A PROSPECTIVE OBSERVATIONAL STUDY ON PREDICTION OF PREECLAMPSIA IN EARLY PREGNANCY BY SPOT URINE PROTEIN-CREATININE RATIO
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 22
Abstract
BACKGROUND Hypertension and proteinuria are minimum criteria to diagnose preeclampsia. Proteinuria is called significant when there is excretion of more than or equal to 300 mg of urinary protein in 24 hrs. period. Even though 24 hrs. urine collection is the Gold standard for the diagnosis of significant proteinuria. Spot urine protein-creatinine ratio is a more rapid and convenient method to detect protein excretion.(1) Therefore, prediction of preeclampsia in early gestation is of utmost importance to detect and to intervene in the management of high-risk pregnancies much earlier to reduce the maternal death and foetal mortality and neonatal morbidity.(2) MATERIALS AND METHODS A prospective observational study was conducted during the period of January 2013 to November 2013. Women with 16 to 20 wks of gestation with singleton pregnancy, both Primi and Multigravida were included. A total number of 300 antenatal women who attended the antenatal clinic in the Department of Obstetrics and Gynaecology at Kilpauk Medical College. They were selected according to inclusion and exclusion criteria. Patient’s urine sample was collected and protein-creatinine ratio was estimated. Protein estimation was done using pyrogallol method. Creatinine estimation was done by modified Jaffe’s method and the ratio was obtained between the two. Patients were advised to attend the antenatal clinic every two weeks. In her follow-up visit she was examined thoroughly, especially her blood pressure and urine albumin was checked. Foetal well-being was assessed at each visit. RESULTS When age group was taken into consideration, about 42.9% developed preeclampsia and 5% did not develop preeclampsia in the age group <20 years. In the age group >30 years, 38.1% developed preeclampsia and 7.9% did not develop preeclampsia. There was statistical significance between normal cohort and preeclamptic cohort. In my study, about 81% preeclampsia occurred in primigravida and only 4.8% occurred in gravida 2 and gravida 3. About 9.5% of preeclamptic cohort and 2.2% of normal cohort were present among gravida 4. Among the people belonging to SE class 5, about 76.2% developed preeclampsia and 23.8% belonged to preeclamptic cohort in women belonging to SE class 4. There is no statistical significance with regard to SE class. About 47.6% of preeclamptic cohort were moderately obese patients. In my study group, preeclampsia did not occur in underweight persons. Only 9.5% of preeclampsia occurred in women with normal BMI and 33.3% in overweight individual. The variable BMI is also statistically significant. The cut-off value for urine PCR was taken as >0.45, to predict preeclampsia with 85.71% sensitivity and 99.64% specificity. When the cut-off value is reduced, the sensitivity increases. The area under the ROC curve for urine PCR is 0.964. CONCLUSION After analysing the study, it was found that urine spot PCR is a simple method and rapid test to predict preeclampsia. From this study, it was found that when the cut-off value for urine spot PCR was >0.45, the sensitivity was 85.71% and specificity was 99.64%. When the cut-off value is more, the specificity increases. It was also found that more number of preeclampsia occurred in women with increased pre-pregnant weight with increased BMI. Therefore, proper weight reduction will reduce the risk of developing preeclampsia. Urine spot PCR can be used to predict preeclampsia with a single random midstream urine sample when compared to 24 hrs. urine-protein estimation and routine dipstick method. Urine spot PCR can be used to predict preeclampsia in early gestation itself, so that the patient can be kept under proper surveillance with more frequent antenatal check-up and to detect the complications earlier to prevent maternal and foetal morbidity and mortality
Authors and Affiliations
Sabari Kasinathan, Nithiya Subbaiyan
Keywords
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- EP ID EP433364
- DOI 10.14260/jemds/2018/609
- Views 90
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