High serum lactate dehydrogenase levels as a prognostic marker for morbid perinatal outcome in pre eclampsia

Abstract

Introduction: Hypertension during pregnancy is an important causative factor of perinatal and maternal morbidity and mortality globally. There are several biochemical markers like ALP, AST, ALT, LDH, Uric acid to ascertain the severity of disease. The aim of our study was to determine the effectiveness of lactate dehydrogenase as a prognostic marker in assessing the sequalae of preeclampsia. Materials and Methods: This analysis was conducted at RMMCH in the Department of OB-GYN for a period of 2 years (2016-2018). It was a prospective case control study. A total of 60 antenatal mothers were included in the study, of which 30 were healthy pregnant females and 30 were pre eclamptics. Results: The mean values of serum LDH levels were found to be high in preeclamptics compared to normotensives which was significant statistically (p value of < 0.001). Adverse perinatal effects were seen in females with raised LDH levels (p value of <0.005). Conclusion: Serum LDH can be utilized as a prognostic marker to ascertain the severity of preeclampsia and it can also be used as a marker to predict the perinatal and maternal outcome. Introduction Hypertensive disorders represent the most prevalent medical complication of pregnancy affecting 7-15% of antenatal women and contribute to one quarter of all admissions 1. According to WHO systematic review on maternal mortality worldwide, hypertensive disease remains the foremost cause of direct maternal mortality along with the triad of hemorrhage and infection. Preeclampsia is a disorder affecting all the organ systems and is specific to pregnancy and puerperium, which manifests by commencement of hypertension and proteinuria >20 weeks gestation and resolves by 12 wks postpartum. The incidence of preeclampsia is 2-8% and is an important cause of perinatal and maternal mortality and morbidity. Defects in placentation and endothelial cell dysfunction are commonly understood pathophysiology of preeclampsia although the exact cause is still unclear 2-3. Endothelial cell dysfunction can contribute to inappropriate vasoconstriction, platelet aggregation, activation of the coagulation system and ultimately decreased blood flow to organs 4,5. Preeclampsia is greatly associated with restriction of fetal growth in utero, reduced birth weight, spontaneous or iatrogenic premature delivery, hyaline membrane disease and more admissions to NICU. Placental abruption, eclampsia, disseminated intravascular coagulation, intracranial hemorrhage, heart failure, hepatic failure and renal failure are the lethal maternal complications. Early screening of hypertension during pregnancy and preeclampsia may reduce perinatal and maternal complications. Lactate Dehydrogenase is an intracellular cytoplasmic enzyme required for interconversion of lactate to pyruvate during hypoxic states. There are five iso enzymes of LDH-LDH1, LDH2, LDH3, LDH4 and LDH5, LDH2 is predominant in serum. LDH is the earliest marker detected in blood during oxidative stress and hypoxia. Hypoxia in preeclampsia increases glycolysis and raises LDH. Quantitative measurement of serum LDH values reflects the range of cellular death and its association with various complications indicating its severity. Serum LDH levels can also be helpful in decision making for the betterment of perinatal and maternal outcome. The analysis of compilation of biomarkers, particularly markers related to vascular dysfunction like LDH and uric acid, may help in predicting and preventing complications in preeclampsia.