Association between Coagulation Factors and Severity of Pre-eclampsia among Pregnant Women in Nigeria

Abstract

Background: Pre-eclampsia remains a major cause of maternal and perinatal morbidity and mortality, particularly in low-resource settings. Alterations in coagulation and fibrinolytic pathways may contribute to disease progression and provide useful indicators of severity. Aim: This study assessed the association between selected coagulation parameters and the severity of pre-eclampsia among pregnant women in Nigeria. Research Methods: A hospital-based analytical cross-sectional study was conducted at the University of Port Harcourt Teaching Hospital, Rivers State, Nigeria. Ninety-six pregnant women with pre-eclampsia were consecutively recruited, including 48 with severe features and 48 without severe features. Prothrombin time (PT), international normalised ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen and D-dimer concentrations were assessed. Data were analysed using appropriate comparative tests, correlation analysis, multivariable logistic regression and receiver operating characteristic (ROC) analysis, with statistical significance set at p < 0.05. Results: Women with severe features had significantly prolonged PT (13.99 ± 1.21 versus 12.61 ± 0.78 seconds), higher INR (1.12 ± 0.10 versus 1.02 ± 0.07), prolonged aPTT (33.79 ± 4.57 versus 29.47 ± 3.12 seconds), and reduced fibrinogen concentrations (3.87 ± 0.69 versus 4.74 ± 0.65 g/L). Median D-dimer concentrations were also significantly elevated (2.48 versus 1.15 mg/L FEU; all p < 0.001). Coagulation abnormalities correlated significantly with blood pressure and platelet count. Multivariable analysis identified all five coagulation parameters as significant predictors of severe features (p < 0.001). D-dimer demonstrated the highest discriminatory performance (AUC = 0.946), with 77.1% sensitivity and 95.8% specificity. Conclusion: Severe pre-eclampsia was associated with significant coagulation abnormalities. D-dimer showed particularly strong discriminatory potential and may complement clinical assessment in identifying women at increased risk of severe disease. Further validation is warranted.