INTRODUCTION:
Hypertensive disorder are amongst the most common medical disorder during pregnancy and considered to be a major cause of maternal and perinatal morbidity and mortality. In India incidence of preeclampsia as recorded from hospital statistics vary widely from 5-15%. Pre-eclampsia and eclampsia are still regarded as “disease of theories” and etiology is still obscured. An association of uric acid with PE has been known since long Several studies have correlated the rise in uric acid with the severity of the PE. Although hyperuricemia does co-relate with maternal morbidity, there is an even stronger association of increased uric acid with risk for small or LBW infants and with overall fetal mortality.
OBJECTIVE:
We aimed to assess whether serum uric acid can be used as a biochemical indicator in patients with gestational hypertension and its role in determining disease severity and maternal and perinatal outcome.
MATERIALS AND METHODS:
In this prospective case study conducted at Government Theni Medical College and Hospital, Tamil Nadu between June 2018 and June 2019, 200 singleton pregnant women with gestational hypertension at more than 20 weeks of gestational age were included. Hemoglobin, hematocrit, platelet count, liver function tests, uric acid levels, and maternal and neonatal complications were assessed. The severity of pre-eclampsia and eclampsia, placental abruption, pre-term labour, HELLP syndrome, post-partum hemorrhage, and hospitalization to the ICU were all considered maternal complications. Fetal complications included low birth weight, IUGR, 5-min APGAR scores <7, hospitalization to the NICU, and IUD.
RESULTS:
Of our 200 participants, 47% were primigravida, 60.5% were at 37 weeks or greater gestational age (USG determined), 45% had pre-eclampsia, 4% eclampsia, and 3% HELLP syndrome. Of all the participants, 33.5% had elevated levels of serum uric acid (>6 mg/dL). Of those with elevated serum uric acid levels (67 subjects), 7.5% (5 subjects) developed HELLP syndrome, 3% developed abruptio placentae, and 14.9% of the neonates died (IUD) (all considered statistically significant with p value < 0.05). There were no maternal death reported in our study. The rates of comparison for IUGR, pre-term birth/low birth weight, and spontaneous expulsion between those with normal
versus elevated serum uric acid levels were not considered statistically significant (p > 0.05).
CONCLUSION:
Our study concludes that the measurement of serum uric acid levels after 20 weeks of gestation is a great diagnostic and prognostic tool to assess fetal outcomes. This study shows that the estimation of serum uric acid levels in pregnancies complicated by hypertension and pre-eclampsia help in assessing the severity of the disease and identifying life-threatening maternal and fetal complications as a result of preeclampsia/eclampsia
