Pregnancy is a physiological process in women which can be associated with certain risks to the health of both the mother and child. [1]. Hypertension is one of the serious complications seen in 7 to 10% of pregnancies leading to maternal and perinatal mortality and morbidity. [1]. Pregnancy-induced hypertension (PIH) is one of the common disorders associated with high blood pressure that occurs in pregnancy for the first time after 20 weeks of gestation and disappears following delivery [2]. It is commonly seen in primigravida compared to multiparous women. [3]. Eclampsia is a severe form of pregnancy-induced hypertension along with seizures resulting from the condition [4].

Most of these conditions can be prevented and treated by early good antenatal care but the circumstances are not so easy in developing countries due to lack of health facilities^. [5,6]. The variety of haematological changes occurs in PIH in that thrombocytopenia is the most common abnormality seen due to increased consumption during low-grade intravascular coagulation [7,8]. This study is undertaken to assess the severity of PIH and coagulopathy related adverse effects by using haematological/coagulation parameters which are rapid, cheaper and easily available, that also guide us for management before the patient goes into a complication.

The study was conducted in the Department of Pathology Sri Siddhartha Medical college Tumkur in collaboration with the department of OBG. The study was done for a period of one and a half years from Jan 2019 to June 2020. It is a prospective study sampling was done by using a random sampling method. A total of 150 pregnant women attending from OPD. Inclusion criteria: Pregnant women more than 28 weeks gestation of pregnancy with blood pressure >140/90mmhg, with or without edema and proteinuria in urine were included in the study. Exclusion criteria: Thromboembolic episode, Hemorrhagic disorder, Epilepsy, Hepatic or renal disorder, Pre-existing DM, HTN <20weeks, H/O Drug intake. The case group included 75 women with PIH and the control group included 75 healthy pregnant women with no risk factor. Routine antenatal investigations like blood group, CBC, BT, CT, blood sugar, HIV, VDRL, HBsAg were done.

The mean and standard deviation of platelet count (lakhs/cu mm) in control is 2.71(lakhs/cu mm) as compared to 1.52(lakhs/cu mm) in the case group. The mean and standard deviation of mean platelet volume (fl) in control is 8.58(fl) as compared to the 8.84(fl) case group. The mean and standard deviation of platelet distribution width (%) in control is 12.5(%) as compared to the 12.69 (%) case group. The differences were statistically significant as shown in (Table 3).

Table 3: Comparison of parameters between and cases and control

p-values based on independent sample t-test, ^*Statistically significant at p-value<0.05

The mean and standard deviation of prothrombin time (sec) in control is 12.25(sec) as compared to the 16.70(sec) case group. The mean and standard deviation of Activated partial thromboplastin time (sec) in control is 25.59 (sec) as compared to the 32.73(sec) case group. The differences were statistically significant as shown in (Table 3).

Patients with Pregnancy-induced hypertension may develop a variety of haematological changes, among all haematological changes, thrombocytopenia is the most common abnormality seen. Thrombocytopenia is common in the third trimester due to hemodilution, increased platelet consumption, increased platelet aggregation by increased levels of thromboxane A2.

In pre-eclampsia there is endothelial dysfunction which will lead to an altered level of fibrinogen, activated partial thromboplastin time, prothrombin time, fibrin degradation products and D-dimers. The present study shows pregnancy is associated with many complicated changes which are not clearly understood involving blood coagulopathy. [1].

The findings were in concordance with the study done by Lakshmi et al shows increased prothrombin time (PT) and activated partial thromboplastin time (APTT) in severe preeclampsia and eclampsia. [17]. The study done by Joshi SR et al shows thrombocytopenia and coagulation abnormalities particularly showing an increase in APTT.[18]. So the present study demonstrated that coagulation parameters were the prognostic markers in predicting the severity of preeclampsia. In Swetha et al, a significant decline in total platelet count (TPC), increase in prothrombin time, activated partial thromboplastin time, bleeding time, and clotting time was seen in PIH as compared to normal pregnancy.

NLR (Neutrophil lymphocytes ratio) is also significantly raised in PIH. TPC and NLR estimation can be taken as an early and rapid procedure for screening preeclampsia cases at admission followed by serial platelet counts while monitoring coagulation indices.[19]. In Mishra et al, in their study preeclampsia and eclampsia, decrease in platelet count (1.69±0.53 lacs/cumm) compared to the control group was statistically significant (p= 0.000) and increase in PT (12.5 ± 1.17 sec) and aPTT (30.5 ± 2.29 sec) were significant (p<0.05).

Platelet count is inversely proportional to the severity of PIH and the risk of coagulopathy increases with worsening thrombocytopenia. There are no cases with normal platelet count where PT or aPTT were prolonged.[20]. Chauhan et al, in their comparative study of coagulation profile in preeclamptic, eclamptic and normotensive patients found that PT was 13.78 seconds in mild.13.8 seconds in severe preëclampsia and 14.1 seconds in normal. However in his study, the increase in prothrombin time was not statistically significant. [21].

No screening test would help in identifying which pregnancy is associated with pregnancy-induced hypertension or assess its severity. Early assessment is necessary to prevent complications and mortality and morbidity. Hence this study is undertaken to assess the severity of PIH and coagulopathy by a method of rapid, cheaper and easily available so that they will guide us for management before the patient goes into a complication. The present study concludes platelet count is one of the useful predictors, rapid, reliable, low cost and easily available routine screening test for coagulopathy in PIH even in rural areas.