Preeclampsia is a multisystem progressive disorder characterized by the new onset of hypertension and proteinuria or the new onset of hypertension plus significant end-organ dysfunction with or without proteinuria, typically presenting after 20 weeks of gestation or postpartum. The pathogenesis involves both abnormal placentation and maternal systemic vascular dysfunction [1]. Approximately 90 percent of cases present in the late preterm (≥34 to <37 weeks), term, or postpartum period and have good maternal, fetal, and newborn outcomes; however, serious maternal and/or perinatal morbidity or mortality can occur. The remaining 10 percent of cases have an early presentation (<34 weeks) and are associated with higher risks of serious perinatal morbidity or mortality due to risks associated with moderately preterm, very preterm, or extremely preterm birth. Although the disorder always resolves in the days or weeks after birth, individuals with a history of preeclampsia are at increased risk of recurrence and increased lifetime risk for cardiovascular-related morbidity and mortality.

Hypertensive disorders of pregnancy (HDP) are among the leading causes of maternal and fetal morbidity and mortality worldwide [2]. Globally, there was a 10.92% (16.30-18.08 million) increase in the incidence of HDP from 1990 to 2019, with the highest regional incidence of 3.84 million in South Asia. The number of deaths due to HDP also increased by 30.05% from 1990, reaching approximately 27.83 thousand in 2019 [3]. The poor maternal and fetal outcomes in HDP are due to the lack of a single specific test that can identify pregnant women at risk for HDP [4].

One such test is serum uric acid (SUA), which can evaluate the severity of HDP and the associated maternal and fetal morbidity and mortality. SUA levels increase in HDP due to tissue breakdown, acidosis, decreased renal clearance, and increased activity of the xanthine oxidase/dehydrogenase enzyme [5,6]. In the first trimester, uric acid levels are<3mg/dl due to uricosuria and increased blood flow (oestrogen effect). and in 3 trimester it reaches upto4-5 mg/dl at term [7].

AIMS AND OBJECTIVE:

To Evaluation of   Perinatal Outcome in Women with Preeclampsia and its Association with Serum Uric Acid Levels: Case Control Study.

METHODOLOGY

A case control study was carried out from January 2020- July 2020, in the Department of Obstetrics & Gynaecology in a medical college and hospital. The study protocol was approved by the institutional ethics committee and institutional study adopting random sampling system sampling procedure. Total 120 participant were approached to project among them 22 were excluded due to technically criteria and 98 were included on the basis of fulling of the eligibility criteria

It was performed on 49 patients of preeclampsia (case group) and 49 normal pregnant women (control group) in between gestational age of 25-41weeks of pregnancy, who were admitted in the department of Obstetrics and Gynaecology of IIMSAR Haldia, both groups were compared for Prenatal outcome and impact of serum uric acid on preeclampsia.

The Inclusion criteria was: Patients of pre-eclampsia in between gestational age of 25-41 weeks of pregnancy. The exclusion criteria for both the groups were: 1. History of any treatment that may affect thyroid profile. 2. History of metabolic syndrome before or during pregnancy. 3. History of hypertensive disorder. 4. History of renal dysfunction. 5. Previous history of thyroid dysfunction in pregnancy and the post- partum period. 6. Previous history of congenitally malformed baby

After the approval of institutional ethical review board, consent from the heads of the educational institutions and the Participants were selected and oral assent from all the selected participants were obtained. A predesigned and pre tested questionnaire was used to interview the students. The data was analysed using SPSS. Participants were categorized into two groups, Case and Control Group.

All eligible candidates were examined physically and clinically by our team. All the Clinical investigation diagnosis were made by Gynaecologist on the basis of inclusion and exclusion criteria. Written consent was taken from all participants No any outsider was allowed in the camp.

RESULT

Total 120 participant were approached to project among them 22 were excluded due to technically criteria and 98 were included on the basis of fulling of the eligibility criteria

It was performed on 49 patients of preeclampsia (case group) and 49 normal pregnant women (control group) in between gestational age of 25-41weeks of pregnancy, who were admitted in the department of Obstetrics and Gynecology of IIMSAR Haldia, both groups were compared for Prenatal outcome and impact of serum uric acid on preeclampsia.

One hundred and Twenty participants were initially approached in the project and screened for inclusion in the study, following which 18.33 % of the participants were excluded while 98 were finally recruited. They were categorized into two groups: group A which comprised 49 pregnant women diagnosed with preeclampsia and group B which comprised 49 normotensive, nonproteinuric controls.

The mean maternal age and gestational ages of both subjects and control are presented in Table 1. The mean ages in both cases and control were 29.13 ± 5.31 and 27.15 ± 5.10, respectively, while the mean gestational ages in both wings were 37.81 ± 3.21 and 37.15 ± 2.31, respectively.

Table 1: Mean maternal age and gestational age of subjects

Up to 18.51% of the preeclamptic that were hyper- uricemia (>6 mg/dL) had special care baby unit admission as against 18.18% of those with normal serum uric acid level. However, this was statistically insignificant. Up to 19.04% of those preeclamptic with abnormal serum uric acid had stillbirth as against 3.57% of the preeclamptic that had normal serum uric acid level.

Table 2: Association between serum uric acid levels and pregnancy outcomes

Our findings also showed that 59.0% of those that were diagnosed with preeclampsia had severe preeclampsia and that 53.0% of the preeclamptic had abnormal uric acid (>6 mg/dL).

And it was also Found That Participants who have serum acid more than 6mg/dl were more severe pre-eclampsia as compared to normal uric acid participants. It was shown in table no 03.

Table3: Associationbetweenserumuricacidlevelsandseverityofpreeclampsia

In table 4 shows that the comparison between the mean arterial blood pressure between the preeclamptic (121.62 ± 10.15 mmHg) and nonpreeclamptics (78.20 ± 5.10 mmHg) which was statistically significant (P < 0.04). 

Table 4: Comparison of mean blood pressure between preeclamptic and nonpreeclamptics

In our study means Systolic bold pressure is (153.32 ± 13.41 mmHG) as compared to non-pre-eclampsia participants which is (111.23 ± 12.10 mmHG) In preeclampsia, a systolic blood pressure of 140 mm Hg or higher is a key diagnostic indicator. This threshold, along with other criteria like high diastolic pressure or proteinuria, helps confirm the diagnosis. If the systolic blood pressure is 160 mm Hg or higher, and/or the diastolic pressure is 110 mm Hg or higher, it indicates severe preeclampsia, which requires more aggressive treatment. 

DISCUSSION

In This Study it was found that one hundred and Twenty participants were initially approached in the project and screened for inclusion in the study, following which 18.33 % of the participants were excluded while 98 were finally recruited. They were categorized into two groups: group A which comprised 49 pregnant women diagnosed with preeclampsia and group B which comprised 49 normotensive, nonproteinuric controls.

In this study it was revealed that the mean maternal age and gestational ages of both subjects and control are presented in Table 1. The mean ages in both cases and control were 29.13 ± 5.31 and 27.15 ± 5.10, respectively, while the mean gestational ages in both wings were 37.81 ± 3.21 and 37.15 ± 2.31, respectively. similar study found in many research [8]

In preeclampsia, an increase in mean arterial pressure (MAP) is a key indicator and can be used for early detection and prediction of the condition. A MAP of 90 mmHg or higher in the second trimester has been shown to be a significant predictor of preeclampsia. While not all women with elevated MAP will develop preeclampsia, it's a valuable tool for identifying those at higher risk.[9] 

In our study it was seen that Up to 18.51% of the preeclamptic that were hyper- uricemia (>6 mg/dL) had special care baby unit admission as against 18.18% of those with normal serum uric acid level. However, this was statistically insignificant. Up to 19.04% of those preeclamptic with abnormal serum uric acid had stillbirth as against 3.57% of the preeclamptic that had normal serum uric acid level [10].

Elevated uric acid levels in pregnant women with preeclampsia are associated with increased risks of adverse maternal and perinatal outcomes. Specifically, high uric acid levels have been linked to increased rates of preterm delivery, low birth weight, and intrauterine growth restriction. Maternal complications associated with preeclampsia and high uric acid include severe hypertension, HELLP syndrome, and other organ dysfunction [11-14] 

Our findings also showed that 59.0% of those that were diagnosed with preeclampsia had severe preeclampsia and that 53.0% of the preeclamptic had abnormal uric acid (>6 mg/dL).

And it was also Found That Participants who have serum acid more than 6mg/dl were more severe pre-eclampsia as compared to normal uric acid participants. It was shown in table no 03. [15-16]

Table 4 shows the comparison between the mean arterial blood pressure between the preeclamptic (121.62 ± 10.15 mmHg) and nonpreeclamptics (78.20 ± 5.10 mmHg) which was statistically significant (P < 0.04)[17-19]

In our study means Systolic bold pressure is (153.32 ± 13.41 mmHG) as compared to non-pre-eclampsia participants which is (111.23 ± 12.10 mmHG) In preeclampsia, a systolic blood pressure of 140 mm Hg or higher is a key diagnostic indicator. This threshold, along with other criteria like high diastolic pressure or proteinuria, helps confirm the diagnosis. If the systolic blood pressure is 160 mm Hg or higher, and/or the diastolic pressure is 110 mm Hg or higher, it indicates severe preeclampsia, which requires more aggressive treatment.

Preeclampsia, a hypertensive disorder during pregnancy, can lead to both maternal and perinatal complications. High systolic blood pressure (SBP) is a key indicator and predictor of these complications, including prematurity, low birth weight, and increased perinatal mortality [20-22].

In this study it was found that study observed that SUA levels vary significantly in HDP, being higher in severe preeclampsia. Preeclampsia present at earlier weeks of gestation. In contrast, gestational hypertension presents mostly at term. There is an increased risk of ICU admission and preterm delivery in patients with high uric acid levels. There is also an increased risk of delivering low-birth-weight babies with high uric acid levels. The mean serum uric acid level in a preeclamptic is higher than that of normotensive, nonproteinuric women. Serum uric acid levels in patients with preeclampsia are associated with severity of the disease. There is significant association between serum uric acid levels in preeclamptic with peri- natal outcome. Significant increased number of low-birth- weight foetus was observed in babies born to hyper- uricemia preeclamptic mothers in comparison with babies born to normouricemic preeclamptic mothers.

SOURCE OD FUNDING: No

CONFLICT OF INTEREST: The authors report no conflicts of interest.

SUBMISSION DECLARATION: This submission has not been published anywhere previously and that it is not simultaneously being considered for any other Journal

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