A PROSPECTIVE OBSERVATIONAL STUDY OF VARIOUS MATERNAL AND PERINAL OUTCOMES IN SEVERE PRE ECLAMPSIA ASSOCIATED WITH THROMBOCYTOPENIA AND LIVER DYSFUNCTION-

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Dr. Renu Yadav
Dr. Shambhavi Soni
Dr. Neelam Rajput

Keywords

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Abstract

Pre eclampsia/eclampsia is one of the 3 leading causes of maternal morbidity and mortality worldwide.Thrombocytopenia complicates up to 7-8% of all pregnancy


Aim and objective-   case study about the maternal and perinatal morbidity and mortality in pre eclampsia with thrombocytopenia and liver dysfunction.


Method and material- prospective observational study of the 100  pregnant women in third trimester with help syndrome admitted in the department of obstetrics and gynaecology, kamla raja hospital which is attached with gajra raja medical college ,Gwalior mp from 30 sept. 2022 to 30 june 2023


Result-  In the present study 100 patients was studied in a span of  two years out of which 68%  of the cases had pregnancy induced hypertension.



  • It was common in the age group 21-30 years (64%) and 55% were primigravida. The incidence of severe PIH with thrombocytopenia were significantly higher compared to group with mild PIH with thrombocytopenia.


LSCS (47.6%) was done in group severe PIH with thrombocytopenia in the period of gestation between 34-37 weeks for foetal indication like severe IUGR and oligohydramnios. Out of 8 cases of eclampsia with thrombocytopenia vaginal delivery were more in the period of gestation between 34-37 weeks (75%). Caesarean deliveries were more in the period of gestation between >37 weeks (66.7%). HELLP syndrome was found in 24% maternal mortality in class II and class III. Mode of delivery was vaginal route in class I (62.5%).  Among all the HELLP patients maternal mortality was 8.3% followed by 41.6% cases presented with eclampsia and PPH (20.9%), 16.7% for renal failure, 12.5% with DIC. Patients with class I HELLP syndrome were treated with fresh frozen plasma and platelets. Dexamethasone rescue regimen was started for all the three classes.


Conclusion- This study shows that maternal and neonatal morbidity and mortality are increased in pregnancies complicated by severe preeclampsia with HELLP syndrome. maternal morbidity can be recognized early, it is possible to prevent severe morbidity through early intervention with delivery, antihypertensive therapy and prophylactic magnesium sulphate treatment.

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References

McCrae KR, Samuel P, Schrciber AD. Pregnancy associated Thrombocytopenia: pathogenesis and management blood 1992;80;2697-2714.
2. Charo IF, Kieffer N, Philips DR. Platelet membrane glycoproteins. Hemostasis and thrombin; basic principles and clinical practice, Philadelphia, PA: JB Lippincott Co.; 1994 .p.489-507.
3. G. Richard Lee, John Frester, John Luken Wintrobes. Clinical hematology Vol.2, 10th edition; 1999 .p.1579-1582.
4. Rodgers RPC, Levin J. A critical reappraisal of the bleeding time. Sem Thromhemost. 1990;16:1-144.
5. Hels AF. The blood and the blood in haemophilia and other haemorrhagic disease. Arch Med 1916;17:203-220.
6. Robbins, Kotran, Kumar Pathologic basis of disease. 3rd edition 1998 .p.91-95.
7. Branchog I, Kulli J. Weinfeld A. Platelet enamel & platelet production in ITP. Br J Haematol 1974;27:127-143.
8. Harker LD, Finch CA. Thrombo Kinelin in man. J. Clin Invest 1969; 48:963-974.
9. Menell JS, Bursel JB. Antenatal Management of the thrombocyto-penias. ClinPerinatol. 1994;21:591-614.
10. Greer IA, Walked J, Cameron AD, et al. A prospective longitudinal study of immunoreactive prostacyclin and TxA2metabolites in normal and hypertensive pregnancy. Clin Exp Hypertens 1985;B4;167-182.
11. Gowiand E, Kay HE, Spillman. Agglutination of platelets by a serum factor in the presence of EDTA.J. Clinico Pathol 1969;22:460-464.
12. Kield & Berg CR, Hershgold EJ. Spurious thrombocytopenia. JAMA 1974;227:628-630
13. Burrows RF, Kelton JG. Fetal thrombocytopenia and its relationship to Maternal thrombocytopenia N-Engl J Med 1993;329:1463-1466.
14. Berchtold, Wenger M. Autoantibodies against platelet glycoprotein in autoimmune thrombocytopenic purpura; their clinical significance and response to treatment. Blood 1993;81:1246-1250.
15. Kenton JG. The serological investigation of patients with autoimmune thrombocytopenia. Thromb Hoemost 1995;74:228-233.
16. Burrows RF, Kelton JG. Low fetal risks in pregnancies associated with idiopathic thrombocytopenic purpura. Am J Obstet Gynecol. 1990;163: 11471150