Tejaswi Mannava Sai, Kanthi Mangala Janu, Vinya Paladugu, Bhaskaran Renjitha
Department of Obstetrics and Gynecology, Amrita Hospital, Kochi, India.
Department of Biostatistics, Amrita Hospital, Kochi, India.
J Obstet Gynaecol India. 2023 Feb;73(1):51-56. doi: 10.1007/s13224-022-01712-0. Epub 2022 Sep 28.
Hypertensive disorders of pregnancy are first identified during pregnancy (gestational hypertension, pre-eclampsia, eclampsia, and HELLP syndrome) or may present as a complication of previously existing disease (chronic hypertension, renal disease, and systemic disease). These hypertensive disorders complicate the pregnancy, leading to significant maternal and perinatal morbidity and mortality, especially in low- and middle-income countries (Chappell in Lancet 398(10297):341-354, 2021). These hypertensive disorders are about 5-10% of all pregnancies.
This is a single institutional study, which was conducted among 100 normotensive asymptomatic antenatal women at, 20-28 weeks of gestation attending our OPD. Voluntary participants were selected based on inclusion and exclusion criteria. Spot urine sample was taken for estimation of UCCR by an enzymatic colorimetric method. These patients were followed up throughout the pregnancy and monitored for the development of pre-eclampsia. UCCR is compared in both groups. Pre-eclampsia women were further followed up to observe the perinatal outcomes.
Among 100 antenatal women, 25 of them developed pre-eclampsia. UCCR of < 0.04 was considered as cutoff and compared between pre-eclampsia and normotensive women. This ratio yielded a sensitivity of 61.54%, specificity 87.84%, positive predictive value 64%, and negative predictive value of 86.67%. It was also observed that primigravida had more sensitivity (83.3%) and specificity (91.7%) in predicting pre-eclampsia compared to multigravida. The mean and median UCCR among pre-eclamptic women was significantly low (0.062 ± 0.076, 0.03) compared to normotensive women (0.15 ± 0.115, 0.12) with a value of < 0.001.
Spot UCCR is a good predictor of pre-eclampsia in primigravida women and can be considered as a routine screening test at 20-28 weeks of gestation during regular antenatal visits.
妊娠高血压疾病首次在孕期被识别（妊娠期高血压、子痫前期、子痫和 HELLP 综合征），或可能表现为既往存在疾病的并发症（慢性高血压、肾病和全身性疾病）。这些高血压疾病使妊娠复杂化，导致显著的孕产妇和围产期发病率及死亡率，尤其是在低收入和中等收入国家（查佩尔，《柳叶刀》398(10297):341 - 354，2021 年）。这些高血压疾病约占所有妊娠的 5 - 10%。
这是一项单机构研究，在我院门诊就诊的 100 名血压正常、无症状的妊娠 20 - 28 周的产前妇女中进行。根据纳入和排除标准选择自愿参与者。采集随机尿样，采用酶比色法估算尿肌酐清除率（UCCR）。在整个孕期对这些患者进行随访，并监测子痫前期的发生情况。比较两组的 UCCR。对子痫前期妇女进一步随访以观察围产期结局。
在 100 名产前妇女中，25 人发生了子痫前期。UCCR < 0.04 被视为临界值，并在子痫前期妇女和血压正常妇女之间进行比较。该比值的敏感性为 61.54%，特异性为 87.84%，阳性预测值为 64%，阴性预测值为 86.67%。还观察到，与经产妇相比，初产妇在预测子痫前期方面具有更高的敏感性（83.3%）和特异性（91.7%）。子痫前期妇女的 UCCR 均值和中位数（0.062 ± 0.076，0.03）显著低于血压正常妇女（0.15 ± 0.115，0.12），P 值 < 0.001。
随机 UCCR 是初产妇子痫前期的良好预测指标，可在妊娠 20 - 28 周定期产前检查时作为常规筛查试验。
