role of clinical parameters and laboratory tests for early identification and severity assessment of pregnancy induced hypertension

ABSTRACT

The purpose of this study is to evaluate the role of the clinical parameters and laboratory tests for early recognition and severity assessment of pregnancy-induced hypertension [PIH]]. Blood pressures, proteinuria, isometric handgrip exercise test, serum uric acid and plasma fibronectin were measured in 100 healthy normotensive primigravid women during the first, second and third trimesters of pregnancy and 7 days postpartum. Of the 100 gravid women, 85 did not develop clinical PIH [no PIH], 11 developed mild PIH and 4 demonstated severe PIH. The systolic, diastolic and mean blood pressures were significantly elevated [p< 0.001] in gravid women who developed PIH when compared to values of the normotensive gravid women from the 12 weeks' gestation onwards. Specificity, for predicting PIH early in pregnancy [13-20 weeks] with blood pressures [130 to 135 / 80 to 85 and MAP 90 to 95 mmhg], ranged from 79.2% to 86.6% and the negative predictive values [NPV] from 84.1% to 88.2%. The diastolic blood pressure had a high relative risk [4.9] among other blood pressure values. The isometric handgrip exercise tarts had a specificity of 90.3% and NPV of 92% with a relative risk [7.4] for PIH. The most significant difference [t=10.12; P< 0.001] of elevated uric acid values between women who developed PIH and the normotensive gravid women was observed form 35 to 35 weeks' gestation after the appearance of hypertension and proteinuria [29-34 weeks]. The specificity and NPV of uric acid were 45.1%, 42.2% respectively with a relative risk [1.5] Fibronectin increased from 83 +/- 15% in the first trimester to 190 +/- 37% of normal at term in women who developed PIH versus 75 +/- 20% to 88 +/- 15% in normotensive women. Fibronectin levels increased [13-20 weeks] earlier than the onset of hypertension and/or proteinuria [29-34 weeks] with specificity of 90.9%, NPV of 89.2% and a relative risk of 8.3. After delivery, fibronectin decreased only in PIH patients [t=9.57; P< 0.001]. A significant positive correlations [P< 0.001] between uric acid and fibronectin with MAP in patients with established PIH were observed