Coagulation and hematological variations in pregnancy: A cross-sectional study on hypertensive and normotensive females

Abstract

Objective: To evaluate and compare coagulation and hematological parameters in hypertensive and normotensive pregnant women.

Methods: This present cross-sectional study was carried out in the Departments of Pathology and Obstetrics & Gynaecology at Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri, Pune, India from September 2023 to March 2025. Hematological parameters [platelet count, mean platelet volume (MPV), platelet distribution width (PDW)] were analyzed using an automated hematology analyzer, while coagulation parameters [prothrombin time (PT)/international normalised ratio, activated partial thromboplastin time (aPTT), and D-dimer] were assessed by standard automated assays. Results were compared between normotensive and hypertensive groups and correlated with disease severity.

Results: The study included 212 antenatal females, with 106 normotensive pregnant women and 106 hypertensive women. Hypertensive women include cases of gestational hypertension (n=55); mild preeclampsia (n=39), and severe preeclampsia (n=12). A significant progressive decrease in platelet count and significant increases in MPV, PDW, PT, aPTT, and D-dimer levels were associated with increasing severity of pregnancy-induced hypertension (P<0.001). Women with severe preeclampsia had the lowest mean platelet counts and the highest coagulation parameter values compared to women with gestational hypertension, mild preeclampsia, and normotensive pregnancies. These findings indicate enhanced platelet activation, endothelial dysfunction, and activation of the coagulation-fibrinolytic system with worsening disease severity.

Conclusions: Significant hematologic and coagulation abnormalities were present in women with pregnancy-induced hypertension. For better maternal-fetal outcomes and early management, routine monitoring is essential.

Keywords

Pregnancy-induced hypertension / Coagulation profile / Platelet indices / Perinatal health / Preeclampsia / Gestational hypertension / Platelet count / D-dimer / Maternal outcomes

Conflict of interest statement

The authors declare no conflicts of interest to disclose.

Funding

The authors received no financial support for the research, authorship, and/or publication of this original article.

Authors’ contributions

Concept and design were performed by Dr Anoushka Sharma and Dr Yaminy Pradeep Ingale; data collection was carried out by Dr Anoushka Sharma and Dr Shilpa Kshirsagar; data handling was done by Dr Anoushka Sharma and Dr Narendra C. Kale; analysis was made by Madhura Gandhi; manuscript preparation was performed by Dr Anoushka Sharma, Dr Yaminy Pradeep Ingale and Dr Charusheela Gore.

Publisher’ s Note

The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

[1] Dundy G, Kumar H, Chaurasia SK, Singh S. Comparison study of coagulation profile in normal term pregnancy and pregnancy-induced hypertension. Natl J Lab Med 2020; 9(2): PO07-10.

[2] Gorasiya A, Shah I, Goswami H, Shah V. Study of coagulation profile and platelet count in pregnancy-induced hypertension, preeclamptic and eclamptic patients. Jnt J Clin Diagn Pathol 2021; 4(4): 75-79.

[3] Duley L. The global impact of pre-eclampsia and eclampsia. Semin Perinatal 2009; 33(3): 130-137.

[4] Roberts JM, August PA, Bakris G, Barton JR, Bernstein IM, Druzin M, et al. Hypertension in pregnancy: Executive summary. Obstet Gynecol 2013; 122(5): 1122-1131.

[5] Peng J, Zhao Q, Pang W, Li Y, Dong X. Changes of coagulation function and platelet parameters in preeclampsia and their correlation with pregnancy outcomes. J Clin Hypertens (Greenwich) 2024; 26(10): 1181-1187.

[6] Steegers EA, von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. Lancet 2010; 376(9741): 631-644.

[7] Mayrink J, Costa ML, Cecatti JG. Preeclampsia in 2018: Revisiting concepts, physiopathology, and prediction. Sci World J 2018; 2018: 6268276.

[8] Agarwal GS, Agrawal AK. Comparative study of coagulation profile and haematological parameters in pregnancy-induced hypertension. Cureus 2024; 16(9): e70529.

[9] Sharma B, Arora S, Kumar R, Bali IK. Platelet and coagulation parameters in pregnancy-induced hypertension and eclampsia: A tertiary hospital-based study. Int J Curr Res Rev 2021; 13(14): 82-88.

[10] Benedetto C, Marozio L, Tavella AM, Salton L, Grivon S, Di Giampaolo F. Coagulation disorders in pregnancy: Acquired and inherited thrombophilias. Ann N Y Acad Sci 2010; 1205: 106-117.

[11] Kuklina EV, Ayala C, Callaghan WM. Hypertensive disorders and severe obstetric morbidity in the United States. Obstet Gynecol 2009; 113(6): 1299-1306.

[12] El-Sayed AA. Preeclampsia: A review of the pathogenesis and possible management strategies based on its pathophysiological derangements. Taiwan J Obstet Gynecol 2017; 56(5): 593-598.

[13] Haram K, Svendsen E, Abildgaard U. The HELLP syndrome: Clinical issues and management. BMC Pregnancy Childbirth 2009; 9: 8.

[14] Indora PG, Agarwal P. A comparative study of coagulation profile and platelet indices at term in pre-eclamptic, eclamptic and normal pregnancy along with fetomaternal outcome. Int J Reprod Contracept Obstet Gynecol 2022; 11(9): 2368-2374.

[15] Upadya M, Rao ST. Hypertensive disorders in pregnancy. Indian J Anaesth 2018; 62(9): 675-681.

[16] Leduc L, Wheeler JM, Kirshon B, Mitchell P, Cotton DB. Coagulation profile in severe preeclampsia. Obstet Gynecol 1992; 79(1): 14-18.

[17] Sibai BM. Diagnosis and management of gestational hypertension and preeclampsia. Obstet Gynecol 2003; 102(1): 181-192.

[18] Easterling TR, Benedetti TJ, Schmucker BC, Millard SP. Maternal hemodynamics in normal and preeclamptic pregnancies: A longitudinal study. Obstet Gynecol 1990; 76(6): 1061-1069.

[19] Bhutani N, Jethani V, Jethani S, Ratwani K. Coagulation profile and platelet parameters in pregnancy-induced hypertension cases and normotensive pregnancies: A cross-sectional study. Ann Med Surg (Lond) 2022; 80: 104124.

[20] Haldar B, Barui G. Study of coagulation profile and platelet indices in pregnancy induced hypertension with special reference to preeclamptic and eclamptic patients. Int J Res Med Sci 2020; 8(3): 1114-1118.

[21] Chaware SA, Birare SD, Naigaonkar NV, Mahule SK. Comparative study of coagulation profile in pre-eclamptic and eclamptic patients with normotensive pregnant patients: A 2-year study. Indian J Pathol Res Pract 2017; 6(2): 445-449.

[22] Vijayalakshmi S, Kavitha D. Comparative analysis of coagulation profile in pregnancy-induced hypertension women and normotensive pregnant women in a tertiary care hospital. Int J Sci Res 2020; 9(1): 62-64.

[23] Chaithra H, Ramesh ST, Riyaz Ahmad. A comparative study of coagulation profile and haematological parameters in pregnancy induced hypertension (PIH). Trop J Pathol Microbiol 2021; 7(3): 150-154.

[24] Joshi SR, Tekwani DT, Bihade A, Joshi R, Murley D. Study of coagulation profile in pregnancy-induced hypertension. MedPulse Int Med J 2015; 2: 299-302.

[25] Chauhan P, Rawat U, Bisht V, Purohit RC. Comparison of coagulation profile in pre-eclamptic and eclamptic patients with normotensive pregnant patients. J Evol Med Dent Sci 2014; 3(12): 3208-3216.

[26] Nirmala T, Kumar PL, Vani BR, Murthy SV, Geetha RL. Study of coagulation profile in pregnancy-induced hypertension. Indian J Pathol Oncol 2015; 2(1): 1-6.

[27] Santos EV, Meirelles Filho J. Measurement of platelet parameters in normal and preeclamptic pregnant women. Rev Bras Ginecol Obstet 2004; 26: 201-206.

[28] Zangeneh M, Ebrahimi B, Veisi F, Khosravi SM, Rezavand N, Ghadami MR. Comparison of platelet indices and count in normal and preeclamptic pregnancies. Iran J Obstet Gynecol Infertil 2012; 15(25): 8-13.

[29] Dadhich S, Agrawal S, Soni M, Choudhary R, Jain R, Sharma S, et al. Predictive value of platelet indices in development of preeclampsia. J SAFOG 2012; 4(1): 17-21.

[30] Annam V, Srinivasa K, Yatnatti SK. Evaluation of platelet indices and platelet counts in pre-eclampsia and eclampsia. Int J Biol Med Res 2011; 2(1): 425-428.

[31] Dundar O, Yoruk P, Tutuncu L, Erikci AA, Muhcu M, Ergur AR, et al. Longitudinal study of platelet size changes in gestation and predictive power of elevated MPV in development of pre-eclampsia. Prenat Diagn 2008; 28(11): 1052-1056.

[32] Ceyhan T, Beyan C, Başer I, Kaptan K, Güngör S, İrfan A. Effect of preeclampsia on complete blood count and platelet indices. Ann Hematol 2006; 85(5): 320-322.

[33] Freitas LG, Alpoim PN, Komatsuzaki F, Carvalho MD, Dusse LM. Preeclampsia: Are platelet count and indices useful for its prognostic? Hematology 2013; 18(6): 360-364.

[34] Bhavana T, Vishal K, Prashant T. Platelet indices in pregnancy-induced hypertension. J Contemp Med Dent 2016; 4(3): 20-26.

[35] Deshpande HG, Jainani UR, Kiran AR, Saha S, Vanrajsinh HV. A comparative study of coagulation profiles in preeclamptic and normotensive patients in relation to maternal and fetal outcomes. Cureus 2024; 16(8): e67940.

[36] Vijaya C, Lekha MB, Shetty A, Geethamani V. Evaluation of platelet counts and platelet indices in pre-eclampsia and eclampsia. J Evol Med Dent Sci 2014; 3(12): 3216-3220.

[37] Namavar Jahromi B, Rafiee S. Coagulation factors in severe preeclampsia. Iran Red Crescent Med J 2009; 11(3): 321-324.

[38] Lone FA, Malik S, Ajaz S, Malik LA, Dar PM. Evaluation of coagulation profile in pregnancy-induced hypertension. Int J Adv Res 2018; 6(6): 501-506.

[39] Rahman R, Begum K, Khondker L, Majumder NI, Nahar K, Sultana R, et al. Role of D-dimer in determining coagulability status in preeclampsia. Mymensingh Med J 2015; 24(1): 115-120.

[40] Zaini R, Al-Rehaili A, Kufia R. Evaluation of plasma D-dimer concentration among normal and complicated pregnancies. Int J Womens Health Reprod Sci 2019; 7(1): 17-23.

[41] Khawaja U, Amin O, Afghan S, Tasnim N. Association between preeclampsia and high D-dimer levels. J Soc Obstet Gynaecol Pak 2019; 9(4): 200-203.

[42] Bozkurt M, Yumru AE, Sahin L, Salman S. Troponin I and D-dimer levels in preeclampsia and eclampsia. Clin Exp Obstet Gynecol 2015; 42(1): 26-31.

[43] Zhou H, Chen R, Liu X. Determination of plasma D-dimer in patients with pregnancy-induced hypertension. Zhonghua Fu Chan Ke Za Zhi 1997; 32(6): 347-349.