Publication History
Submitted: March 07, 2024
Accepted: March 16, 2024
Published: March 31, 2024
Identification
D-0265
Citation
Ashmita Pathak (2024). Association of Serum Lactate Dehydrogenase Level with Maternal & Fetal Outcome in Women with Pregnancy Induced Hypertension at BPKIHS. Dinkum Journal of Medical Innovations, 3(03):226-239.
Copyright
© 2024 DJMI. All rights reserved
226-239
Association of Serum Lactate Dehydrogenase Level with Maternal & Fetal Outcome in Women with Pregnancy Induced Hypertension at BPKIHSOriginal Article
Ashmita Pathak 1 *
- Department of Obstetrics and Gynaecology, BPKIHS, Dharan, Nepal.
* Correspondence: pathakashmita6@gmail.com
Abstract: Hypertension is a chronic condition common in society and pregnant women are not exemption to it. Hypertension in pregnancy is defined as “systolic blood pressure of ≥140 mmHg and/or diastolic blood pressure of ≥90mmHg. There are various parameters of Pregnancy induced hypertension like serum uric acid levels, risk factors, maternal and fetal outcomes have been done in B.P.Koirala Institute of Health Sciences previously but there are limited data on serum lactase dehydrogenase level in pregnancy induced hypertension This study was aimed at assessing the serum LDH level in women with PIH that may help in predicting the degree of severity of the disease, maternal and fetal complications and guiding timely intervention whenever indicated in pregnancy induced hypertension at BPKIHS, Dharan, Nepal. It was a prospective observational study conducted in the Department of Obstetrics and Gynaecology, B.P.Koirala Institute of Health Sciences, Dharan. All Pregnant women with provisional diagnosis of pregnancy induced hypertension admitted in maternity ward of Obstetrics and Gynecology Department fulfilling inclusion criteria in antepartum period were taken for the study. This study demonstrated that higher level of LDH > 800IU/L was observed with increased severity of PIH like eclampsia. Serum LDH level >800 IU/L was more in women with maternal complications like postpartum hemorrhage, abruptio placentae, and HELLP syndrome. This study also showed that the birth weight was lower in serum LDH >800U/L group and the fetal weight decreased with increasing severity of PIH.
Keywords: Serum Lactate, Dehydrogenase, Pregnancy, Hypertension at BPKIHS
- INTRODUCTION
Hypertension is a chronic condition common in society and pregnant women are not exemption to it. Hypertension in pregnancy is defined as “systolic blood pressure of ≥140 mmHg and/or diastolic blood pressure of ≥90mmHg after 20 weeks of gestation on two occasions 4 to 6 hours apart but within a maximum of a week period in a woman with previously normal blood pressure [1]. Hypertensive disorders represents the most common medical complication of pregnancy affecting 7-15% of all gestations and account for a quarter of all antenatal admissions. Hypertensive disorders of pregnancy and their complications rank as one of the major cause of maternal mortality and morbidity in the world [2]. Together with hemorrhage and infection, hypertension forms deadly triad that contributes to maternal morbidity and mortality during pregnancy and childbirth [3]. It is strongly associated with fetal growth restriction and prematurity so it contributes largely to perinatal morbidity and mortality. According to the severity and organs involvement, hypertensive disorders in pregnancy (HDP) can be classified as gestational hypertension, preeclampsia (PE) and eclampsia syndrome, chronic hypertension and preeclampsia superimposed on chronic hypertension [4]. The incidence is more prevalent in developing countries. The World Health Organization (WHO) systematically reviewed maternal mortality worldwide and in developed countries, 16% of maternal deaths were reported to be due to hypertensive disorders. This proportion is greater than three other leading causes that include haemorrhage 13 %, abortion 8% and sepsis 2%. The incidence of preterm birth due to preeclampsia (PE) alone is around 15%.9 Preeclampsia is strongly associated with intrauterine fetal growth restriction, low birth-weight, spontaneous or iatrogenic preterm delivery, respiratory distress syndrome and admission to intensive care unit [5]. The incidence of pregnancy induced hypertension is more common in young and nulliparous women. However, multiparous pregnant women with a new partner have an increased risk of preeclampsia similar to that of nulliparous women [6]. Several medical conditions like chronic hypertension, diabetes mellitus, renal disease and hypercoagulable states are associated with increased risk for complications. Hypertensive disorders in pregnancy can have potentially dangerous complications. Its severity ranges from elevation of blood pressure to subnormal level, treated in out-patient department (OPD) basis with medical management to the level of eclamptic fits with multiple organ involvement leading to death. Development of pregnancy induced hypertension(PIH) is associated with increased long term maternal health risks like hypertension in later life, stroke, ischemic heart disease and metabolic syndrome [7]. It is a multi-system disorder in which organs are affected at cellular level affecting the hepatic, hematologic, renal, cardiovascular and cerebrovascular systems [8]. Complications of PIH depends on severity, duration of illness and its onset of period of gestational age. To explain its occurrence, several hypotheses has been proposed [9]. The spiral arterioles within the decidua basalis undergo extensive remodelling during normal implantation. Endovascular trophoblasts replace the vascular endothelial and muscular linings to form high flow less resistance vessels. In preeclampsia, trophoblastic invasion is incomplete [10]. As a result of this, endovascular trophoblasts line decidual vessels but not myometrial vessels. The deeper myometrial arterioles retain their endothelial lining and musculoelastic tissue, and their mean external diameter is only half that of corresponding vessels in normal placentas [11]. Poor trophoblastic invasion results in oxidative stress, hypoxia, and the release of factors that promote endothelial dysfunction, inflammation, and other possible reactions [12]. In general, the magnitude of defective trophoblastic invasion is thought to correlate with severity of the hypertensive disorders [13]. Lactate dehydrogenase (LDH) is an intracellular enzyme which converts pyruvic acid to lactic acid during the process of glycolysis [14]. Glycolysis is the major energy pathway in the placenta, hypoxia in preeclampsia further enhances glycolysis and increases LDH iso-enzyme activity in trophoblasts resulting in higher lactate production [15].It normally appears throughout the body in small amount but levels are several times greater inside the cells especially in RBC and hepatocytes than in the plasma [16].Tissue breakdown release LDH so its levels are increased in the scenario of increased cell leakiness, hemolysis and cell death and therefore LDH can be used as a biochemical marker for tissue breakdown [17]. Studies have shown that LDH activity are higher in placentas of preeclampsia than normal pregnancy. Preeclampsia is a multisystem disorder that leads to cell lysis and release of LDH [18]. So, serum LDH levels can be used to assess the extent of cellular death and thereby the severity of disease and occurrence of complications [19]. Pre-eclamptic patients with higher levels of LDH are at high risk of developing subsequent complications with poor maternal and fetal outcome [20]. This shows that LDH level is a useful and reliable biochemical marker in pre-eclampsia. Identification of these high risk patients with elevated LDH level, their close monitoring and prompt management may prevent these complications with subsequent decrease in maternal and fetal morbidity and mortality [21]. Serum LDH level is raised in PIH and indicate extent of cellular death thus helps in identifying severity of PIH and the occurrence of complications. These are preventable if identified at an earlier stage and can be managed. Close monitoring should be done with raised level of LDH level in pregnant women with PIH to prevent maternal and fetal morbidity and mortality [22]. Studies on various other parameters of Pregnancy induced hypertension like serum uric acid levels, risk factors, maternal and fetal outcomes have been done in B.P.Koirala Institute of Health Sciences previously but there are limited data on serum lactase dehydrogenase level in pregnancy induced hypertension [23]. Therefore, the present study was aimed at assessing the serum LDH level in women with PIH that may help in predicting the degree of severity of the disease, maternal and fetal complications and guiding timely intervention whenever indicated in pregnancy induced hypertension at BPKIHS, Dharan, Nepal.
- MATERIALS & METHODS
It is a hospital based Prospective Observational study, where all pregnant women with >20 weeks of gestation presenting to Obstetrics and Gynecology Emergency of B.P. Koirala Institute of Health Sciences, Dharan, with provisional diagnosis of pregnancy induced hypertension. Now using one sample mean formula to estimate sample size,
Where Z is the value from the standard normal distribution reflecting the confidence level that was used (e.g., Z = 1.96 for 95%),
SD: is the standard deviation of the outcome variable
µ: normal cut off value (according to Gupta et. al29.)
: 627 (according to Gupta et.al29.)
Then n= 290
But according to medical record of BPKIHS 2018, only 150 cases were admitted with pregnancy induced hypertension. Therefore, corrected sample size formula used to find out actual sample size:
However, the study considered all patients of pregnancy induced hypertension and was included in this study who attended BPKIHS during the study period. This was a prospective observational study conducted in the Department of Obstetrics and Gynaecology, B.P.Koirala Institute of Health Sciences, Dharan. All Pregnant women with provisional diagnosis of pregnancy induced hypertension admitted in maternity ward of Obstetrics and Gynecology Department fulfilling inclusion criteria in antepartum period were taken for the study.
- RESULTS & DISCUSSION
During the study a total of 166 cases of PIH were admitted in maternity and labor room for delivery. The total number of deliveries during study period was 8925. Among these, the total number of hypertensive disorder in pregnancy was 166 so the incidence of hypertensive disorder in pregnancy was 1.85% of total deliveries.
Table 01: Baseline characteristics of the PIH patient
Characteristics | N | Mean ±Std. Deviation |
Age (years) | 106 | 26.50±5.328 |
POG (weeks) at presentation | 106 | 36.95±3.768 |
POG (weeks) at delivery | 106 | 37.57±2.921 |
Height (cm) | 106 | 153.29±5.127 |
Weight (kg) | 106 | 66.29±11.408 |
Systolic BP (mmHg) | 106 | 149.81±13.521 |
Diastolic BP (mmHg) | 106 | 99.72±11.419 |
Hospital stay (days) | 106 | 5.18±3.499 |
Among the 106 patients enrolled in the study, the patients had mean age of 26.50±5.328 years, average POG at presentation to the hospital was 36.95±3.768 weeks, whereas mean POG at delivery of 37.57±2.921 weeks, the mean systolic blood pressure was149.81±13.521 mmHg, and diastolic blood pressure was 99.72±11.419 mmHg. The average length of stay in the hospital was 5.18±3.499 days. General analysis was done on variables like severity of PIH, age of patients, parity, gestational age at the time of delivery and serum LDH level calculating frequency and percentage.
Table 02: Number of PIH patients according to severity
PIH patients | Number | Percentage (%) |
Gestational Hypertension | 22 | 20.8 |
Non severe preeclampsia | 51 | 48.1 |
Severe preeclampsia | 27 | 25.5 |
Eclampsia | 6 | 5.7 |
Total | 106 | 100 |
Among 106 PIH patients, 22 (20.8%) had gestational hypertension, 51 (48.1%) non-severe preeclampsia, 27(25.5%) severe preeclampsia and 6 (5.7%) had eclampsia.
Figure 01: Distribution of age in patients with pregnancy induced hypertension
Among 106 patients enrolled in the study most of the cases i.e. 45 (42.5%) belonged to age group of 25-29 years. Age ranged from 16 years to 43 years and the mean age was 26.50±5.328 years.
Figure 02: Distribution of parity in patients with pregnancy induced hypertension
Among 106 patients, 51.9% were multiparous and remaining 48.1% of the patients were primiparous. Gestational age at the time of presentation in PIH
Table 03: Number of PIH patients according to gestational age at presentation in weeks
Gestational age in weeks (weeks) | Number of cases | Percentage (%) |
20-28 | 3 | 2.83 |
28-31 | 5 | 4.71 |
32-36 | 29 | 27.35 |
37-39 | 44 | 41.50 |
≥40 | 25 | 23.58 |
Total | 106 | 100 |
Among 106 patients, majority of PIH patients i.e. 41.50% presented at 37-39 weeks period of gestation (POG) followed by 28 patients(27.35%) at 32-36 weeks period of gestation.
Figure 03: Distribution of patients according to serum LDH level
Out of 106 PIH patients, 31 (29.2%) had LDH <600 IU/L, 36 (34.0%) had LDH 600-800 IU/L and 39 (36.8%) had LDH >800 IU/L. Serum LDH ranged from 113 to 2105 IU/L. Correlation of systolic and diastolic blood pressure was done with serum LDH level using Fischer exact test. Association of systolic blood pressure and serum LDH levels.
Figure 04: Association of systolic blood pressure and serum LDH levels.
Among 31 PIH patients who had SBP≥160mmHg 4(12.9%) had LDH<600 U/L, 9(29.03%) had LDH 600-800U/L and 18(58.06%) had LDH >800 U/L. The serum LDH levels increased significantly with higher systolic blood pressure (p value 0.008).
Figure 05: Association of diastolic blood pressure and serum LDH levels.
Among the 31 patients with DBP≥110mmHg, 3 (9.67%) patients had LDH<600U/L, 10(32.25%) had LDH 600-800U/L and 18(58.06%) had LDH >800 U/L. Serum LDH levels increased significantly with increasing diastolic blood pressure (DBP) (p value: 0.003).
Table 04: Severity of PIH according to LDH level
Severity of PIH | <600
N =31 |
600-800
N = 36 |
>800
N = 39 |
Total
N=106 |
P value |
Gestational Hypertension | 7
22.6% |
6
16.7% |
9
23.1% |
22 | 0.012 |
Non-severe preeclampsia | 21
67.7% |
19
52.8% |
11
28.2% |
51 | |
Severe preeclampsia | 3
9.7% |
9
25.0% |
15
38.5% |
27 | |
Eclampsia | 0 | 2
5.6% |
4
10.3% |
6 |
*Fisher’s exact test
Out of 39 patients having LDH >800IU/L, 4 (10.3%) were eclampsia, 15 (38.5%) severe preeclampsia, 11(28.2%) non-severe preeclampsia and 9 (23.1%) gestational hypertension (p value 0.012). So, LDH level increased with increasing severity of PIH. Hence it showed that with the increase in level of LDH, severity of PIH also increased.
Table 05: Severity of PIH patients with mean serum LDH
Severity of PIH | Mean serum LDH(IU/L) |
Gestational Hypertension | 817.55±345.05 |
Non severe preeclampsia | 665.55±235.34 |
Severe preeclampsia | 897.73±341.86 |
Eclampsia | 1135.67±513.01 |
Total | 782.75±330.27 |
P value | <0.001 |
*Anova test
There was significant rise in mean LDH levels with increasing severity of disease. The mean serum LDH was 817.55±345.05IU/L in gestational hypertension, 666.55±235.34IU/L in non-severe preeclampsia, 897.33±341.86IU/L in severe preeclampsia, and 1135.67±513.01IU/L in eclampsia (p value <0.001).
Figure 06: Association between severities of PIH with serum LDH level
Figure 06 depicts a scatter plot with scatter points indicating a statistically significant positive association between the severity of PIH and serum LDH levels (p value <0.001).
Table 06: Mode of delivery according to level of LDH
Mode of delivery | Serum Lactate dehydrogenase level (IU/L) | ||||
<600
N=31 |
600-800
N=36 |
>800
N=39 |
Total
N=106 |
P value | |
Vaginal delivery | 14
(45.2%) |
10
(27.8%) |
13
(33.3%) |
37
(34.9%) |
0.487 |
Vacuum Assisted Vaginal delivery | 0 | 1
(2.8%) |
2
(5.1%) |
3
(2.8%) |
|
Caesarean section | 17
(54.8%) |
25
(69.4%) |
24
(61.5%) |
68
(62.3%) |
*Fisher’s exact test
Among 106 patients, 37(34.9%) patients had vaginal delivery, 3(2.8%) had vacuum assisted vaginal delivery, and 68(62.3%) had caesarean section. There was 33.3% vaginal deliveries, 5.1%vacuum assisted vaginal deliveries and 61.5% caesarean section in patients with LDH >800 IU/L. However, it was not statistically significant. Maternal complications were correlated in relation to LDH level using Pearson Chi-square test and Fisher’s exact test.
Table 07: Maternal complications according to LDH level
Maternal complication | Serum Lactate dehydrogenase level (IU/L) | ||||
<600
N=31 |
600-800
N=36 |
>800
N=39 |
Total
N=106 |
P value | |
Yes | 0 | 2
(5.6%) |
10
(25.6%) |
12
(11.3%) |
0.001 |
No | 31
(100%) |
34
(94.4%) |
29
(74.4%) |
94
(88.7%) |
*Chi-square test
Among 106 cases, 12 (11.3%) developed maternal complications and was statistically significant (p 0.001). None of the complications developed in serum LDH <600IU/L groups, 2 (5.8%) patients had complications LDH 600-800IU/L group, and 10(25.6%) had complications in LDH>800IU/L group.
Figure 07: Complications of Pregnancy induced hypertension
Among 12(11.3%) patients having complications, the most common complication was postpartum hemorrhage, followed by abruptio placenta, HELLP syndrome and acute kidney injury. There was one maternal mortality.
Table 08: Complications of PIH according to LDH level
Maternal Complications | Serum Lactate dehydrogenase level (IU/L) | ||||
<600
N=31 |
600-800
N=36 |
>800
N=39 |
Total
N=106 |
P value | |
Abruptio placentae | 0 | 1
(2.8%) |
2
(2.1%) |
3
(2.8%) |
0.774 |
HELLP syndrome | 0 | 0 | 2
(5.1%) |
2
(1.9%) |
0.330 |
Postpartum hemorrhage (PPH) | 0 | 1
(2.8%) |
6
(15.4%) |
7
(6.6%) |
0.022 |
Maternal death | 0 | 0 | 1
(2.6%) |
1
(0.9%) |
1.00 |
Acute kidney injury(AKI) | 0 | 0 | 1
(2.6%) |
1
(0.9%) |
1.00 |
Fischer exact test
Among the PIH subjects in serum LDH>800IU/L group, most of them 12 (30.76%) had complications. Most common complication was postpartum hemorrhage (15.4%) which was statistically significant (p 0.022). The other complications were abruptio placenta (2.8%), and HELLP syndrome.
Table 09: Need of maternal ICU stay according to LDH level
Need of maternal ICU admission | Serum Lactate dehydrogenase level (IU/L) | ||||
<600
N=31 |
600-800
N=36 |
>800
N=39 |
Total
N=106 |
P value | |
Yes | 1
(3.22%) |
3
(8.33%) |
6
(15.4%) |
10
(9.4%) |
0.238 |
No | 30
(96.77%) |
33
(91.66%) |
33
(84.6%) |
96
(90.6%) |
*Chi square test
Out of 106 PIH patients, 10 (9.4%) needed ICU admission. Out of these 6 patients had LDH >800 IU/L, 3 cases had LDH 600-800 IU/L and 1 case was admitted with LDH<600 IU/L and the need of maternal ICU was comparable among the different serum LDH group. Among patients those required ICU care; 3 patients were of PPH, 3 eclampsia, 1 abruption placenta, 1 abruption with PPH, 1 abruption with HELLP syndrome, and 1 patient eclampsia with acute kidney injury. Perinatal complications were correlated in relation to LDH by using Pearson Chi square test, Fisher’s exact test and Anova test.
Table 10: Gestational age at the time of delivery in PIH according to LDH level
Gestational age at the time of delivery
In weeks (weeks) |
Serum Lactate dehydrogenase level (IU/L) | P value | |||
<600
N = 31 |
600-800
N= 36 |
>800
N=39 |
Total
N=106 |
||
20-28 weeks | 0 | 0 | 0
|
0 | 0.823 |
28-31 weeks | 0 | 1
(2.7%) |
3
(7.7%) |
4
(3.8%) |
|
32-36 weeks | 7
(22.5%) |
9
(25%) |
9
(25.6%) |
26
(24.5%) |
|
37-39 weeks | 17
(54.83%) |
17
(47.2%) |
16
(41.0%) |
50
(47.2%) |
|
≥ 40 weeks | 7
(22.5%) |
9
(25%) |
10
(25.36%) |
26
(24.5%) |
*Fisher’s exact test
Majority of PIH cases were in gestational age of 37-39 weeks at the time of delivery. Among PIH cases those having LDH level > 800 IU/L, 16 (42.1%) cases were in gestational age 37-39 weeks and it was comparable to other groups.
Table 11: Birth weight according to serum LDH level
Birth weight group | Serum lactate dehydrogenase level (IU/L) | ||||
<600
N=31 |
600-800
N=36 |
>800
N=39 |
Total
N=106 |
P value | |
<1500g | 1
(3.2%) |
2
(5.5%) |
6
(15.4%) |
9
(8.5%) |
0.013 |
1500-2499g | 4
(12.9%) |
11
(30.5%) |
15
(38.5%) |
30
(28.3%) |
|
2500-3999g | 26
(83.8%) |
21
(58.3%) |
18
(46.2%) |
65
(61.3%) |
|
≥4000g | 0 | 2
(5.5%) |
0 | 2
(1.9%) |
*Fisher’s exact test
There was significant (p 0.013) relationship between birth weight and LDH level. Increase in birth weight was seen in group with serum LDH<600U/L i.e. 1(3.2%) had birth weight <1500gm, 4(12.9%) had birth weight 1500-2499gm and 26(83.8%) had birth weight 2500-3999gm. Similarly low birth weight was seen in serum LDH >800U/L i.e. 6(15.4%) had birth weight <1500gm, 15(38.5%) had birth weight 1500-2499gm and 18(46.2%) had birth weight 2500-3999gm.
Table 12: Mean Gestational age at the time of delivery and mean birth weight according to LDH level
Fetal outcome | Serum Lactate dehydrogenase (IU/L) | ||||
<600
N=31 |
600-800
N=36 |
>800
N=39 |
Total
N=106 |
P value | |
Mean gestational age (weeks) at the time of delivery | 38.06± 2.20 | 37.78± 2.74 | 37.11±3.43 | 36.97±3.49 | 0.263 |
Mean birth weight (gm) | 2952.5±684.3 | 2739.7±745.9 | 2375.1±831.5 | 2667.8±791.8 | 0.007 |
*ANOVA
The mean gestational age at the time of delivery decreased successively with the increase in level of serum LDH. It was 38.06±2.20 weeks in women with LDH levels <600IU/l, 37.78±2.74 weeks when LDH levels were between 600 and 800 IU/L and 37.11±3.43 weeks in women with LDH levels >800 IU/l. There was no significant association between serum LDH level and mean gestation age at the time of delivery (p=0.263). The mean birth-weight decreased with the increase in LDH level which was 2952 ±684gm in women with LDH levels <600 IU/l, 2739±745gm in women with LDH levels between 600-800IU/l and women with >800 IU/l it was 2375.13±831.59gm which was statistically significant (p value- 0.007).
Table 13: Relation of Apgar score at 5 minutes and LDH level
Apgar score at 5 min | Serum Lactate dehydrogenase level (IU/L) | P value | |||
<600 | 600-800 | >800 | Total | ||
Apgar score 1-6 | 1
(6.3%) |
3
(11.4%) |
6
(16.7%) |
10
(9.4%) |
0.199 |
Apgar score ≥7 | 29
(93.8%) |
32
(88.6%) |
29
(83.3%) |
90
(90.1%) |
|
Total | 30 | 35 | 35 | 100 |
*6 cases were excluded (IUFD/Still birth)
There was no significant relation between Apgar score at 5 minutes and serum LDH level.Among 106 cases, neonates born to 10 patients (9.4%) had Apgar score between1-6 and neonates born to 90 patients (90.1%) had Apgar score ≥7.
Table 14: Perinatal complications according to LDH level
Perinatal outcomes | Serum Lactate dehydrogenase (IU/L) | ||||
<600
N=31 |
600-800
N=36 |
>800
N=39 |
Total
N=106 |
P value
(0.468) |
|
IUGR | 3
(9.67%) |
4
(11.1%) |
3
(7.7%) |
10
(9.4%) |
0.917 |
IUFD/Stillbirth | 1
(3.2%) |
1
(2.7%) |
4
(10.3%) |
6
(5.7%) |
0.371 |
Admission to NICU/Nursery/NNW | 2
(6.4%) |
3
(8.3%) |
7
(17.9%) |
23
(21.69%) |
0.563 |
Neonatal death(NND) | 0 | 0 | 1
(2.6%) |
1
(0.9%) |
1.00 |
In this study, it showed 10 (9.4%) of total PIH patients had IUGR. Among those having LDH level >800 IU/L, 3(7.7%) had IUGR. The study showed 6 (5.7%) IUFD. Among those having LDH level >800 IU/L, 4 (10.3%) had IUFD. Twenty three cases (11.3%) had admission to NICU/Nursery/NNW. The most common reason for admission was prematurity 7 neonates (30.43%), followed by meconium aspiration syndrome 5 neonates (21.73%), and respiratory distress syndrome 4 neonates (17.39%).Neonatal death occurred in 1 neonate (0.9%) who had meconium aspiration syndrome, and had LDH > 800 IU/L.
3.2 Discussion
Pregnancy induced hypertension is a multisystem disorder, it complicates 7-15 % of all pregnancies. It can progress to its severe form resulting in life threatening complications to the mother as well as fetus if timely interventions are not taken [24]. Worldwide, hypertensive disorder in pregnancy remains a leading cause of maternal mortality. According to practice bulletin 33 published by ACOG in 2002, it estimated that 10–15% of the 500,000 maternal deaths each year was due to PIH [25]. According to WHO 2012, four millions women across the world develop hypertensive disorder in pregnancy every year and it was estimated 50000 to 76000 women die of this condition every year. It is responsible for 15-20% of maternal death worldwide [26]. In Nepal, the maternal mortality was 239 per 1,00,000 live birth according to Nepal Demographic Health Survey 2016, hypertensive disorder in pregnancy being the second most common cause [27]. In the present study, among 106 patients enrolled, 75 (70.75%) patients had SBP between 140 -159mmHg and 31 (29.24%) patients had SBP ≥160 mmHg. Meanwhile, 75 (70.75%) patients had DBP between 90-109 mmHg and 31 (29.24%) patients had DBP ≥110mmHg. Those patients with severely increased systolic and diastolic BP had higher LDH levels. Among 31 PIH cases who had SBP ≥160 mmHg, 18 (58.06%) had LDH > 800 IU/L, 9 (29.03%) between 600-800IU/L and 4 (12.90%) had LDH <600 IU/L [28]. Similarly, among 31 PIH cases with DBP ≥110mmHg%, 18 (58.06%) had LDH>800 IU/L, 10 (32.25%) between 600-800 IU/L and 3 (9.67%) had LDH <600 IU/L [29]. Total 12 babies (11.3%) got admission to NICU/Neonatal ward/Nursery in present study. Among these 7(58.33%) babies whose mother had LDH level >800 IU/L, 3 (25%) babies mother had LDH 600-800IU/L and 2 (16.66%) babies got admitted [30].
- CONCLUSIONS
This observational study conducted in B.P. Koirala Institute of Health Sciences in department of Obstetrics and Gynecology to evaluate the association between serum LDH level and severity of PIH, maternal and fetal complications. This study demonstrated that higher level of LDH > 800IU/L was observed with increased severity of PIH like eclampsia. Serum LDH level >800 IU/L was more in women with maternal complications like postpartum hemorrhage, abruptio placentae, and HELLP syndrome. This study also showed that the birth weight was lower in serum LDH >800U/L group and the fetal weight decreased with increasing severity of PIH. This study also showed that more fetal complications like IUGR, IUFD and neonatal death were more common in PIH patients with LDH level >800 IU/L. Thus, increase in serum LDH level was associated with severity of PIH along with maternal and fetal complications.The result of present study also recommends further studies to evaluate the cut off value of LDH level at which fetal and maternal complications tend to occur.
REFERENCES
- Kavitha, L. B. (2020). Study of Serum Uric Acid Levels in First Trimester as a Predictor of Pre Eclampsia (Doctoral dissertation, Rajiv Gandhi University of Health Sciences (India)).
- Sitaula, S., Manandhar, T., Thapa, B. D., Shrestha, R., & Dharel, D. (2020). Prevalence of hemolysis, elevated liver enzymes, low platelet count syndrome in pregnant women in a tertiary care hospital. JNMA: Journal of the Nepal Medical Association, 58(226), 405.
- Saroja Poudel & Dr. Rajesh Niraula (2024). Comprehensive study of Placenta Previa & Its Psychological Consequences. Dinkum Journal of Medical Innovations, 3(02):174-187.
- Al Hayek, A., & Sobki, S. COMPARISON OF POINT-OF-CARE AND LABORATORY GLYCATED HEMOGLOBIN A1C AND ITS RELATIONSHIP TO TIME-IN-RANGE AND GLUCOSE VARIABILITY.
- Kavya, M. Y. (2019). To Study and Correlate the Severity of Birth Asphyxia with Serum Levels of Glucose, Uric Acid and Electrolytes in the Cord Blood of Asphyxiated Neonates (Doctoral dissertation, Rajiv Gandhi University of Health Sciences (India)).
- Preet, A., & Anand, A. R. (2023). A study on lactate dehydrogenase levels in hypertensive disorders of pregnancy and its correlation with feto-maternal outcome. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 12(8), 2470-2475.
- Shovit Dutta (2024). Knowledge & Practice about Personal Hygiene among Primary School Students in Rural Chattogram, Bangladesh . Dinkum Journal of Medical Innovations, 3(02):72-88.
- Murillo-Llanes, J., Varon, J., Pavel Gonzalez-Ibarra, F., Castro Apodaca, F. J., Mariscal-Juarez, J. A., Castillo-Lupio, D., … & Canizalez-Roman, A. (2024). Clinical features, biochemical markers, and acute phase reagents of inflammation in hypertensive crises of pregnancy. Critical Care & Shock, 27(2).
- Rahardjo, B., & Primarintan, T. N. (2023). Exploring The Relationship Between Lactate Dehydrogenase Levels, Leukocyte Counts, Low Birth Weight, and The Severity of Preeclampsia in Pregnant Women: A Cross-Sectional Study at Saiful Anwar Hospital Malang (July 2021 to June 2022). Asian Journal of Health Research, 2(2), 42-49.
- Anupama Sharma, Dr. Himanshu Shah & Dr. Vandana Mourya (2024). The evaluation of maternal morbidity and perinatal morbidity & mortality in Breech Delivery and Its Comparison with Mode of Delivery. Dinkum Journal of Medical Innovations, 3(02):89-101.
- Agrawal, Y. Study of Serum Lactate Dehydrogenase in Pregnancy Induced Hypertension Sangeeta B. Singh, Shikhaa Mahajan 2, SP Singh 3, Farah Deeba Khan 4, Asha Kumari 5.
- Fang, Z., Zheng, S., Xie, Y., Lin, S., Zhang, H., & Yan, J. (2023). Correlation between serum ferritin in early pregnancy and hypertensive disorders in pregnancy. Frontiers in Nutrition, 10, 1151410.
- Cai, X., Wang, T., & Xie, L. (2023). Lactate dehydrogenase is associated with flow-mediated dilation in hypertensive patients. Scientific Reports, 13(1), 768.
- Lewandowski, K. C., Tadros-Zins, M., Horzelski, W., Krekora, M., & Lewinski, A. (2023). Renin, Aldosterone, and Cortisol in Pregnancy-Induced Hypertension. Experimental and Clinical Endocrinology & Diabetes, 131(04), 222-227.
- Samrat Upadhya, Prachi Upadhya & Syeda Hajra Batool (2023). Perinatal Mortality Rate in South-Asian Countries: A Systematic Review. Dinkum Journal of Medical Innovations, 2(10):426-442.
- Varghese, B., Jala, A., Meka, S., Adla, D., Jangili, S., Talukdar, R. K., … & Adela, R. (2023). Integrated metabolomics and machine learning approach to predict hypertensive disorders of pregnancy. American Journal of Obstetrics & Gynecology MFM, 5(2), 100829.
- Rahardjo, B., & Primarintan, T. N. (2023). Exploring The Relationship Between Lactate Dehydrogenase Levels, Leukocyte Counts, Low Birth Weight, and The Severity of Preeclampsia in Pregnant Women: A Cross-Sectional Study at Saiful Anwar Hospital Malang (July 2021 to June 2022). Asian Journal of Health Research, 2(2), 42-49.
- Pradip Rijal, Aatiqa Tariq & Syeda Hajra Batool (2023). The Study of Differential Expression of Genes Controlling Reproductive Function in Immune Cells of PCOS Women. Dinkum Journal of Medical Innovations, 2(05):157-169.
- Awoyesuku, P. A., Ohaka, C., Altraide, B. O., Amadi, S. C., Iwo-Amah, R. S., Ngeri, B., & Jumbo, A. I. Maternal serum lactate dehydrogenase level as a predictor of adverse pregnancy outcome in women with severe preeclampsia. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 13(2), 202.
- Modak, R., Biswas, D. K., Talha, A., & Pal, A. Correlation of serum lactate dehydrogenase (LDH) level with feto-maternal outcome in normal pregnancy and preeclamptic disorders.
- Zainab, S., Akbar, A., Ehsan, A., Mushtaq, S., Tabbasum, H., & Ikram, M. (2024). Serum Lactate Dehydrogenase as an Indicator of Maternal and Neonatal Outcomes in Hypertensive Disorders of Pregnancy. Pakistan Armed Forces Medical Journal, 74(2), 451-454.
- Lungu, N., Popescu, D. E., Manea, A. M., Jura, A. M. C., Doandes, F. M., Popa, Z. L., … & Boia, M. (2024). Hemoglobin, Ferritin, and Lactate Dehydrogenase as Predictive Markers for Neonatal Sepsis. Journal of Personalized Medicine, 14(5), 476.
- Murillo-Llanes, J., Varon, J., Pavel Gonzalez-Ibarra, F., Castro Apodaca, F. J., Mariscal-Juarez, J. A., Castillo-Lupio, D., … & Canizalez-Roman, A. (2024). Clinical features, biochemical markers, and acute phase reagents of inflammation in hypertensive crises of pregnancy. Critical Care & Shock, 27(2).
- Shipman, A. R., Bahrani, S., & Shipman, K. E. (2024). Investigative algorithms for disorders affecting plasma lactate dehydrogenase: a narrative review. Journal of Laboratory and Precision Medicine, 9.
- Shipman, A. R., Bahrani, S., & Shipman, K. E. (2024). Investigative algorithms for disorders affecting plasma lactate dehydrogenase: a narrative review. Journal of Laboratory and Precision Medicine, 9.
- Zhou, Y., Xiao, C., & Yang, Y. (2024). Pre-pregnancy body mass index combined with peripheral blood PLGF, DCN, LDH, and UA in a risk prediction model for pre-eclampsia. Frontiers in Endocrinology, 14, 1297731.
- Olatunji, L. A., Badmus, O. O., Abdullahi, K. O., Usman, T. O., & Adejare, A. (2024). Depletion of hepatic glutathione and adenosine by glucocorticoid exposure in Wistar rats is pregnancy-independent. Toxicology Reports, 12, 485-491.
- Simon, S., Krishnan, V., & Ramachandran, L. (2024). A Hospital-based Study on assessing the significance of Serum Lactate dehydrogenase level in Preeclampsia and its association with Maternal and Fetal outcome. Research Journal of Pharmacy and Technology, 17(5), 2109-2113.
- Simon, S., Krishnan, V., & Ramachandran, L. (2024). A Hospital-based Study on assessing the significance of Serum Lactate dehydrogenase level in Preeclampsia and its association with Maternal and Fetal outcome. Research Journal of Pharmacy and Technology, 17(5), 2109-2113.
- Awoyesuku, P. A., Ohaka, C., Altraide, B. O., Amadi, S. C., Iwo-Amah, R. S., Ngeri, B., & Jumbo, A. I. Maternal serum lactate dehydrogenase level as a predictor of adverse pregnancy outcome in women with severe preeclampsia. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 13(2), 20
Publication History
Submitted: March 07, 2024
Accepted: March 16, 2024
Published: March 31, 2024
Identification
D-0265
Citation
Ashmita Pathak (2024). Association of Serum Lactate Dehydrogenase Level with Maternal & Fetal Outcome in Women with Pregnancy Induced Hypertension at BPKIHS. Dinkum Journal of Medical Innovations, 3(03):226-239.
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