Association between Coagulation Factors and Severity of Pre-eclampsia among Pregnant Women in Nigeria
E. I. Ezebuiro
Department of Obstetrics and Gynecology, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.
I. A. Onuah
Department of Surgery, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.
C. O. Onyemereze
Department of Obstetrics and Gynecology, Abia State University Teaching Hospital, Aba, Nigeria.
N. I. Ugwu
Department of Haematology & Immunology, Faculty of Basic Clinical Sciences, Alex Ekwueme Federal University, Ndufu-Alike, Ikwo, Ebonyi State, Nigeria.
F. C. Alumona
Department of Obstetrics and Gynecology, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.
K. K. Mba
Department of Physiology, Abia State University, Uturu, Nigeria.
C. J. Mba
Department of Physiology, Abia State University, Uturu, Nigeria.
U. P. Okite
Department of Haematology and Blood Transfusion, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.
S. N. Ikegwuonu
Medical Laboratory Scientist, Nosmaris Medical Diagnostic Ltd, Aguda, Surulere, Lagos State, Nigeria.
A. I. Airaodion
*
Department of Biochemistry, Lead City University, Ibadan, Oyo State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Pre-eclampsia remains a major cause of maternal and perinatal morbidity and mortality, particularly in low-resource settings. Alterations in coagulation and fibrinolytic pathways may contribute to disease progression and provide useful indicators of severity.
Aim: This study assessed the association between selected coagulation parameters and the severity of pre-eclampsia among pregnant women in Nigeria.
Research Methods: A hospital-based analytical cross-sectional study was conducted at the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria. Ninety-six pregnant women with pre-eclampsia were consecutively recruited, including 48 with severe features and 48 without severe features. Prothrombin time (PT), international normalised ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen and D-dimer concentrations were assessed. Data were analysed using appropriate comparative tests, correlation analysis, multivariable logistic regression and receiver operating characteristic (ROC) analysis, with statistical significance set at p < 0.05.
Results: Women with severe features had significantly prolonged PT (13.99 ± 1.21 versus 12.61 ± 0.78 seconds), higher INR (1.12 ± 0.10 versus 1.02 ± 0.07), prolonged aPTT (33.79 ± 4.57 versus 29.47 ± 3.12 seconds), and reduced fibrinogen concentrations (3.87 ± 0.69 versus 4.74 ± 0.65 g/L). Median D-dimer concentrations were also significantly elevated (2.48 versus 1.15 mg/L FEU; all p < 0.001). Coagulation abnormalities correlated significantly with blood pressure and platelet count. Multivariable analysis identified all five coagulation parameters as significant predictors of severe features (p < 0.001). D-dimer demonstrated the highest discriminatory performance (AUC = 0.946), with 77.1% sensitivity and 95.8% specificity.
Conclusion: Severe pre-eclampsia was associated with significant coagulation abnormalities. D-dimer showed particularly strong discriminatory potential and may complement clinical assessment in identifying women at increased risk of severe disease. Further validation is warranted.
Keywords: Pre-eclampsia, coagulation factors, disease severity, prothrombin time, fibrinogen, D-dimer, pregnancy