Abstract
Objective
The aim of the study was to find out the role of Serum lactate dehydrogenase in prediction of adverse outcomes of PE & E i.e., severity of disease and occurrence of complications.
Materials and Methods
This study was conducted in the Department of Obstetrics and Gynaecology, MGM Medical College, Indore. A total of 200 women were studied; they were divided into control (n = 100), severe pre-eclampsia (n = 32), eclampsia (n = 68). Demographic and hematological parameters were studied including LDH levels.
Results
The incidence of severe pre-eclampsia—1.2 % & Eclampsia 2.7 %, PE & E patients were significantly younger, with low gravidity and parity. They had significantly increased systolic and diastolic pressure, liver enzymes, uric acid, urine albumin, and LDH levels. Serum urea and creatinine were normal in majority of cases. The symptoms and complications of PE along with perinatal mortality were increased significantly in patients with LDH >800 IU/l compared with those who had lower levels. Complications like Retinopathy, ARF, Abruptio, DIC, CVA, MODS, Shock were also associated with high level of serum LDH >800 IU/L. Low birth weight of babies was also associated with high level of serum LDH levels in PE & E patients. The incidence of poor perinatal outcome was higher in PE & E patients with high serum LDH level (>600 IU/L).
Conclusion
LDH is the earliest marker seen in blood during hypoxia and oxidative stress. It is a useful biochemical marker that reflects the severity of and the occurrence of complications of PE & E; these are preventable if identified at an earlier stage and adequately managed at a higher center. Test is easily available, so screening of all cases of PE & E with LDH levels must be made mandatory.
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References
Craici I, Wagner S, Garovic VD. Pre-eclampsia and future cardiovascular risk: formal risk factor or failed stress test? Ther Adv Cardiovasc Dis. 2008;2(4):249–59.
Cunningham FC, Leveno KJ, Bloom SL, et al. Williams obstetrics. 23rd ed. New York: McGraw-Hill; 2010. p. 706.
Tsoi SCM, Zheng J, Xu F, et al. Differential expression of lactate dehydrogenase isozymes (LDH) in human placenta with high expression of LDH-A4 isozyme in the endothelial cells of pre-eclampsia villi. Placenta. 2001;22(317):22.
Kay HH, Zhu S, Tsoi S. Hypoxia and lactate production in trophoblast cells. Placenta. 2007;28(8-9):854–60.
Burd LI, Simmons MA, Makowski EL, et al. Placental production and foetal utilization of lactate and pyruvate. Nature. 1975;254:710–1.
Bougneres PF, Rocchiccioli F, Nurjhan N, et al. Stable isotope determination of plasma lactate conversion into glucose in fasting infants. Am J Physiol. 1995;268:E652–800.
Markert CL, Shaklee JB, Whitt GS. Evolution of a gene: multiple genes for LDH isozymes provide a model of the evolution of gene structure, function and regulation. Science. 1975;189:102–500.
Semenza GL, Roth PH, Fang HM, et al. Transcriptional regulation of genes encoding glycolytic enzymes by hypoxia-inducible factor 1. J Biol Chem. 1994;269:23757–63.
Hofmeyr GJ, Belfort M. Proteinuria as a predictor of complications of pre-eclampsia. BMC Med. 2009;7:11.
Tompkins MJ, Thiagarajah S. HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome: the benefit of corticosteroids. Am J Obstet Gynecol. 1999;181:304–9.
O’Brien JM, Milligan DA, Barton JR. Impact of high-dose corticosteroid therapy for patients with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Am J Obstet Gynecol. 2000;183(4):921–4.
O’Brien JM, Shumate SA, Satchwell SL, et al. Maternal benefit to corticosteroid therapy in patients with HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome: impact on the rate of regional anesthesia. Am J Obstet Gynecol. 2002;186:475–9.
Sibai BM. Diagnosis, controversies, and management of the syndrome of hemolysis, elevated liver enzymes, and low platelet count. Obstet Gynaecol. 2004;103(5):1–981.
Ali BS, Ghafoorian J, Alizadeh Sm. Severe pre-eclampsia and eclampsia in Kerman, Iran, complications and outcomes. Med Sci Monit. 2004;10(4):CR163–7.
Demir SC, Evruke C, Ozgunen FT, et al. Factors that influences morbidity and mortality in severe pre-eclampsia, eclampsia and hemolysis, elevated liver enzymes, and low platelet count syndrome. Saudi Med J. 2006;27(7):1015–8.
Qublan HS, Ammarin V, Bataineh O. Lactic dehydrogenase as a biochemical marker of adverse pregnancy outcome in severe pre-eclampsia. Med Sci Monit. 2005;11(8):CR393–7.
Liu D, Liu H, Zeng W. Clinical analysis of PIH with abnormal liver function in 66 patients. Hunan Yi Ke Da Xue Xue Bao. 1998;23(3):302–24.
Jaiswar SP, Gupta A, Sachan R, et al. Lactic dehydrogenase: a biochemical marker for preeclampsia–eclampsia. J Obstet Gynaecol India. 2011;61(6):645–8.
Kozic JR, Benton SJ, Hutcheon JA, et al. Abnormal liver function tests as predictors of adverse maternal outcomes in women with pre-eclampsia. J Obstet Gynaecol Can. 2011;33(10):995–1004.
Sonagra AD, Dattatreya K, Jayaprakash Murty DS. Serum LDH, ALP and uric acid in hypertensive disorders of pregnancy. Int J Pharm Bio Sci. 2012;2(3):201–9.
Compliance with ethical requirements and Conflict of interests
Study was done after taking consent from the cases enrolled and also permissions were taken from Institutional Ethical committee and the authors declare that they have no conflict of interest.
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Dave, A., Maru, L. & Jain, A. LDH (Lactate Dehydrogenase): A Biochemical Marker for the Prediction of Adverse Outcomes in Pre-eclampsia and Eclampsia. J Obstet Gynecol India 66, 23–29 (2016). https://doi.org/10.1007/s13224-014-0645-x
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DOI: https://doi.org/10.1007/s13224-014-0645-x