Guruprasad Hosamani

Assistant Professor, Department of OBGYN, Raichur Institute of Medical Sciences, Raichur, INDIA.

Email: guruhosmani@yahoo.com

RESULTS

200 patients were studied in present study. The maximum number of patients of pre-eclampsia were from age group 20-24 years (51%) , next being 25-29 years (31%).

Table 1: Distribution of age

In present study maximum number of cases were primigravida (51%), G2 were (32%), G3 were (11%).

Table 2: Distribution of Gravida status

In our study maximum number of cases are > 38 weeks of gestation (49%), cases between 36-38 weeks were 27% and between 32-34 weeks were 15%.

Table 3: Distribution of Gestational age (weeks)

In our study with serum LDH <600 with urine albumin 2+ was 16%, 1+ in 15%, nil in 11%, traces in 5% and 3+ in 4%. Serum LDH between 600 to 800 with urine albumin 1+ in 23%, 2+ and nil with 3% each. Serum LDH >800 with urine albumin 1+ and 2+ is 9% each, with 3+ and nil in 1% each. p value is 0.001 which is statistically significant.

Table 4: Urine albumin according to LDH

In our study serum LDH <600 had abruption with PPH, DIC, eclampsia and PPH in 2% each, with serum LDH 600-800 had PPH in 6.9% and with serum LDH >800 had PPH in 5% cases. p value is 0.85 which is statistically not significant.

Table 5: Maternal outcome according to LDH

In our study serum LDH<600 underwent elective LSCS in 47.1%, NVD in 47.1%, emergency LSCS in 3.9% and forceps assisted vaginal delivery in 2%. Serum LDH 600-800 underwent NVD in 72.4%, elective LSCS in 24.1% and emergency LSCS in 3.4%. serum LDH >800 underwent elective LSCS in 55%, NVD in 40% and emergency LSCS in 5%. p value is 0.286 which is statistically not significant.

Table 6: Mode of delivery according to LDH

In our study mean APGAR 1 mins with serum LDH 600-800 is 7.7, >800 is 7.5, <600 is 7.2 respectively. mean APGAR 5 mins with serum LDH 600-800 is 8.7, >800 is 8.5, <600 is 8.3. p value is 0.083 and 0.217 APGAR 1min and APGAR 5mins, hence statistically not significant.

Table 7: Mean APGAR according to LDH

In our study serum LDH <600 had a IUGR in 7.8%, fetal distress in 5.9%, neonatal death and stillbirth in 3.9% each, IUD, LBW, MSL and premature births in 2% each. Serum LDH between 600-800 had IUGR and LBW in 3.4% each. Serum LDH with >800 had IUGR in 15% and neonatal death and stillbirth in 5% each which is clinically significant. p value is 0.585 which is statistically not significant.

Table 8: Perinatal outcome according to LDH

DISCUSSION

The placenta has a very significant role in the pathogenesis of PIH, therefore the one and only definitive treatment for the preeclampsia is delivery of the fetus. The main mechanisms involved in the placenta causing the disease are abnormal trophoblastic invasion, endothelial cell injury or activation, immune rejection of the placenta, compromised placental perfusion, altered vascular reactivity and imbalance between prostacyclin and thromboxane. In our study, the study age of most pregnancies occurred in age group 20-24years followed by 25-29 years. Similar findings were noted by Jaiswar et al.⁶ and Pallavi singh et al.⁷. In our study, most of the patients were primigravida. Similar findings were noted by Pallavi Singh et al.⁷ In present study mean LDH in severe pre-eclampsia and eclampsia patients were 570.5 IU/L. Rubina Aziz et al.⁸ and Metin Ingec et al.⁹ noted mean LDH in severe pre-eclampsia and eclampsia patients as 348.34 IU/L and 1118 IU/L respectively. The mean LDH levels in the severe preeclampsia group were significantly higher compared to non-severe pre-eclampsia patients. Similar findings were noted by Metin Ingec et al.⁹ Kiren K Malik et al.¹⁰ studied the correlation of Lactic dehydrogenase levels with severity of preeclampsia. A total of 120 pregnant women with preeclampsia (60 with mild and 60 with severe preeclampsia) and 60 healthy normotensive controls were studied. The study showed a statistically significant increase in terms of LDH and liver enzymes (p<0.05) in patients with severe preeclampsia. LDH levels >600IU/L were seen in 62% of women with severe preeclampsia compared to 20% in normotensives and patients with mild preeclampsia. In this study LDH concentrations >800 IU/L had significant increase in frequency of epigastric pain and vomiting. In severe preeclampsia with LDH >800 IU/L women had significant increase in all complications noticed eclampsia being the most frequent one. Elevated levels of LDH, indicative of cellular damage, can be used as a biochemical marker because it reflects complications and fetal outcome. In a similar study by James N Martin et al.¹¹, to investigate the utility of an admission battery of findings and laboratory data in the discrimination of patients with or without HELLP syndrome at high risk for development of significant maternal morbidity , they found that the presence of nausea and vomiting, epigastric pain or both in association with values that are in excess of the cut-offs for lactate dehydrogenase, aspartate aminotransferase and uric acid concentrations. In a prospective study by Qublan et al.¹² 111 preeclampsia women and 60 normotensive controls were included in the study. The symptoms and complications of preeclampsia along with foetal outcome were analyzed according to the levels of LDH. A significant association of serum LDH levels with severe preeclampsia was demonstrated. Increase in the incidence of perinatal deaths was observed in patients with increasing levels of serum LDH levels. Intrauterine fetal death was seen in 4.8% of cases, intrauterine growth restriction in 33.9% and prematurity in 77.9%. Neonatal deaths were reported in 95.2% in severe preeclampsia group. Severely preeclamptic women with LDH levels of < 800 IU/l showed a significant increase in complications in terms of eclampsia, abruption placenta and various other complications compared to women who had lower serum LDH levels. The Qublan et al. Study concluded that Pre-eclampsia is a pregnancy-specific disease, and in its severe form, serious multisystem complications may occur and elevated levels of lactic dehydrogenase, indicative the cellular damage and dysfunction, can be used as a biochemical marker because it reflects the severity of the disease, the occurrence of complications, and foetal outcome.¹² Serum LDH is the earliest marker in blood during hypoxia and oxidative stress. It is raised in cases of pre-eclampsia and eclampsia. Detection of high-risk patients with increased levels of LDH mandates close monitoring, prompt and correct management to decrease both maternal and foetal morbidity and mortality. Estimation of serum Lactate Dehydrogenase can be used as a prognostic marker for preeclampsia and eclampsia.

Limitations of present study were sample size studied was small and a smaller number of eclampsia patients. Larger studies are required to document findings.

CONCLUSION

Higher LDH levels are indicative of maternal and fetal complications. higher serum LDH levels more than 500 IU/L to 600 to 800 IU/L have closer association with severe preeclampsia. Pre-eclampsia patients with raised LDH levels should be closely monitored.

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