Abstract
Pregnancy induced hypertension (PIH) is commonly encountered in hypertensive disease in pregnancy (HDP) and important cause of feto-maternal morbidity and mortality. Abnormal changes of placenta development in PIH leads to abnormal elevation of second trimester maternal hCG level. Thus, it may have a role in prediction of PIH. The objective of this study was to evaluate the ability of serum hCG levels during early second trimester to predict PIH and obstetric outcome at later gestation. We conducted a cohort study which comprised 34 pregnant women varying from 14–20 weeks of gestation with serum hCG level taken at points of recruitment. Serum hCG was measured by a chemiluminescent immunoassay. Three (8.8%) pregnant women developed late onset PIH while the remainder were normotensive. The diagnostic performance of second trimester hCG in predicting PIH as assessed by receiver operator characteristic curve was poor (AUC = 0.398). Multiple of median (MoM) were used to improve the hCG performance and MoM of >2 MoM were considered as elevated hCG level. All pregnancies with PIH had <2 MoM. In normotensive pregnancy, 29 (93.5%) women had hCG <2 MoM and 2 (6.5%) women had hCG >2 MoM (p>0.655). There was no significant association of hCG level and pregnancy outcome. In conclusion, estimation of second trimester hCG is a poor predictive marker for PIH. These findings are limited by the less number of hypertensive cases.
Keywords :
human chorionic gonadotrophin,
hypertension,
pregnancy,
Abstrak
Masalah hipertensi akibat kehamilan (PIH) adalah antara punca utama penyakit hipertensi di kalangan wanita hamil. Ia juga merupakan penyebab utama bagi morbiditi dan mortaliti terhadap ibu dan anak. Pertumbuhan serta perkembangan uri yang tidak normal di dalam PIH menyebabkan peningkatan paras hormon hCG di trimester kedua. Jesteru itu, hormon hCG mempunyai peranan di dalam ramalan kejadian PIH. Objektif kajian ini adalah untuk menilai keupayaan hormon hCG di trimester kedua dalam meramal kejadian PIH serta impak obstetrik. Kajian kohort ini melibatkan pengambilan darah bagi analisa paras hormon hCG bagi 34 orang wanita hamil di antara tempoh kehamilan 14-20 minggu. Analisa paras hormone hCG adalah melalui kaedah ‘chemiluminescent immunoassay’. Tiga orang wanita hamil (8.8%) menghidapi PIH manakala selebihnya adalah normal. Fungsi hormon hCG di trimester kedua dalam meramal PIH adalah rendah (AUC = 0.398). ‘Multiple of median’ (MoM) igunakan untuk meningkatkan keupayaan hormon hCG dengan nilai MoM melebihi 2 dianggap sebagai tahap hCG tinggi. Semua kehamilan dengan PIH mempunyai nilai <2 MoM. Bagi kehamilan normal, 9 (93.5%) mempunyai nilai <2 MoM dan 2 (6.5%) dengan nilai >2 MoM (p>0.655). Tiada hubungan yang signifikan antara tahap hormon hCG dengan impak kehamilan akibat PIH. Kesimpulannya, nilai hormon hCG pada trimester kedua sebagai penanda ramalan untuk PIH adalah rendah. Limitasi kajian adalah disebabkan kekurangan jumlah kes hipertensi.
Kata Kunci :
darah tinggi,
human chorionic gonadotrophin,
kehamilan,
Correspondance Address
Munirah Md Mansor. Department of Pathology,
Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak,
56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91459507 E-mail: dr.muni83@gmail.com
