Monisha, M (2022) A Study on the Association of Elevated D-Dimer Levels and the Extent of Severity of Pre Eclampsia. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Pre-eclampsia, a pathology of pregnancy by nature, is a dynamic process of varying severity associated with high levels of maternal and fetal morbidity and mortality. Preeclampsia involves an increase in inflammatory mediators and pro-coagulation factors and decreased amount of fibrinolytics in response to cellular dysfunction attributable to the condition. The state of hypercoagulability rendered by pregnancy worsens and organ malfunction can occur. D-dimer is a fibrin degradation product and the main component of a thrombus. Its presence suggests activation of the coagulation cascade and fibrinolysis. The clinical utility of measuring D-dimer lies in its high negative predictive value (98%–100%) and high sensitivity (95%–100%) for detection of thromboembolic events. This prospective study is undertaken to assess the severity of pre-eclampsia using D-dimer levels that will guide in the management and prevention of complications in pregnancy induced hypertension. AIM OF THE STUDY: To study the association of elevated D-dimer levels and extent of severity of preeclampsia. MATERIALS AND METHODS: 70 cases with pre eclampsia who are admitted at Government RSRM lying in hospital are included in this prospective observational study. Levels of D dimer at the time of hospitalization or during the time of diagnosis of pre eclampsia are measured by immunoturbidimetry, taking as reference the levels for a normal pregnant population adjusted for gestational age. D dimer test is done only once during admission or during the first diagnosis of pre eclampsia. The severity of the disease is followed up until delivery or termination of pregnancy using other investigations suggestive of end organ damage (liver dysfunction –elevated transaminase and renal dysfunction-elevated creatinine), development of eclampsia, pulmonary edema, thromboembolic events and Foetal growth restriction. INCLUSION CRITERIA: Age >18 years, Patients who give consent for undergoing the blood investigation, Gestational age > 20 weeks to 40+3 weeks, Single pregnancy with a living foetus, Diagnosis of pre-eclampsia at hospitalization according to ACOG criteria (2013). EXCLUSION CRITERIA: Twin pregnancy, Use of anticoagulants during pregnancy, Systemic lupus erythematosus, Foetal death, Smoking, diseases affecting organs affected by preeclampsia, Chronic renal failure, Autoimmune hepatitis, Intrahepatic cholestasis. CONCLUSION: In our study, there was a strong association between severity of pre-eclampsia and elevated D-dimer levels (>97.5 percentile for gestational age), reinforcing the evidence that one of the condition's physiopathologic bases lies in the activation of the coagulation system and fibrinolysis. The exact time during pregnancy in which the mechanisms that unchain the pathology and allow the D-dimer to be used as a predictor marker have not been defined. Increased levels of D-dimer should be interpreted as evidence of activation of the physiopathologic mechanisms that contribute to placental ischemia and multiple organ dysfunction in pre-eclampsia.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221916061 |
| Uncontrolled Keywords: | Association, Elevated D-Dimer Levels, Severity, Pre Eclampsia. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology > MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 03 May 2021 09:43 |
| Last Modified: | 03 Dec 2023 05:31 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/15706 |
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