The development of a profile scoring system for early identification and severity assessment of pregnancy-induced hypertension

Abstract

Two commonly encountered problems in the management of patients with pregnancy-induced hypertension (PIH) or pregnancy-aggravated hypertension (PAH) are (1) a delay in early recognition of disease, and (2) imprecise assessment of the severity of the disease. Gravid women suffering from PIH may present in a protean manner which can be misleading to the clinician who relies strictly upon classic clinical parameters in the management of the patient. Many hematologic changes associated with PIH have been documented. However, a comprehensive evaluation of these changes, as depicted by simultaneous laboratory testing, has not been reported. The purpose of this study was twofold: (1) to formulate a profile scoring system in which clinical parameters and laboratory tests were utilized in concert, not as a predictor, but as a standardized method of early recognition of PIH, and (2) to evaluate the profile scoring system's accuracy in assessing the severity of the disease. Empirically, a “profile” was developed that included five clinical parameters (rollover test, mean arterial blood pressure, ocular arteriolar vasospasm, hand and facial edema, patellar reflexes) and eight laboratory tests (urine protein, serum urate, urea nitrogen, creatinine, albumin, total proteins, platelet count, and plasma fibrinogen). Values for each parameter and test were categorized into the accepted normal and abnormal ranges for pregnancy. On the basis of the degree of abnormality, weighted numerical scores of increasing magnitude were arbitrarily assigned to the respective value ranges. For a given patient, the sum of the individual parameter and test scores constituted the profile score. The sample population consisted of 108 patients with “at risk” characteristics or clinical manifestations of PIH. From one to six profile scores per patient were obtained between 24 weeks' gestation and the onset of labor. Simultaneously, the clinical status of the patient was evaluated and assigned to one of four categories: (1) no PIH, (2) incipient PIH, (3) mild PIH, and (4) severe PIH. Of the 108 sample patients, 14 did not develop clinical PIH (no PIH), 17 developed mild gestational or intrapartum hypertension only (incipient PIH), 45 manifested mild preeclampsia (mild PIH), and 32 demonstrated severe preeclampsia (severe PIH), four of whom were eclamptic. Profile scores ± standard error of the mean (SEM) relative to the patient's clinical status were as follows: no PIH = 7.1 ± 0.5, incipient PIH = 10.7 ± 0.4; mild PIH = 15.5 ± 0.4; and severe PIH = 28.3 ± 0.9. On the basis of our study data, we believe that profile scoring is an effective system for the early identification of PIH. Also, we believe that, when patients with clinically overt PIH are evaluated, this approach enhances our ability to quantitate the severity of the disease objectively.