Mahesh Sowmya, Borgohain Deepa
Department of Obstetrics and Gynaecology, Assam Medical College and Hospital, Dibrugarh, Assam India.
J Obstet Gynaecol India. 2020 Feb;70(1):30-35. doi: 10.1007/s13224-019-01264-w. Epub 2019 Sep 26.
Preeclampsia is a multisystem endothelial disease leading to glomeruloendotheliosis with endothelial leak causing significant proteinuria. It is associated with high maternal and fetal risks and fetomaternal morbidity and mortality. Spot urinary albumin-to-creatinine ratio (ACR) leads to earlier detection of glomerular damage leading to prompt management of preeclamptic patients.
To study the correlation between fetomaternal outcomes of preeclamptic patients with spot urinary ACR.
Spot urinary ACR was measured in 70 consecutive patients with preeclampsia in Assam Medical College, Dibrugarh. The best cutoff value to differentiate between significant and insignificant proteinuria was calculated. Mean spot urinary ACR was calculated in all maternal outcomes (mode of onset of labor and mode of delivery), and maternal complications (elevated liver enzymes, renal insufficiency, severe hypertension, coagulation disturbances and thrombocytopenia, antepartum and postpartum hemorrhage) and fetal complications and outcomes (birth weight, Apgar score, IUGR, need for resuscitation, NICU requirement, neonatal sepsis, jaundice and mortality) and the correlation were studied.
The best cutoff value to differentiate significant and insignificant proteinuria was calculated as 291.9 mg/g beyond which adverse fetomaternal outcomes and complications were seen. All maternal and fetal outcomes and complications had high mean spot urinary ACR and were found to be significant ( < 0.05). Mode of delivery and birth weight of babies showed no statistical significance though low-birth-weight babies had high mean spot ACR.
Compared with 24-h urinary protein excretion, spot urinary ACR is a simple and accurate indicator of significant proteinuria and helps to detect fetomaternal outcomes in preeclamptic women which may lead to prompt management to reduce fetomaternal complications.
子痫前期是一种多系统内皮疾病，可导致肾小球内皮病变，内皮渗漏引起大量蛋白尿。它与孕产妇和胎儿的高风险以及母婴发病率和死亡率相关。随机尿白蛋白与肌酐比值（ACR）可更早检测到肾小球损伤，从而及时管理子痫前期患者。
研究子痫前期患者随机尿ACR与母婴结局之间的相关性。
在迪布鲁格尔的阿萨姆医学院，对70例连续的子痫前期患者测量随机尿ACR。计算区分大量蛋白尿和少量蛋白尿的最佳临界值。计算所有孕产妇结局（分娩发动方式和分娩方式）、孕产妇并发症（肝酶升高、肾功能不全、重度高血压、凝血障碍和血小板减少、产前和产后出血）以及胎儿并发症和结局（出生体重、阿氏评分、宫内生长受限、复苏需求、新生儿重症监护病房需求、新生儿败血症、黄疸和死亡率）的平均随机尿ACR，并研究其相关性。
区分大量蛋白尿和少量蛋白尿的最佳临界值计算为291.9mg/g，超过该值可见不良母婴结局和并发症。所有孕产妇和胎儿结局及并发症的平均随机尿ACR均较高，差异有统计学意义（<0.05）。分娩方式和婴儿出生体重虽无统计学意义，但低体重婴儿的平均随机ACR较高。
与24小时尿蛋白排泄量相比，随机尿ACR是大量蛋白尿的简单准确指标，有助于检测子痫前期女性的母婴结局，从而可能促使及时管理以减少母婴并发症。
