric acid), liver functions (total protein, albumin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase), and complete blood count(CBC). it was carried in two hospital in Abuja which are University of Abuja Teaching Hospital and Maitama General Hospital. The study covers between September 2019 to May 2020.
Chapter Five
Conclusions and Recommendation
5.1 Conclusion
In Nigerian women with pre-eclampsia; both diastolic and systolic blood pressure increase. Serum creatinine, uricacid, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and WBC significantly increase; while platelets count significantly decrease which may predispose these women to thrombocytopenia.
5.2 Recommendation
This study recommends that; in pregnant women:
- Liver function tests including alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase are strongly recommended as routine follow up investigations.
- Renal function tests including creatinine and uric acid are advised to be a part of antenatal care routine investigations, as early indicators for preeclampsia.
- Blood pressure should be measured routinely in pregnant women.
- Platelets count should be routine investigation in normal follow up of pregnant women in the antenatal care clinics.
- More research with big sample size is recommended to roll out these findings.


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