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EVIDENCE OF EARLY DISSEMINATED INTRAVASCULAR COAGULATION IN PRE‐ECLAMPSIA

PRELIMINARY studies suggest that the coagulation abnormalities of pre-eclampsia may become recognizable at the very earliest detectable stages of the disorder. In particular, evidence of platelet consumption may be simply detected by a fall in platelet count at this stage. In this study, 119 hypertensive pregnant women were followed serially for a minimum of 42 days with measurements of plasma uric acid and platelets. A rise in plasma uric acid has been used as a marker of the time of onset of superimposed pre-eclampsia. Serial changes in platelet count have been measured in three groups of women. Sixty-seven women showed no change in plasma uric acid; 24 women had a mild elevation of plasma uric acid (50 to 100 pmol/l increment from baseline); and 28 women had a moderate or severe elevation of plasma uric acid (more than 100 pmol/l increment from baseline). The two groups with raised plasma uric acid developed significantly depressed platelet counts at delivery compared to the non-pre-eclamptic group with no change in plasma uric acid. In the group with moderate or severe hyperuricaemia the platelet count was significantly depressed compared to baseline readings at the time the uric acid began to rise-which was on average 43 days before delivery. This confirms that the low platelet count of pre-eclampsia is an early feature of the disorder.