Laboratory Ordering Practices in Pregnancy Induced Hypertension and Association of Haematological, Coagulation and Biochemical Parameters with the Severity of Pre-eclampsia
DOI:
https://doi.org/10.21276/apalm.3644Keywords:
Laboratory ordering practices, Perception survey, Cost assessment, InterventionAbstract
Background: Pregnancy induced hypertension (PIH) is a commonly encountered complication. The study aimed to evaluate the laboratory ordering practices for PIH at Shree Krishna Hospital (SKH), Karamsad to assess adherence to recommended guidelines for test ordering in PIH. By doing so, the study aims to standardize these practices across the Obstetrics and Gynaecology Department (OBGY). The study involves assessing laboratory parameters to differentiate between mild and severe pre-eclampsia. To evaluate the laboratory ordering practices in patients of pregnancy induced hypertension at the Department of Obstetrics and Gynaecology, Shree Krishna Hospital, Karamsad. To assess the association of haematological, coagulation and biochemical parameters with the severity of pre-eclampsia.
Methods: A retrospective and prospective observational study (DeC'22-Mar'24) included women with singleton pregnancies at 32-40 weeks gestation. Women with multiple pregnancies, chronic conditions, or a history of cardiac, liver, or renal disease were excluded. A total of 85 (30 mild and 55 severe PIH cases) participated in the study. The test ordering practices were assessed against FOGSI (Federation of Obstetric and Gynaecological Societies of India) guidelines. A perception survey was conducted targeting the residents and consultants of the OBGY Dept at SKH.
Results: The study demonstrated variable adherence to the recommended FOGSI guidelines. For coagulation tests 15.29%, for Serum Electrolytes 62.35% and for Urine Protein 84.70% compliance rate with guidelines was found. An amount of 89,050.0 Indian rupees was spent on additional laboratory tests. Survey response indicated that tests are often ordered "just to be safe". The statistical significance was found for haemoglobin, ALT, AST, and LDH levels between mild and severe PIH cases.
Conclusion: The study emphasizes a need for an improvement in managing PIH through better adherence to laboratory ordering guidelines as there was a notable inconsistency in following established protocols for laboratory testing that resulted in over utilization. The overall cost of these over-ordered tests was substantial enough (89,050 Rs) to impact both the hospital and the patients.
References
1. Kintiraki, Evangelia et al. "Pregnancy-Induced hypertension." Hormones (Athens, Greece) vol. 14,2 (2015): 211-23. doi:10.14310/horm.2002.1582
2. Ives. Christopher W et al. "Preeclampsia-Pathophysiology and Clinical Presentations: JACC State-of-the-Art Review." Journal of the American College of Cardiology vol. 76,14 (2020): 1690-1702. doi:10.1016/j.jacc.2020.08.01
3. High risk factors of pregnancy and their management at an ANC clinic under the Pradhan Mantri Surakshit Matritva Abhiyan (PMSMA) Accessed: https://pmsma.mohfw.gov.in/wp-content/uploads/2016/10/High-Risk-Conditions-in-preg-modified-Final.pdf
4. Kodiathodi S, Curpad S, Paul S. Should coagulation screen be performed in all patients with gestational hypertension and pre-eclampsia. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2010 Jun 1;95(Suppl 1):Fa55-. https://www.google.com/search?q=https://doi.org/10.1136/adc.2010.189753.72
5. Thompson, Xavier et al. "Implementation of a Clinical Decision Laboratory Ordering Algorithm for Preeclampsia: A Quality Improvement Initiative." Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC vol. 42,10 (2020): 1223-1229.e3. doi: 10.1016/j.jogc.2020.03.016
6. Jakes, Adam Daniel et al. "Reducing laboratory costs through rational testing in suspected pre-eclampsia." BMJ open quality vol. 11,1 (2022): e001684. doi:10.1136/bmjoq-2021-001684
7. Sedrak, Mina S et al. "Residents' self-report on why they order perceived unnecessary inpatient laboratory tests." Journal of hospital medicine vol. 11,12 (2016): 869-872. doi: 10.1002/jhm.2645
8. Boddapati A, Inuganti Venkata R, Riyaz P, B.V V, Deepak V. Hematological and Biochemical Abnormalities in Pregnancy-Induced Hypertension. jcbr 2022; 6 (2):12-20 http://jcbr.goums.ac.ir/article-1-355-en.html
9. Maged, Ahmed M et al. "Association of biochemical markers with the severity of pre-eclampsia." International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics vol. 136,2 (2017): 138-144. doi:10.1002/ijgo.12029
10. Kasraeian, Maryam et al. "Evaluation of serum biomarkers for detection of preeclampsia severity in pregnant women." Pakistan journal of medical sciences vol. 34,4 (2018): 869-873. doi:10.12669/pjms.344.14393
11. Chaware S A, Dhake R, Ingole A S, Bahattare V N, Bhopale K S. Study of coagulation profile in pre-eclampsia and eclampsia. Medpulse- International Medical Journal March 2015;2(3): 164-170
12. Dundy G, Kumar H, Chaurasia SK, Singh S. Comparison study of coagulation profile in normal term pregnancy and pregnancy induced hypertension. National Journal of Laboratory Medicine. 2020 Apr, Vol-9(2): P007-PO10. DOI:10.7860/NJLM/2020/37740:2390
13. Mirza AB. Coagulation Profiles in PIH-a) To determine coagulation index to distinguish severe preeclampsia from normal pregnancy b) to assess the correlation of coagulation parameters in normal pregnancy & in varying grades of pre-eclampsia. International Journal of Science and Research 2015;4(8):387-390. Paper ID: SUB157215
14. Khalid F, Mahendraker N, Tonismae T. HELLP Syndrome. [Updated 2023 Jul 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih/books/NBK560615/
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Jenish Christian, Monica Gupta
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).
