1. Evaluation of Protein C in Pregnant Nigerian Women
Theresa Nwagha1,, Uchenna Nwagha 2, Obike Ibegbulam 1 Sunday Ocheni1
1) Department of Haematology and Immunology University of Nigeria Teaching Hospital, Ituku Ozalla Enugu Nigeria, 2) Department of Obstetrics and Gynaecology University of Nigeria Teaching Hospital Ituku Ozalla Enugu Nigeria
Table2; Distribution of APC ratio among Respondents
Background
The physiologic changes in the haemostatic system during pregnancy tilts the balance towards hypercoagulability.1 Thromboembolic phenomenon is under reported among pregnant Nigerians. The paucity of data documenting changes in the haemostatic system and hence low index of clinical suspicion among obstetricians and care givers are hugely contributory to this
Results
Platelets:
Non pregnant controls= ( )x 109/l,
the pregnant subjects in the second trimester and third trimester = (42.81 )x109/l. and ( 49.63) x109/l respectively. ANOVA (<0.0001).
The post hoc multiple comparison : Non pregnant control subjects versus the pregnant subjects in their 2nd trimester of pregnancy (P<0.0001) the control subjects versus pregnant subjects in their 3rd trimester (P<0.0001) the 2nd trimester versus 3rd trimester (P=0.004). Figure 1 show trends in variation of Platelet count among the group.
APC ratio
Control (n/%)
2nd trimester (n/%)
3rd trimester (n/%) ≥4
42(54)
107(74)
56(39)
<4
8(16)
38(26)
89(61)
total
50(100)
145(100)
Ӽ2 value is df 2
Figure2; Variation in Prothrombin time between non pregnant and pregnant groups
Design and Aim of the Study
To establish the mean levels of activated protein C ratio (measure of protein C resistance), prothrombin time (PT), activated partial thromboplastin time (APTT) and platelet count in pregnant Nigerians We performed a prospective study in pregnant women who received ante natal care between May 2010 to November 2010 at the University of Nigeria Teaching Hospital in Enugu State, South Eastern Nigeria.
Patients and Methods
In the period of the study, two hundred pregnant women in the 2nd and 3rd trimester and 50 non pregnant female controls were recruited PCA ratio, (coagulometric assay) Prothrombin time (PT), Activated partial thromboplastin time and platelets count were determined. The Kinghawk semi-automated coagulometer KH 202 was used for the coagulation and Sysmex KX 21 for the platelet count. Data was analyzed using SPSS statistical software version 11 and Graph pad prism statistical software version 5.02 and Graph pad prism Stat mate version 2.00.
Table 1 shows demographic characteristics of pregnant women and their non pregnant controls
Figure 4; Trends in variation of Activated protein C ratio among the pregnant and non pregnant subjects
Figure3:Variation in APTT among pregnant and non pregnant groups
Fihure1:Trends in variation in the platelet counts among the group
Protein C2
Non pregnant controls and pregnant subjects in their second and third trimester with PCA ratio ≥4 were 20%, 52%and 27% respectively , APC sensitivity ratio ≤4 were 8%, 38% and 61% respectively. (Chi square analysis) (p=0.000) in the mean PCA ratio of the non-pregnant controls and the pregnant subjects =4.27(0.44), 3.87( 0.50) and 4.34 (0.43) respectively. ANOVA=(P<0.0001). 2
The post hoc multiple comparison = the non-pregnant control subjects versus pregnant subjects in their 3rd trimester and the pregnant subjects between the 2nd trimester versus 3rd trimester (P<0.0001). 2
The differences between non pregnant control subjects versus the pregnant subjects in their 2nd trimester of pregnancy were not contributory (P=0.671). . Table 2 shows distribution of APC ratio among respondents and Figure 4 shows trends in variation of Activated protein C ratio among the groups2
Conclusion
. There are changes in protein C activity (PCA ratio), PT, APTT and platelet count in our pregnant women. This largely would imply the possibility of thromboembolic disorders in pregnancy and hence the appropriateness of heightened index of clinical suspicion among our obstetricians and care givers
PT and APTT levels
Non pregnant controls =PT, ( 0.77) seconds, APTT (3.44) seconds.
Pregnant subjects in 2nd and 3rd trimesters ,PT=12.19( 0.84) seconds and 13.10( 2.09 )seconds respectively, APTT=36.83(3.61)seconds and 39.51(4.44) seconds respectively ANOVA (0.001).
Post hoc multiple comparison: PT and APTT of the control subjects versus the pregnant subjects in their 2nd trimester of pregnancy and pregnant subjects in second trimester versus the 3rd trimester= (P<0.0001), The differences noted between the control subjects versus pregnant subjects in their 3rd trimester for both PT and APTT were not contributory (P=0.960) and (P=0.642) respectively. Figure 2 and 3 show trends in variation of PT and APTT among the groups respectively.
Variables
Control
2nd trimester
3rd trimester
Age (Years)
23.92(5.96)
26.68(3.98)
Height (m)
1.63(0.06)
1.57(0.14)
Weight (Kg)
62.22(8.99)
71.60(14.52)
73.93(11.86)
BMI (Kg/m2)
23.19(3.08)
29.32(6.69)
32.67(12.73)
Parity
0.34(1.12)
2.50(1.62)
Gestational age (wks) -
21.2(3.8)
32.0(2.9)
References:
. Faught W, Garner P, Jones J, Ivey B. Changes in protein C and protein S levels in normal pregnancy. Am J Obstet Gynecol 1995; 172:
Nwagha UT, Nwagha UI, Ibegbulam OG, Ocheni S, Okpala I, Ezeonu PO, et al. Increased prevalence of activated protein C resistance during pregnancy may implicate venous thrombo embolic disorders as a common cause of maternal mortality in Nigeria. J Basic Clin Reprod Sci 2012;1:19-24.
Table1 Some demographic and anthropometric characteristic of the tesst and control sunjects)