Association of serum calcium and uric acid level with hypertensive disorders of pregnancy [pre eclampsia and eclampsia] and there correlation with disease severity

Abstract

Background: Hypertensive disorders are the most common medical complications during pregnancy and are associated with high maternal and fetal mortality and morbidity.One way to reduce the impact of arterial hypertension on maternal mortality is to establish the correct diagnosis of preeclampsia, and to proceed with an early intervention when it is diagnosed. The clinical signs are considered to be a late manifestation of a disease. The utility of two biochemical markers like hyperuricemia and hypocalcemia for the diagnostic purposes and for the prognosis remains largely to be explored. Objectives: (1) To determine the role of calcium & uric acid in the pathogenesis of preeclampsia. (2) To determine the serum level of calcium and uric acid & its correlation with the severity with preeclampsia. Study Design: Hospital based cross sectional case control study. Methods: The study was conducted in the Ante Natal Ward in Obstetrics &Gynaecology Department, BankuraSammilani Medical College, Bankura, WB, which serves a rural population where majority of the patients belong to the tribal groups. Mild pre eclamptic patient defined as blood pressure of at least 140/90 mm of Hg. at least on two occasions at least 6 hrs apart accompanied by proteinuria of at least 300 mg per 24 hrs or at least 1+ on dipstick testing. 64 Severe preeclamptic patient defined as having one or more criteria of the following-  BP ≥160/110 mm of Hg at least on two occasions at least 6 hrs apart  Proteinuria of ≥5gm/24hrs or at least 3+ on dipstick testing  Oliguria<500ml/24hrs or Cerebral or visual disturbances or Pulmonary edema or any other features of end organ damage. Statistical Analysis: Student's t test, Chi square test and statistical software Medcalc 11.3.0, Q1 Macros 2012. Results: There were no statistical significant difference in age, BMI, or birth weight of the baby between normal pregnant women and women with PIH but preeclamptic patients present early in gestational age and that was statistically significant. The serum calcium level in eclampsia and severe pre-eclampsia were significantly less than normal pregnant woman but there was no significant difference in serum calcium between normal pregnant woman and mild pre-eclamptic woman. The serum uric acid level in eclamptic woman and severe pre- eclamptic woman were significantly more than that of normal pregnant woman but there was no significant difference in serum uric acid between noral pregnant woman and mild pre-eclamptic woman. Conclusion: So the study indicates that hyperuricemia and Hypocalcaemia is significantly associated with Preeclampsia and their level varies with the severity of the disease process. Routine estimation of serum uric acid and calcium level may be useful as diagnostic marker in high risk pregnancies.