Prevalence and Types of Abnormal Coagulation Parameters in Preeclampsia With Severe Features at Kenyatta National Hospital, 2019; a Cross Sectional Study.

Abstract

Introduction: Pre-eclampsia with severe features is a major medical and public health concern. Participants with preeclampsia with severe symptoms often present with abnormal coagulation parameters. Dysfunction of the blood coagulation system, especially the fibrinolysis is a salient feature of preeclampsia. This varies in severity and therefore necessitates different treatment modalities. Endothelial dysfunction being the baseline of preeclampsia pathogenesis activates tissue factor that in turn begins a sequence that leads to abnormal coagulopathy. Objective: To determine the prevalence and types of coagulation parameters among women with preeclampsia with severe features from 34 weeks till delivery at KNH, 2019. Methodology: This was a cross-sectional study conducted at Kenyatta National Hospital (KNH) labor and antenatal wards, involving women with preeclampsia with severe features from 34 weeks gestation till delivery. The sample size was ninety eight (98). Participants meeting the inclusion criteria had blood samples taken for a coagulation screen- Activated partial thromboplastin time (APTT) and prothrombin time (PT), full blood count with emphasis on platelet counts. Assessment of liver function tests- Alanine transaminase (ALT) and Aspartate transaminase (AST) was done for case definition. All samples were analyzed under controlled processes at KNH, which is ISO accredited laboratory. Data was extracted from questionnaires and uploaded into an SPSS spreadsheet (version 25) for analysis. Frequencies and proportions of demographic data were calculated and presented in a table. Prevalence estimates with corresponding 95% confidence intervals of abnormal coagulation parameters, types of abnormal coagulation parameters, and proportions of adverse maternal and neonatal outcomes in adverse coagulation parameters were calculated using the exact Clopper-Pearson method. Results: Ninety eight (98) women with preeclampsia with severe features of legal age were recruited with 96 consenting for enrollment into the study. Majority were aged below 35 years (79%) and65% of the participants were unemployed. The prevalence of abnormal coagulation parameters was 43 % (95% CI: 32.8-52.6%). Most of the participants had more than one abnormal coagulation parameter. Postpartum hemorrhage (PPH) and intrauterine fetal demise (IUFD) were more prevalent in participants with prolonged PT levels at 14% and 43% respectively. Conclusion: The prevalence of abnormal coagulation parameters in patients with preeclampsia with severe features is high and more studies are needed to determine if abnormal coagulation parameter increases the risk of adverse maternal and fetal outcomes.