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First Antenatal Visit Haematocrit and Pregnancy Induced Hypertension
Author(s) -
Goh Judith TW
Publication year - 1991
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1991.tb02810.x
Subject(s) - preeclampsia , medicine , pregnancy , aspirin , etiology , eclampsia , obstetrics , biology , genetics
EDITORIAL COMMENT: Women with severe preeclampsia often have a reduced circulatory blood volume and increased haematocrit. It was a nice idea to see if the booking haematocrit value was predictive of subsequent preeclampsia/severe preeclampsia. The answer in this study was negative but this should not be the end of the enquiry. It may be worth seeking such an associated/predictive test (with the possibility of prevention or amelioration of preeclampsia by rest, dietary measures and/or aspirin) at a later time in pregnancy since preeclampsia and its presumed provoking placental poison is not likely to be operative early in pregnancy. Alternatively further analysis of booking haematocrit values could be useful if the study group included a group of women who went on to develop early‐onset (before 3 7 weeks) severe preeclampsia ‐ such a study would require large numbers to recruit sufficient patients with severe preeclampsia Our reviewer when commenting on current views on the aetiology of preeclampsia stated that the ‘uteroplacental bed, primed by genetic factors and disturbed by immunological reactions, produces a biochemical defect (an imbalance between the placental production of the prostaglandins (prostacyclin and thromboxane ‐ the production of which is affected by aspirin)) which lead to placental ischaemia. Placental ischaemia in turn leads to release of uterine renin and an increase in angiotensin activity. These effects trigger reduction in plasma volume, increased coagulability and a vicious cycle of deteriorating organ function’. This thesis provided by our reviewer assumes that the low blood volume inpatients with severe preeclampsia does not antedate pregnancy. Summary: First antenatal visit haematocrit values during the first and second trimesters were retrospectively collected from 546 nulliparas with singleton pregnancies. The results were analysed for correlation with development of pregnancy induced hypertension (PIH) later in pregnancy. It was found that women with higher haematocrit values, especially over 0.40, had an increased risk of developing PIH. However, there appeared to be no absolute level of haematocrit which had sufficient discriminative value to be useful in clinical practice.