Chadha Arzoo, Tayade Surekha
Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, IND.
Cureus. 2022 Mar 20;14(3):e23341. doi: 10.7759/cureus.23341. eCollection 2022 Mar.
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. Results The sensitivity of UPCR for predicting adverse maternal outcomes was 79.37% (95% CI: 71.25-86.06), specificity was 46.67% (95% CI: 21.27-73.41), positive predictive value (PPV) was 92.59% (95% CI: 88.53-95.29), negative predictive value (NPV) was 21.21% (95% CI: 12.43-33.81), and the accuracy was 75.79% (95% CI: 67.97-82.69); for adverse fetal outcomes, the sensitivity was 76.98% (95% CI: 68.65-84.01), specificity was 13.33% (95% CI: 1.66-40.46), PPV was 88.18% (95% CI: 85.69-90.29), NPV was 6.45% (95% CI: 1.79-20.67), and the accuracy was 70.21% (95% CI: 61.94-77.62). Conclusion Based on our findings, UPCR is a simple laboratory tool that can help predict abnormal fetomaternal outcomes in preeclampsia with good sensitivity and PPV and can be used as an adjunct to assist in clinical decisions.
子痫前期是导致孕妇发病和死亡的主要原因，会导致不良的母婴结局。预测胎儿和母亲的健康结局将有助于早期干预，以减少进一步的损害。人们已经研究了各种生化检测方法，如β-人绒毛膜促性腺激素（β-HCG）、抑制素A、激活素A、妊娠相关血浆蛋白A（PAPP-A）、胎儿DNA以及彩色多普勒，以评估它们预测胎儿和母亲健康结局的能力；然而，这些检测方法大多复杂且昂贵。在众多表明妊娠高血压疾病结局严重程度的变量中，尿蛋白肌酐比值（UPCR）是一项重要指标。本研究的目的是找出UPCR与子痫前期母婴结局之间的关联。
对141例出现蛋白尿的子痫前期妇女进行了一项前瞻性观察研究，这些妇女被分为两组：UPCR<0.3的占11%，UPCR≥0.3的占89%。对这些患者进行随访直至分娩，观察母婴结局。
UPCR预测不良母亲结局的敏感性为79.37%（95%CI：71.25 - 86.06），特异性为46.67%（95%CI：21.27 - 73.41），阳性预测值（PPV）为92.59%（95%CI：88.53 - 95.29），阴性预测值（NPV）为21.21%（95%CI：12.43 - 33.81），准确性为75.79%（95%CI：67.97 - 82.69）；对于不良胎儿结局，敏感性为76.98%（95%CI：68.65 - 84.01），特异性为13.33%（95%CI：1.66 - 40.46），PPV为88.18%（95%CI：85.69 - 90.29），NPV为6.45%（95%CI：1.79 - 20.67），准确性为70.21%（95%CI：61.94 - 77.62）。
基于我们的研究结果，UPCR是一种简单的实验室工具，能够以良好的敏感性和PPV帮助预测子痫前期异常的母婴结局，可作为辅助手段协助临床决策。
