Comparativestudy Of Coagulation Parameters And Gestational Outcomes Of Women With Hypertensive Disorders Of Pregnancy And High Normal Blood Pressure

Background:Hypertensive disorders of pregnancy(HDP)is a complex disease of pregnancy and high blood pressure,which can be injurious to the systems and organs.HDP endangers the health and life of the pregnant woman and the fetus.The condition can only be controlled but not cured before termination of pregnancy.Therefore,it is of great significance for early diagnosis and prevention of HDP.The central pathogenesis of HDP is maternal endothelial dysfunction.The injured endothelium may activate platelets and coagulation factors,that lead to dysfunction of the coagulation and fibrinolysis systems.So the coagulation parameters can be used as predictive factors of HDP.The platelet count(PLT),mean platelet volume(MPV),platelet distributing width(PDW),thrombin time(TT),prothrombin time(PT),activated partial thromboptastin time(APTT)and fibrinogen(FIB)are ideal indicators of coagulation function in HDP patients according to the researches in recent years.However,the present studies have not reached a completely unified conclusion due to the complicated changes of coagulation and fibrinolytic function in pregnant women with HDP.The guideline for the prevention,detection,evaluation,and management of high blood pressure in adults was officially issued by the American College of Cardiology Foundation(ACC),the American Heart Association(AHA),and Several authoritative organizations on November 13,2017.It modified the definition of high blood pressure as the systolic blood pressure(SBP)of 130-139 mm Hg or diastolic blood pressure(DBP)of 80-89 mm Hg,which is in the high normal blood pressure category according to Commentary on Chinese Guidelines for the Management of Hypertension in the Community(2014 revised edition).When blood pressure falls below 130/80 mm Hg,the risk of death is 27 per cent lower than when blood pressure falls below 140/90 mm Hg,the guidelines say.The new guidelines' classification of high blood pressure nearly doubled the incidence of high blood pressure in women between the ages of 20 and 44 from 10 percent to 19 percent,when most women are in the same age range.The purpose of the study is to know whetherthere is any difference about coagulation parameters and perinatal outcomes ofpregnant women ofhigh normal blood pressure from maternal of normal blood pressure and HDP.Methods:1.To collecte and retrospectively analyze the clinical datas of women prenatal examined and deliveried in Maternal and Child Health Hospital in Songjiang District on January 1,2015 solstice June 31,2017.They were divided into three groups according to blood pressureon the basis of Blood Pressure Measurement Guidance of China.Each group was sorted by the hospital number,and SPSS software was used for random sampling.500 cases were selected from each group.At least 2 times of non-same-day SBP of 130-139 mm Hg or DBP of 80-89 mm Hgishigh normal blood pressure group.At least 2 times of SBP?140mm Hg and DBP?90mm Hg is HDP group.SBP < 130 mm Hg and DBP < 80 mm Hg is normal blood pressure group.HDP group meeted the diagnostic criteria for HDP in obstetrics and gynecology(9th edition).High normal blood pressure group and normal blood pressure group were merged into non-hypertensive group,with 1000 cases.2.To collect all the information of three groups:age,basic blood pressure,education level,number of pregnancis,number of births,pre-pregnancy weight,pre-pregnancy BMI,pre-birth weight,gestational weight gain.Their PLT,MPV,PDW,TT,PT,APTT and FIB at second trimester and third trimester,their gestational outcomes about gestational anemia,oligohydramnios,placental abruption,postpartum hemorrhage,fetal distress,cesarean delivery,preterm birth,low birth weight,and compare the changes of the three groups.Results:1.Compared with the non-hypertensive group,the HDP group had higher basic blood pressure,higher proportion of junior high school and below.The ratio of Pre-pregnancy overweight,obesity,and excessive GWG are high in the HDP group.The HDP group is higherin TT,APTT and FIB in the second trimester,lower in PLT and APTT,buthigherin MPV,PDW,PT and FIB in the third trimester.The incidence of gestational anemia,oligohydramnios,placental abruption,postpartum hemorrhage,fetal distress,cesarean delivery,preterm birth,low birth weightin the HDP group were higher than the non-hypertensive group,and the differences were statistically significant(P <0.05).2.Compared with the normal blood pressure group,the women in the high normal blood pressure group had higher basal blood pressure,lower proportion of junior high school and below,lower pregnancy and parity.The ratio of overweight or obesity before pregnancy,excessive GWG in the high normal blood pressure group are higher in the normal blood pressure group.The PLT,TT,PT and FIB are high in the second trimester,PT and FIB are high in the third trimester.The rate of cesarean section is high.All the differences were statistically significant(P <0.05).3.Compared with the HDP group,the high normal blood pressure group are younger,had lower basal blood pressure,a lower proportion of junior high school education and below,and had lower ratios of overweight or obesity before pregnancy.The high normal blood pressure group had low TT and FIB,high PT in the second trimester,high PLT and APTT,low MPV,PDW,PTin the third trimester.The incidence of gestational anemia,oligohydramnios,placental abruption,postpartum hemorrhage,fetal distress,cesarean delivery,preterm birth,low birth weight in the high normal blood pressure group were lower than the HDP group,and the differences were statistically significant(P <0.05).Conclusion:1.The coagulation system in women with hypertensive disorders of pregnancy is hypercoagulable in the third trimester,and adverse pregnancy outcomes have increased significantly.Overweight,obesity before pregnancy,and excessive gestational weight gain are potential risk factors for hypertensive disorders of pregnancy.2.Pre-pregnancy body mass index and weight gain during pregnancy are high in normal high blood pressure pregnant women,but the coagulation function is not prone to hypercoagulability.Except for the increase in cesarean delivery,the adverse pregnancy outcomes have not increased significantly.3.Normal high blood pressure pregnant women do not need to be included in the management of hypertension during pregnancy at present,because the number is limited,more information is needed for larger data and long-term prospective studies.