PREDICTION OF PRE-ECLAMPSIA AMONG PREGNANT WOMEN IN USMANU DANFODIO UNIVERSITY TEACHING HOSPITAL, SOKOTO, USING MATERNAL SERUM BETA-HUMAN CHORIONIC GONADOTROPIN

Abstract

Background: Pre-eclampsia is a major cause of maternal and perinatal morbidity and mortality worldwide. Exact aetiology of this potentially fatal disorder remains poorly understood. A number of theories have been put forward where different biochemical markers have been implicated in the causal association of pre-eclampsia. Most current hypotheses regarding the pathophysiologic mechanisms of pre-eclampsia reveal early placental abnormalities. Previous attempts have been made to determine the role of maternal serum human chorionic gonadotropin (a product of the placenta) in the pathophysiology of pre-eclampsia. However, none has ever been carried out in this environment. An effective predictive measure will allow careful surveillance of mothers at high risk of pre-eclampsia so as to detect the condition early and institute appropriate management.

Objectives: To determine the correlation between maternal serum beta human chorionicgonadotropin (β-hCG) and the development of pre-eclampsia as well as to evaluate its utility as a predictive test for pre-eclampsia.

Methodology: It was a prospective cross-sectional study carried out on pregnant women in the second trimester of pregnancy between 14-20 weeks of gestation presenting at antenatal clinic of Usmanu Danfodiyo University Teaching Hospital. Detailed history was taken and thorough clinical examination was carried out. A pretested structured interviewer administered questionnaire was filled out for all the participants. Blood sample was then taken under aseptic technique for quantitative serum β-hcg estimation using the ELISA technique. The subjects were followed up till delivery and observed for development of pre-eclampsia. They were then divided into two groups: group A – women who developed pre-eclampsia, and group B – women who did not develop pre-eclampsia till delivery.

Data analysis was done using computer software SPSS Version 20. Independent T-test was used to compare mean of serum β-hCG values between the two groups of women, setting the level of significance (P-value) at < 0.05. Correlation between serum β-hCG concentration and blood pressure was studied to see whether the two variables exhibit any linear correlation. Backward stepwise logistic regression was then used to determine a prediction model for pre-eclampsia.

RESULTS: The socio-demographic characteristics between the patients who developed pre- eclampsia and those who did not develop pre-eclampsia were comparable with no statistically significant difference observed. The mean level of maternal serum β-hCG in the pre-eclamptic group was significantly higher compared to women with no features of pre-eclampsia (283.47 ± 46.64 mIU/ml vs. 211.90 ± 39.09 mIU/ml), (t= 7.25, p=0.000). There was statistically significant positive correlation between the maternal serum β-hCG concentration with the mean systolic blood pressure (r= 0.432, p= 0.000) and mean diastolic blood pressure (r= 0.364, p= 0.000), among women with pre-eclampsia. The sensitivity and specificity of β-hCG as a diagnostic test in pre-eclampsia was 61.1% and 96.5% respectively with cutoff point of 282.3mIU/ml. The area under the curve (AUC) was 0.873 with 95% confidence interval (0.769-0.976).

CONCLUSION: Elevation of maternal serum β-hCG in early second trimester at (14-20 weeks) is a useful indicator to identify women who are likely to develop pre-eclampsia in the same pregnancy.

PREDICTION OF PRE-ECLAMPSIA AMONG PREGNANT WOMEN IN USMANU DANFODIO UNIVERSITY TEACHING HOSPITAL, SOKOTO, USING MATERNAL SERUM BETA-HUMAN CHORIONIC GONADOTROPIN