Delivery outcomes are presented in Table 3. Table 3. Neonatal outcomes are described in Table 4. There was no difference in the proportion of perinatal deaths between the groups.
Table 4. Odds ratios are presented in Table 5. Table 5. The optimal place of management inpatient vs. Current practice in the UK at the time of the study was to deliver a pre-eclamptic woman if she had uncontrollable blood pressure on maximal triple therapy , had deteriorating haematological or biochemical parameters or if there was evidence of substantial fetal compromise on fetal Doppler or cardiotocography.
Women were not routinely delivered after a set time period from diagnosis and therefore the variance in gestational age at delivery between the groups is likely to represent differences in clinical condition rather than predetermined management strategy. Women are also more likely to be delivered earlier, due to iatrogenic intervention. The large number of prospectively studied women is one of the major strengths of the study. Outcomes were collected by detailed case note review by dedicated researchers, rather than by relying on hospital coding which can be inaccurate.
Only women at high risk of developing pre-eclampsia were included in the trial and therefore a limitation of the study is the lack of healthy controls.
However, comparison between women with pre-eclampsia and women with hypertension chronic or gestational , usually managed as outpatients, provides a more clinically useful comparison.
Care was taken to exclude patients with renal disease, since they have higher risk of pregnancy related complications [ 13 ]. By some definitions, proteinuria is not required for the diagnosis of pre-eclampsia[ 14 ], and in others different thresholds for proteinuria to diagnose pre-eclampsia are given [ 5 ] [ 7 , 15 - 17 ]. Variable criteria and thresholds have been used in clinical guidelines and trials. Whilst we recognise that other parameters including severity of hypertension, biochemical abnormalities and fetal compromise are likely to guide decisions regarding delivery than proteinuria, a clinical threshold to guide professionals in antenatal care is important, in order to facilitate admission women at higher risk of adverse events.
For this reason we chose to evaluate thresholds used in current clinical practice, rather treating proteinuria as a continuous measure. Thornton and colleagues compared maternal and fetal outcomes in singleton pregnancies with pre-eclampsia diagnosed according to the Australasian Society of Study of Hypertension in Pregnancy Consensus Statement, and were considered to have non-proteinuric pre-eclampsia. Also, in common with the present study, Chan and colleagues showed parallels between adverse maternal and fetal outcomes and higher levels of proteinuria in women with proteinuric pre-eclampsia, although a specific cut-off for use as a screening test was not identifiable [ 22 ].
Our data suggest that the presence of proteinuria in women with hypertensive disorders of pregnancies is important and that the quantity of proteinuria is relevant to both maternal and neonatal outcomes, however there may be a threshold of proteinuria above which clinical outcomes are unchanged. Recently, the Pre-eclampsia Integrated Estimate of Risk Study PIERS study has evaluated the relationship between pregnancy outcome in pre-eclampsia and proteinuria in women, as assessed using dipsticks, spot urine protein: creatinine ratios or hour urine collections[ 17 ].
In contrast to the present study, it was concluded that proteinuria was overall unrelated to outcome. Indeed it is likely that the heterogeneity amongst these and many previous studies is a facet of the different diagnostic criteria employed in the definition of pre-eclampsia, which originates from incomplete comprehension of its pathophysiology and likely diverse aetiology[ 24 ].
An important distinction between our findings and others, are the additional co-morbidities in the women studied. Diagnosis and management of gestational hypertension and preeclampsia. Guide to clinical preventive services: report of the U. Preventive Services Task Force. Washington, D. The duration of hypertension in the puerperium of preeclamptic women: relationship with renal impairment and week of delivery. Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems.
Cochrane Database Syst Rev. Aspirin for the prevention of preeclampsia in women with abnormal uterine artery Doppler: a meta-analysis. Effect of antioxidants on the occurrence of preeclampsia in women at increased risk: a randomised trial.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv aafp.
Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Previous: The Patient with Daily Headaches. Next: Diagnosis and Treatment of Hypothermia. Dec 15, Issue. Diagnosis and Management of Preeclampsia. B 25 Pregnant women with diastolic blood pressure of to mm Hg or higher should receive antihypertension medication. C 4 , 5 Women at increased risk for preeclampsia who have low calcium intake should increase their calcium intake. Strength of Recommendations Key clinical recommendation Label References All pregnant women should be screened for preeclampsia at the first prenatal visit and periodically throughout the remainder of the pregnancy.
Preeclampsia as a Hypertensive Disorder of Pregnancy Figure 1. TABLE 2 Risk Factors for Preeclampsia Pregnancy-associated factors Chromosomal abnormalities Hydatidiform mole Hydrops fetalis Multifetal pregnancy Oocyte donation or donor insemination Structural congenital anomalies Urinary tract infection Maternal-specific factors Age greater than 35 years Age less than 20 years Black race Family history of preeclampsia Nulliparity Preeclampsia in a previous pregnancy Specific medical conditions: gestational diabetes, type I diabetes, obesity, chronic hypertension, renal disease, thrombophilias Stress Paternal-specific factors First-time father Previously fathered a preeclamptic pregnancy in another woman Information from references 4 and 8.
Read the full article. Get immediate access, anytime, anywhere. Choose a single article, issue, or full-access subscription. Earn up to 6 CME credits per issue. Purchase Access: See My Options close. Best Value! To see the full article, log in or purchase access. More in Pubmed Citation Related Articles. Email Alerts Don't miss a single issue. Sign up for the free AFP email table of contents. Navigate this Article. Severe preeclampsia. Pregnancy-associated factors.
Chromosomal abnormalities. Oocyte donation or donor insemination. Structural congenital anomalies. Urinary tract infection. Maternal-specific factors. Age greater than 35 years. Age less than 20 years. Family history of preeclampsia. Preeclampsia in a previous pregnancy. Paternal-specific factors. However, studies about the association of the amount of proteinuria and the severity of preeclampsia, and perinatal outcomes are limited.
Data on women with preeclampsia were retrospectively collected from a university teaching hospital from September to June and analysed. Chin J Obstetrics Gynecol. Hypertension in pregnancy. Obstet Gynecol. Article Google Scholar. Isolated proteinuria is a risk factor for pre-eclampsia: a retrospective analysis of the maternal and neonatal outcomes in women presenting with isolated gestational proteinuria.
J Perinatol. Does proteinura in preeclampsia have enough value to predict pregnancy outcome? Clin Exp Obstet Gynecol. Guidelines for the diagnosis and treatment of hypertensive disorders complicating pregnancy Chin J Obstet Gynecol. Maternal and fetal outcome in women with gestational hypertension in comparison to gestational proteinuria: a 3-year observational study.
Hypertens Pregnancy. Association of proteinuria threshold in pre-eclampsia with maternal and perinatal outcomes: a nested case control cohort of high risk women. PLoS One. Role of proteinuria in defining pre-eclampsia: Clinical outcomes for women and babies. Clin Exp Pharmacol Physiol. Hypertensive disorders of pregnancy: ISSHP classification, diagnosis, and management recommendations for international Practice. Non-proteinuric pre-eclampsia: a novel risk indicator in women with gestational hypertension.
J Hypertens. Preeclampsia: maternal systemic vascular disorder caused by generalized endothelial dysfunction due to placental Antiangiogenic factors.
Int J Mol Sci. Yang Z. Etiology and Management of Oligohydramnios. J Pract Obstet Gynecol. Perinatal outcomes in preeclampsia that is complicated by massive proteinuria. Protein creatinine ratio in random urine sample of hypertensive pregnant women: maternal and perinatal outcomes. Maternofoetal complications and their association with proteinuria in a tertiary care hospital of a developing country.
J Pregnancy. Proteinuria in pre-eclampsia: how much matters? Pregnancy Hypertens. Download references. All authors contributed to the article. XL and HH provided summaries of previous research studies. All authors read and approved of the final manuscript. You can also search for this author in PubMed Google Scholar. Correspondence to Ling Chen. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Correlation test between various diagnostic indicators and adverse outcomes. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material.
If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
Reprints and Permissions. Lei, T. Proteinuria may be an indicator of adverse pregnancy outcomes in patients with preeclampsia: a retrospective study. Reprod Biol Endocrinol 19, 71
0コメント