A study of the correlation of spot urinary protein - creatinine ratio in antenatal patients with hypertensive disorders on severity of preeclampsia, maternal organ dysfunction and its implication on perinatal outcomes

Abstract

To evaluate the correlation of spot urinary proteincreatinine ratio in single voided urine sample in antenatal patients with hypertensive disorders for assessing the severity of preeclampsia, maternal organ dysfunction and its implication in perinatal outcomes. Material and Methods: 150 cases of Pregnancy Induced Hypertension admitted in ward/Labour room of Department of Obstetrics & Gynaecology, SRMSIMS were studied and grouped into mild and severe preeclampsia depending upon blood pressure and clinical parameters. Midstream urine sample estimation for protein-creatinine ratio was done along with the biochemical parameters for renal and liver function tests. The correlation of spot urinary protein-creatinine ratio with severity of preeclampsia along with the derangements in fundoscopy, liver function and renal function tests with increasing severity of proteinuria using optimal protein-creatinine ratio of 0.3 and effects of Pre-eclampsia on perinatal outcomes were evaluated. Results: Protein-Creatinine ratio of 0.3 can be used as an optimal cutoff to detect the severity of preeclampsia. On evaluation of organ dysfunction in relation to Protein-creatinine ratio, a statistically significant p value was observed between increasing grades of pre-eclampsia with abnormal fundoscopy, abnormal renal function tests and abnormal liver function tests. While studying the fetal parameter in terms of IUFD, prematurity, low birth weight, APGAR < 7 at 5 minutes, NICU admission no statistically significant result was found with respect to the value of protein-creatinine ratio but still it was seen that protein creatinine ratio could be used as a single parameter for early detection of maternal organ dysfunction and perinatal outcome and thereby helps in management and improve prognosis. Conclusion:The optimal spot Protein-creatinine ratio cut off point of 0.3 can be used to assess the disease severity in hypertensive disorders of pregnancy and early detection of maternal organ involvement, maternal and perinatal outcomes. Clinical significance: Determination of protein/creatinine ratio is a valuable tool to determine the severity of disease and adverse maternal and perinatal outcomes.