Estimation of proteinuria as a predictor of complications of pre-eclampsia: a systematic review (original) (raw)
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Role of proteinuria in defining pre-eclampsia: Clinical outcomes for women and babies
Clinical and Experimental Pharmacology and Physiology, 2010
1. The presence of proteinuria is not essential to the diagnosis of pre-eclampsia under many diagnostic consensus statements. The aim of the present study was to assess maternal and perinatal outcomes after proteinuric pre-eclampsia compared with other non-proteinuric disease presentations.
Critical analysis of proteinuria estimation methods in pre-eclampsia: A main research article
IP Innovative Publication Pvt. Ltd., 2017
Purpose of the study: The gold standard 24-hour urine collection method for protein estimation is inconvenient and is associated with a delay in laboratory analysis. This study was undertaken to analyse the salphosalicylic acid test, urine dip stick test, urine protein to creatinine ratio with 24-hour urine protein estimation in pre-eclampsia cases. Materials and Method: This is a comparative study and consists of a single group of 240 subjects. This study was conducted in the Department of Obstetrics and Gynecology in collaboration with the. The subjects included 240 pre-eclampsia women. A first voided morning sample was obtained for sulphosalicylic acid test, Dipstick test, urine protein and creatinine estimation, urine culture and Subsequent urine samples were collected for the 24-hour urine protein estimation. Main findings: For significant proteinuria sulphosalicylic acid test with 1+ proteinuria has sensitivity, specificity, PPV, NPV of 59%,48%,39%,67% where as 2+ has 44%, 88%, 75% and 67% respectively, dipstick test with 1+ proteinuria has sensitivity, specificity, PPV, NPV of 71%, 52%, 54%,70% where as 2+ has 49%, 87%, 75% and 69% respectively. The spot urine protein to creatinine ratio and 24-hour urine protein were significantly correlated (r=0.98; P<0.0001). The cutoff value for the protein to creatinine ratio as an indicator of protein excretion ≥300 mg/day was 0.285. The sensitivity, specificity PPV and NPV were 100%, 99.02%, 100% and 99% respectively. Conclusion: The spot urine protein to creatinine ratio is a better method for estimation of proteinuria in pre-eclampsia.
Proteinuria in preeclampsia: is it important?
Ginekologia polska, 2018
Our aim is to evaluate the laboratory results and proteinuria levels of preeclamptic women and their relation-ships to maternal and fetal outcomes. One hundred preeclamptic pregnant women who gave birth in our clinic between 2013 and 2015 were included in our study retrospectively. The data collected from the patients included gestational week, age, gravidity, parity, abortus history, blood pressure, biochemical parameters, delivery method, maternal hospitalization time, cesarean indication, complications, blood products required, plasmapheresis use and dialysis need. The details about the newborns were recorded retrospectively. The relationships between preeclampsia signs and maternal and neonatal out-comes were analyzed. The protein amounts were analyzed via 24-hour collected urine analyses and spot urine analyses. A statistically significant positive correlation was observed between neonatal intensive care unit needs and pro-teinuria levels. Fetal growth restriction, respiratory ...
Severe proteinuria as a parameter of worse perinatal/neonatal outcomes in women with preeclampsia
Pregnancy Hypertension, 2020
The present study aimed to determine the relationship between the severity of proteinuria and maternal/neonatal outcomes among women with preeclampsia. Study design: Proteinuria severity was measured at preeclampsia diagnosis and at delivery in 94 women with preeclampsia (among 2904 women with singleton pregnancies, who delivered after 22 gestational weeks). Preeclampsia was defined as hypertension with proteinuria. Main outcome measures: Protein:creatinine (P/C) ratio to worse the maternal outcome was 4.8 among women with preeclampsia. Results: The frequencies of HELLP syndrome and maternal pulmonary edema in women with a P/C ratio ≥5.0 (35.5% and 35.5%, respectively) were significantly higher than those in women with a P/C ratio < 5.0 (12.7%, P = 0.014 and 6.4%, P < 0.001, respectively). The best P/C ratio cutoff value to determine early-onset preeclampsia and early preterm birth (EPB) was 4.1 (P < 0.001 and P < 0.001, respectively). The best P/C ratio cutoff values to determine the interval between the preeclampsia diagnosis and delivery < 7 days and the need to undergo cesarean section were 1.8 and 1.5, respectively. The best P/C ratio cutoff value to determine maternal pulmonary edema and central serous chorioretinopathy (CSC) was 4.8 (P = 0.020 and P = 0.014, respectively). Finally, the best P/C ratio cutoff values to determine EPB and maternal CSC in women with preeclampsia were 4.1 (odds ratio, 10.9; 95% confidence interval; 4.08 to 29.2, P < 0.0001) and 4.8 (odds ratio, 17.6; 95% confidence interval; 0.898 to 344, P = 0.0008), respectively, according to the multivariate analysis. Conclusions: A higher P/C ratio at delivery in women with preeclampsia might cause EPB and CSC. However, in 2013, the ACOG removed the severity criteria of proteinuria from the diagnostic criteria for preeclampsia [7]. Thus, in 2015, the Japan Society for the Study of Hypertension in Pregnancy recommended that the termination of pregnancy among women with conservatively managed preeclampsia is not necessary merely because they have severe proteinuria. In 2018, the International Society for the Study of Hypertension in Pregnancy (ISSHP) defined presence of proteinuria is not necessary to diagnose preeclampsia [8]. In the current Japanese criteria for "Hypertension disorders in pregnancy" since 2018, preeclampsia was defined as onset hypertension since 20 GW with one or more other maternal complication(s) following proteinuria, including liver dysfunction without underlying liver diseases, perinatal
Cureus, 2022
Background and objective Preeclampsia is a major contributor to morbidity and mortality among pregnant women and leads to poor fetomaternal outcomes. Predicting fetal and maternal health outcomes will enable early interventions so as to reduce further damage. Various biochemical tests like beta-human chorionic gonadotropin (β-HCG), inhibin A, activin A, pregnancy-associated plasma protein-A (PAPP-A), fetal DNA, and color Doppler have been studied for their ability to predict fetal and maternal health outcomes; however, most of these tests are complex and costly. Among the many variables that indicate the severity of outcomes in hypertensive disorders of pregnancy, the urinary protein-to-creatinine ratio (UPCR) is an important index. The aim of the study was to find out the association between UPCR and fetomaternal outcomes in preeclampsia. Material and methods A prospective observational study was conducted among 141 women with preeclampsia presenting with proteinuria, who were divided into two groups: 11% with UPCR <0.3 and 89% with UPCR ≥0.3. These patients were followed up till delivery to look for maternal and fetal outcomes.
2017
Results: The mean resolution time of proteinuria was 3 days; 3.5 days in the SPE group and 2.1 days in the NSPE group (p=0.002). The resolution time of proteinuria had a good predictive value for poor maternal outcome with an ROC-AUC of 0.73 (95% CI 0.59–0.88; p=0.002), the sensitivity and specificity were 62.5% and 80.2%, respectively. Proteinuria lasted longer than 3 days related with a higher risk of poor maternal outcomes. The ROCAUC value of the resolution time of proteinuria for severe preeclampsia was found to be 0.70 (95% CI 0.61–0.80; p = 0.001). The sensitivity and specificity were 72.1% and 63.5%, respectively. Amount of proteinuria at diagnosis had a statistically significant relationship with the presence of proteinuria at discharge (OR 2.70; 97.5% CI 1.32–6.02; p = 0.0096).
Austin Journal of Reproductive Medicine & Infertility, 2019
Objective: To evaluate the diagnostic value of protein/creatinine (p/c) ratio in a single voided urine sample for quantitation compared to those of 24h urine sample in patient with pre-eclampsia. Patients and Methods: A prospective study was conducted in Basrah maternity and child hospital during the period from October 2013 to October 2014. The study involved 60 pregnant women with hypertension attending the antenatal clinic and admitted to obstetrics ward regardless the severity of the disease. The main measurement was estimation the urinary protein to urinary creatinine ratio by random direct measurement and a 24-hour urinary protein excretion. The data obtained was statically analyzed. Results: Out of 60 patients with gestational hypertension, 49 patients had significant proteinuria (>300 mg/day) and 11 patients had proteinuria less than (300 mg/day). Also, 17 out of 60 patients had p/c ratio <3 mg/dl and 43 patients had p/c ratio >3.5 mg/dl. The p/c ratio was able to correctly identify 42 out of 49 patients with significant proteinuria. It has been estimated that protein/creatinine ratio with sensitivity of 81.6%, specifity of 27.7% positive predictive value 93%, negative predictive value 70%, false positive rate 27.2%, false negative rate 18.3%. Conclusion: The study suggest that the p/c ratio in single voiding urine is highly accurate test (P<0.01) for discriminating between in significant proteinuria. This could be a reasonable alteration to the 24-hour collection for detection of significant proteinuria in hospitalized pregnant women with suspected preeclampsia.
Hypertension in Pregnancy, 2020
Objective: This study evaluated the association between proteinuria levels and maternal, and perinatal outcomes of preeclampsia patients and determined the cutoff values for predicting severe complications. Methods: We retrospectively evaluated the records of 412 patients with proteinuric preeclampsia. Results: Median proteinuria levels were significantly higher in patients with severe maternal and adverse perinatal outcomes than in those without such outcomes, except in cases of placental abruption and late preterm delivery. Conclusion: Proteinuria levels may aid in diagnosing preeclampsia and indicating early intervention. The revised guidelines do not suggest that proteinuria encountered during pregnancy is clinically insignificant.
Australian and New …, 2006
Background: Because of the importance of pre-eclampsia and proteinuria in pregnancy, a faster and simpler diagnostic method is needed. Aim: To compare random urine protein to creatinine ratio (p:c ratio) with 24-h urine protein excretion rate in pregnant women with a suspicion of pre-eclampsia. Methods: The study was conducted on 100 pregnant women with gestational ages of ≥ 20 weeks; 50 patients were suspected of having pre-eclampsia and 50 were healthy pregnant women. A random urine sample for p:c ratio determination and a 24-h urine sample for protein measurement were obtained. Results: All women suspected of having pre-eclampsia had significant proteinuria. The single-voided p:c ratio demonstrated a sensitivity of 94% with a specificity of 96% at the cutoff ≥ 0.2 mg/mg. There was strong correlation between the two methods in this group (r = 0.70, P < 0.001, R 2 = 49%). Using the same cutoff in the pregnant women who were not thought to have pre-eclampsia, the sensitivity of the test (p:c ratio) was 29% and the specificity was 87%. Pearson's correlation coefficient was 26 (P < 0.06). Negative predictive value and positive predictive value were 34 and 83%, respectively. Conclusion: There is a strong correlation between 24-h urine protein excretion and single-voided urine p:c ratio in women suspected of having pre-eclampsia. A single-voided p:c ratio of ≥ 0.2 mg/mg is highly predictive for significant proteinuria. However, this test was not found to be a reasonable alternative to 24-h urine collection; and it must be followed by 24-h urine collection in a clinically suspect patient with a p:c ratio of < 0.2 mg/mg.