Objective: To study the adverse maternal and perinatal outcomes
in women with severe features of preeclampsia among different ranges of
proteinuria. Design: Prospective Cohort Study.
Setting: Department of Obstetrics and Gynaecology, Jawaharlal
Institute of Post-graduate Medical Education and Research (JIPMER),
Puducherry, India. Population: 202 singleton women with severe
features of preeclampsia. Methods: Women satisfying the
inclusion criteria were managed based on department protocol, assessed
based on delivery outcomes, adverse maternal and perinatal outcomes.
These women were followed up till 12 weeks postpartum. Main
Outcome Measures: Composite adverse maternal and perinatal outcomes
were recorded using ROC curves. Sensitivity, specificity, positive and
negative predictive values of proteinuria were used in predicting
adverse outcomes. Results: There was a significant association
between the values of antepartum 24-proteinuria and urine PCR
(p<0.001). There were 33 stillbirths (16.34%) and 19 neonatal
deaths (11.24%). 24-hour proteinuria was found to have a significant
correlation with composite adverse perinatal outcome (p=0.002) and
individual outcomes of NICU admission for >48 hours
(p=0.01) and neonatal sepsis (p=0.02) but not adverse maternal outcomes
(p=0.998). The optimum cut-off adverse neonatal outcomes was 905 mg
proteinuria/day (sensitivity-74.2%; specificity-51%). 15% of the
women had a persistently elevated urine PCR at 3 months postpartum.
Conclusion: In women with severe features of preeclampsia,
severe and massive proteinuria were related to composite adverse
perinatal outcome, but not composite adverse maternal outcome. 24-hour
urine protein, but not Urine PCR was significantly associated with
persistent proteinuria. The women with persistent postpartum proteinuria
(15%) require long term follow up to assess the development of chronic
renal diseases. Funding: No external funding was utilized for
this study. Keywords: hypertension, preeclampsia; proteinuria
Tweetable abstract: Proteinuria is associated with adverse
perinatal outcomes and persistent proteinuria in women with severe
features of preeclampsia.
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