PROTEIN C AND PROTEIN S ABNORMALITIES IN PATIENTS WITH PLACENTAL ABRUPTION AND ITS ASSOCIATION WITH ADVERSE FETO-MATERNAL OUTCOME
Keywords:NICU, IUD, LSCS, SGA
Placental abruption is an important cause of maternal and fetal morbidity and mortality. Inherited thrombophilia, which includes Protein C and Protein S deficiency, is an important risk factor for abruption.
Objective: To find the prevalence of Protein C and Protein S abnormalities in patients with placental abruption and its association with adverse feto-maternal outcome.
Methods: A prospective observational study conducted in a tertiary hospital India from 2018 to 2020 for a period of 18 months. All pregnant women with abruption (n=254) were recruited. Peripheral blood samples of patients were collected in 3.2% sodium citrate vacutainers. All these coagulation investigations were performed on compact ceveron Alpha Automated Coagulation Analyzer(Compact bio-sciences Ltd),based on clotting, chromogenic and turbidimetric analysis. Adverse feto-maternal outcome was assessed by finding out the proportion of Prematurity, small for gestation age(SGA), Neonatal intensive care (NICU) admissions, Intra Uterine Death (IUD), number of maternal death, vaginal deliveries, caesarean section, blood transfusion
Result: 222 out of 254 cases had protein C in the normal range i.e 67-135 (87.40%). 1 patient had (0.39%) had protein C deficiency and rest 12.20% had protein C level greater than normal range. Out of 254 subjects no case had protein S deficiency. About 43.70% had normal protein S value(33-101).56.30% subjects had value greater than normal range .Range was between 53-148 and mean value was 103 ± 16.51.
Adverse fetal outcome was assessed in the patients having abnormal protein C and protein S values, here, mainly those having values greater than the normal range.
In our study 1.40% had NND, 6.99% had IUD, 8.39% had perinatal mortality, 39.16% had blood transfusion,26.57 % had LSCS, 40.56% had SGA, 29.32% NICU admission in subjects with abnormal protein S value. For those with normal protein S value 4.50% had NND, 6.31% had IUD, 10.81% had perinatal mortality, 39.64% had blood transfusion, 39.64 % had LSCS, 40.56% had SGA , 29.81% had NICU admission.
3.13% of those with abnormal protein C had IUD, 6.25% had perinatal mortality,3.13% had NND,34.38% had blood transfusion,43.75% had SGA babies,22.58% had NICU admission,25 % had LSCS. For those with normal values, 2.70% had NND, 7.21% had IUD, 9.91% had perinatal mortality, 40.09 % had blood transfusion, 40.54% had SGA, 30.58% had NICU admission,33.33 % had LSCS.
Conclusion: Protein C and Protein S deficiency was not found in our patients with abruption rather the values were greater than the normal range. No significant adverse feto-maternal outcome was found in patients with values of Protein C and Protein S greater than normal.
Keywords: NICU, IUD, LSCS, SGA
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