Research Article
Volume 10 Issue 9 - 2021
Evaluating the Value of Blood D-Dimers in Pregnant Women with Preeclampsia as a Predictor for Onset of HELLP Syndrome: Case Control Study
Oranye Benjamin Chukwuka*, Aimakhu Christopher and Oladapo Olayemi
Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Oyo State, Nigeria
*Corresponding Author: Oranye Benjamin Chukwuka, Department of Obstetrics and Gynecology, University College Hospital, Ibadan, Oyo State, Nigeria.
Received: August 29, 2020; Published: August 16, 2021




Abstract

Introduction: Preeclampsia is a common medical complication of pregnancy. It could be complicated by HELLP syndrome. HELLP syndrome is a multi-systemic disorder that complicates pregnancy with associated foeto-maternal morbidity and mortality. It could be a life-threatening obstetric complication. When diagnosed early and appropriate intervention instituted promptly, these complications can be picked early or even prevented.

Objective: This main aim of this study was to determine if the presence of blood D-dimers in women with preeclampsia is an early predictor of HELLP syndrome.

Methodology: This study was a prospective case-control study carried out at the Depart. of Obs. and Gyn., UCH and at AMTH, between November 2015 to April 2016. Ninety pregnant women with preeclampsia as cases and ninety with normal pregnancy as controls were recruited into the study before delivery and monitored till after delivery. Blood samples was collected for serum D-dimer assay. A structured proforma was utilised to extract socio-demographic, maternal obstetric history, and record results of tests. Data was collated and analysed using SPSS version 20. The level of significance was set at be P < 0.05.

Results: The mean age for cases was 31.4 years and controls was 31.3 years. The two groups were matched for GA. Caesarean section was the commoner route of delivery for preeclampsia patients. The mean d-dimer levels were elevated above the cut-off 0.5 mg/l in both groups. The pre-delivery was 3.37 mg/l and 1.47 mg/l and post-delivery was 3.22 mg/l and 3.14 mg/l for cases and controls respectively. This was statistically significant. (p-value < 0.001). Upon conclusion of the study, a higher proportion of the cases had elevated D-dimer levels (95.2%) compared to controls (89.5%). This was not statistically significant. (p-value 0.447). The prevalence of HELLP syndrome was 0.6% and only one patient with preeclampsia developed the syndrome while one patient without preeclampsia was diagnosed with the syndrome post-delivery. This was too low to perform a logistic regression and hence elevated D-dimer cannot be used to predict HELLP syndrome in the subjects from this study.

Conclusion: Elevated d-dimer levels were detected in patients with preeclampsia, but it was not predictive of HELLP syndrome due to low prevalence in our environment.

Keywords: Preeclampsia; HELLP Syndrome Prediction; D-Dimer; University College Hospital; Adeoyo Maternity Teaching Hospital; Feto-Maternal Complications

References

  1. Current Diagnosis and Treatment. Obstetrics and Gynecology. 10th McGraw-Hill, Medical Publishing Division. New York (2006).
  2. Weinstein L. "It has been a great ride: the history of HELLP syndrome". American Journal of Obstetrics and Gynecology 193 3-1(2005): 860-863.
  3. Mihu D., et al. “HELLP syndrome - a multisystemic disorder”. The Journal of Gastrointestinal and Liver Diseases 4 (2007): 419-424.
  4. Gleeson R., et al. “HELLP syndrome: a condition of varied presentation”. Irish Journal of Medical Science 165 (1996): 265-267.
  5. Osmanagaoglu MA., et al. “Comparison between HELLP syndrome, chronic hypertension, and superimposed preeclampsia on chronic hypertension without HELLP syndrome”. Journal of Perinatal Medicine 32 (2004): 481-485.
  6. Poldre PA. “Haptoglobin helps diagnose the HELLP syndrome”. American Journal of Obstetrics and Gynecology 157 (1987): 1267.
  7. Neiger R., et al. “D-dimer test for early detection of HELLP syndrome”. The Southern Medical Journal4 (1995): 416-419.
  8. Brenner B. “Haemostatic changes in pregnancy”. Thrombosis Research5-6 (2004): 409-414.
  9. Kline JA., et al. “D-dimer concentrations in normal pregnancy: new diagnostic thresholds are needed”. Clinical Chemistry5 (2005): 825-829.
  10. Heffner A and Kline J. “Role of the peripheral intravenous catheter in false-positive D-dimer testing”. Academic Emergency Medicine 8 (2001): 103-106.
  11. Linhares JJ., et al. “Factors associated with mode of delivery in women with pre-eclampsia”. Revista Brasileira de Ginecologia e Obstetrícia6 (2014): 259-263.
  12. Thomas L., et al. “LDH reference values”. The Journal of Laboratory Medicine5 (2005): 301-308.
  13. Proietti AB., et al. “Assessment of fibrinogen degradation products in preeclampsia using immunoblot, enzyme-linked immunosorbent assay, and latex-based agglutination”. Obstetrics and Gynecology5 (1991): 696-700.
  14. Rahman TM and Wendon J. “Severe hepatic dysfunction in pregnancy”. QJM: An International Journal of Medicine 95 (2002): 343-357.
  15. Sibai BM., et al. “Maternal-perinatal outcome associated with the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia-eclampsia”. American Journal of Obstetrics and Gynecology 155 (1986): 501.
  16. Thefeld W., et al. “Referenzwerte fur die Bestimmungen der Transaminases GOT and GPT sowie der alakalischem phosphatase im serum mit optimierten Standard methoden”. Deutsche Medizinische Wochenschrift 93 (1974): 343-351.
  17. Neiger R., et al. “Plasma fibrin D-dimer in pregnancies complicated by partial placental abruption”. Tennessee Medical 10 (1997): 403-405.
Citation: Oranye Benjamin Chukwuka., et al. “Evaluating the Value of Blood D-Dimers in Pregnant Women with Preeclampsia as a Predictor for Onset of HELLP Syndrome: Case Control Study”. EC Gynaecology 10.9 (2021): 01-11.

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