The Study Of Thromboelastography In Severe Preeclampsia Complicated With HELLP Syndrome

Background:Pre-eclampsia(PE)is characterized by the development of hypertension and proteinuria after 20 weeks of gestation,along with multiple organ dysfunction.One severe complication associated with pre-eclampsia is the HELLP syndrome,an acronym denoting Hemolysis,Elevated Liver enzymes,and Low Platelet count.Its main clinical hallmarks are hemolysis,elevated liver enzymes and thrombocytopenia,and the incidence rate of this syndrome rages from 0.5%to 0.9%.The pathogenesis of preeclampsia is mainly related to the imbalance of coagulation-fibrinolysis system.Thromboelastogram(TEG)is an analyzer that can reflect the continuous dynamic process of coagulation and fibrinolysis.It is mainly used to comprehensively detect the whole process of coagulation and fibrinolysis and platelet function.Over recent years,its usage in clinical settings has expanded due to its ability to offer a complete picture of hemostasis,coupled with its advantages such as high sensitivity,swift detection,accurate data,and user-friendly results.Purpose:By detecting the general data,routine biochemical indexes,coagulation indexes and thromboelastogram of patients with severe preeclampsia and HELLP syndrome,we aim to ascertain the presence of any statistically significant differences.To explore the clinical guiding significance of TEG in the development of severe preeclampsia into HELLP syndrome.Method:In this study,the clinical data of 154 pregnant women with severe pre-eclampsia and severe pre-eclampsia complicated with HELLP syndrome from November 2018 to October 2021 were retrospectively analyzed.According to whether severe pre-eclampsia complicated with HELLP syndrome or not,they were divided into two groups,namely,15 cases complicated with HELLP syndrome(research group)and 139 cases complicated with severe pre-eclampsia(control group).The control group was divided into thrombelastogram group(83 cases)and thrombelastogram group(56 cases).The basic information of pregnant women and laboratory examination results were extracted from the medical records of pregnant women for analysis.The differences of general data,routine biochemical index+traditional coagulation index,routine biochemical index+traditional coagulation index+TEG between the two groups were compared.We aimed to construct a predictive model using TEG to identify high-risk patients with HELLP syndrome.Results:Compared to the control group,evaluation of age,gestational age at onset,gestational age at termination,and history of pre-eclampsia demonstrated that age was the only statistically significant factor.The incidence of severe pre-eclampsia with HELLP syndrome complication was higher in older pregnant women.Assessment of routine biochemical indices and traditional coagulation parameters indicated that total bilirubin(TBIL),alanine aminotransferase(ALT),aspartate aminotransferase(AST),lactate dehydrogenase(LDH),and creatinine(Cr)were elevated,whereas platelet count(PLT)was reduced(P<0.05).Traditional coagulation parameters such as prothrombin time(PT),activated partial thromboplastin time(APTT),and fibrinogen(FIB)showed no significant differences.When comparing the routine biochemical indices,trassditional coagulation parameters,and TEG to the control group,TBIL,AST,LDH,and Cr were elevated in the biochemical indices,whereas PLT was decreased(P<0.05).No significant differences were observed in traditional coagulation parameters(PT,APTT,and FIB),but the maximal amplitude(MA)in TEG was significantly reduced(P<0.05),with the remaining indices showing no significant differences.The predictive model(Model 2)constructed in this study has good prediction ability,which shows that thromboelastography is one of the risk factors for severe preeclampsia to develop into HELLP syndrome,and it can help medical staff to better screen the high-risk population of HELLP syndrome.Conclusion:1.Elderly pregnant women with severe preeclampsia need to be more vigilant about the occurrence of HELLP syndrome.2.When severe preeclampsia is complicated with HELLP syndrome,there is no significant difference in traditional coagulation indicators such as PT,APTT,and FIB.It is considered that physiological hypercoagulability is offset by consumptive hypercoagulability,but the number of platelets is reduced;In addition,liver and kidney function damage has significantly worsened.3.TEG provides a more sensitive and intuitive measure than traditional coagulation indices for detecting hypercoagulability in severe pre-eclampsia and hypocoagulability in HELLP syndrome patients.4.Thromboelastography can serve as a predictive indicator for the development of severe pre-eclampsia into HELLP syndrome.This assists healthcare professionals in better identifying populations at high risk for HELLP syndrome,improving treatment strategies,minimizing the incidence of adverse pregnancy outcomes,and thereby ensuring maternal and neonatal health.