Owaraganise Asiphas, Migisha Richard, Ssalongo Wasswa G M, Tibaijuka Leevan, Kayondo Musa, Twesigomwe Godfrey, Ngonzi Joseph, Lugobe Henry Mark
Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, Uganda.
Infectious Diseases Research Collaboration, Kampala, Uganda.
Obstet Gynecol Int. 2021 Aug 30;2021:9751775. doi: 10.1155/2021/9751775. eCollection 2021.
Preeclampsia is a priority obstetric emergency requiring urgent diagnosis and treatment to avert poor pregnancy outcomes. Nonproteinuric preeclampsia poses even greater diagnostic challenges due to contested diagnostic criteria by the clinical practice guidelines and variable clinical presentation. Previously, preeclampsia was only diagnosed if high blood pressure and proteinuria were present. This study determined the prevalence of nonproteinuric preeclampsia and associated factors among women admitted with hypertensive disorders of pregnancy at a referral hospital in southwestern Uganda.
Women with hypertensive disorders of pregnancy were consecutively enrolled in a cross-sectional study at Mbarara Regional Referral Hospital between November 2019 and May 2020. We interviewed all pregnant women ≥20 gestation weeks presenting with hypertension and obtained their sociodemographic, medical, and obstetric characteristics. We excluded women with chronic hypertension. We measured bedside dipstick proteinuria in clean-catch urine. Preeclampsia was defined as hypertension plus any feature of severity including <100,000 platelets/ul, creatinine >1.1 g/dl, and liver transaminases ≥twice upper normal limit with or without proteinuria. We defined nonproteinuric preeclampsia in participants with <+2 urine dipstick cut-off and determined the factors associated with nonproteinuric preeclampsia using logistic regression.
We enrolled 134 participants. The mean age was 26.9 (SD ± 7.1) years and 51.5% were primigravid. The prevalence of nonproteinuric preeclampsia was 24.6% (95% CI: 17.9-32.7). Primigravidity (aOR 2.70 95% CI: 1.09-6.72, = 0.032) was the factor independently associated with nonproteinuric preeclampsia.
Nonproteinuric preeclampsia was common, especially among primigravidae. We recommend increased surveillance for nonproteinuric preeclampsia, especially among first-time pregnant women, who may not be detected by the traditional criteria. Obstetrics care providers should emphasize laboratory testing beyond proteinuria, among all women with hypertensive disorders of pregnancy to optimally diagnose and manage nonproteinuric preeclampsia.
子痫前期是一种优先处理的产科急症，需要紧急诊断和治疗以避免不良妊娠结局。由于临床实践指南中诊断标准存在争议且临床表现多样，无蛋白尿性子痫前期带来了更大的诊断挑战。以前，只有在出现高血压和蛋白尿时才诊断为子痫前期。本研究确定了乌干达西南部一家转诊医院中因妊娠高血压疾病入院的女性中非蛋白尿性子痫前期的患病率及相关因素。
2019年11月至2020年5月期间，在姆巴拉拉地区转诊医院对患有妊娠高血压疾病的女性进行了一项横断面研究。我们对所有妊娠≥20周且患有高血压的孕妇进行了访谈，并获取了她们的社会人口学、医学和产科特征。我们排除了患有慢性高血压的女性。我们对清洁中段尿进行床边试纸法蛋白尿检测。子痫前期定义为高血压加上任何严重特征，包括血小板计数<100,000/μl、肌酐>1.1 mg/dl以及肝转氨酶≥正常上限的两倍，无论有无蛋白尿。我们将试纸法尿蛋白<+2的参与者定义为无蛋白尿性子痫前期，并使用逻辑回归确定与无蛋白尿性子痫前期相关的因素。
我们纳入了134名参与者。平均年龄为26.9（标准差±7.1）岁，初产妇占51.5%。无蛋白尿性子痫前期的患病率为24.6%（95%置信区间：17.9 - 32.7）。初孕（调整后比值比2.70，95%置信区间：1.09 - 6.72，P = 0.032）是与无蛋白尿性子痫前期独立相关的因素。
无蛋白尿性子痫前期很常见，尤其是在初产妇中。我们建议加强对无蛋白尿性子痫前期的监测，特别是在首次怀孕的女性中，她们可能无法通过传统标准被检测出来。产科护理人员应在所有患有妊娠高血压疾病的女性中强调除蛋白尿之外的实验室检查，以最佳地诊断和管理无蛋白尿性子痫前期。
