HAEMOSTATIC VARIABLES IN ECLAMPTICS AT USMANU DANFODIYO UNIVERSITY TEACHING HOSPITAL (UDUTH) SOKOTO, NIGERIA

Abstract

BACKGROUND
Eclampsia is a life-threatening complication that affects approximately 0.1% of all pregnancies worldwide. In Sokoto Northern Nigeria, eclampsia complicates 4.29% of pregnancies and contributes up to 46% of adolescent maternal mortality. Haemostatic abnormalities are among the complications of eclampsia and have been associated with poorer materno-fetal outcomes. This work was undertaken to determine the effect of eclampsia on haemostatic system with a view to providing strategies for prompt interventions.
MATERIALS AND METHODS
A total of 200 women were recruited for the study comprising of 100 eclamptics as study group and 50 each of pregnant non-eclamptics (PNE) and non-pregnant (NP) women as control groups. All consenting subjects had structured questionnaire filled, physical examination performed and blood samples taken. Full Blood Count (FBC) was done by automation using XT-2000i haematology analyzer while Bleeding Time (BT) was performed using the Ivy’s method. Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), Thrombin Time (TT), fibrinogen and D-dimer tests were conducted by semiautomation using HumaClot junior coagulometer. Similarly, Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), Lactate Dehydrogenase (LDH) and total bilirubin were assayed by semi-automation using Humalyzer chemical analyzer.
RESULTS
The mean platelet count (176.96±76.55 X 109/l) of the eclamptics was significantly lower than those of the PNE (206.48±60.27 X 109/l) and NP (247.44±67.61 X 109/l) groups, p<0.05. Thrombocytopaenia was recorded in 20% of the eclamptics. There was no statistically significant difference in the mean BT of the eclamptics (2.74±1.69 mins), PNE (3.52±0.84 mins) and NP (3.60±0.90 mins), p>0.05.
PT, APTT and TT were significantly longer (p<0.05) in the eclamptics than PNE and NP, with PT values of 22.82±13.91 secs vs. 14.12 ±1.66 secs and 13.58±1.79 secs, APTT of 48.56±18.08 secs vs. 44.59±10.22 secs and 33.34±3.93 secs and TT of 25.80±22.53 secs vs. 21.29±2.75 and 17.65±1.81 respectively.

Fibrinogen levels were significantly lower in the eclamptics (445.02±194.44 mg/dl) compared to the PNE (530.80±158.44 mg/dl) but higher than NP (176.78±76.96 mg/dl), p<0.05. Hypofibrinogenaemia was recorded in 5% of the eclamptics. Significantly elevated D-dimer levels >2000ng/ml were recorded among the eclamptics with a mean value of 56661.06±1991.18ng/ml compared to 1808.12±728.89ng/ml and 88.04±44.61ng/ml for PNE and NP group respectively, p <0.05.
The incidences of HELLPS and DIC among the eclamptics were 11% and 9% respectively while HELLPS coexisting with DIC occurred in 3% of the eclamptics. These complications were associated with both maternal and fetal deaths. Maternal thrombocytopaenia was found to be a predictor of both maternal death (aOR=1.911 p=0.024) and the development of maternal complications such as HELLP (aOR=1.976 p=0.008), DIC (aOR=1.891 p=0.041) and HELLPS coexisting with DIC (aOR=1.901 p=0.026).
CONCLUSION
This study has shown that haemostatic abnormalities such as thrombocytopaenia, prolonged PT, APTT and TT, hypofibrinogenaemia and elevated levels of D-dimer do occur in eclampsia. HELLP syndrome and DIC are additional occurrences in eclampsia that are associated with both maternal and fetal deaths. Maternal thrombocytopaenia was found to be predictive of both mortality and the occurrence of HELLPS and DIC among the eclamptics.
These findings underscore the need for haemostatic surveillance in pregnancies at risk of eclampsia. By this, early haemostatic derangement which may herald adverse materno-fetal outcome could be identified and prompt intervention taken.

HAEMOSTATIC VARIABLES IN ECLAMPTICS AT USMANU DANFODIYO UNIVERSITY TEACHING HOSPITAL (UDUTH) SOKOTO, NIGERIA