Perinatal outcomes in preeclampsia that is complicated by massive proteinuria

Newman, Mark; Robichaux, Alfred G.; Stedman, Charles M.; Jaekle, Ronald; Fontenot, M.; Dotson, T.; Lewis, David F.

doi:10.1067/mob.2003.84

Cited by 96 publications

(91 citation statements)

References 9 publications

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“…Similarly massive proteinuria defined as protein >10 g/24 h is associated with early onset preeclampsia, early gestational age at delivery, and prematurity. [20] However in terms of fetal outcome once this is controlled for prematurity there are no associated adverse events seen with proteinuria hence it is the prematurity that is the cause of all adverse events and not the degree of proteinuria. A recent systematic review concluded that the level of proteinuria does not correlate with maternal and fetal outcome.…”

Section: Diagnosis and Prognosismentioning

confidence: 99%

Preeclampsia: A review of the evidence

Jido

Yakasai

2013

Ann Afr Med

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Preeclampsia is a common complication of pregnancy associated with high maternal and perinatal morbidity and mortality especially in developing countries. There is considerable progress in the understanding of the pathophysiology and the management of the diseases, although the aetiology and primary pathology remained elusive. Integration of current evidence in the clinical management of the condition has witnessed improved maternal and fetal outcomes in many societies. In developing countries variations in management often not based on current evidence accounts for comparatively higher morbidity and mortality. This article aims to provide an overview of our present understanding of preeclampsia help care providers and our managers focus practice and policy to reflect existing evidence.

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Section: Diagnosis and Prognosismentioning

confidence: 99%

Preeclampsia: A review of the evidence

Jido

Yakasai

2013

Ann Afr Med

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“…6 From a number of small, heterogeneous studies, heavy proteinuria (5 g/d, 10 g/d, or an increase by 2 g/d) may be somewhat useful or useful as test for predicting eclampsia, stillbirth, perinatal death, SGA infants, or NICU admission. [7][8][9][10][11][12][13][14][15] Within a cohort of women admitted to hospital with preeclampsia, we examined whether the amount of antenatal proteinuria assessed by urinary dipstick, spot urinary Pr/Cr, or 24-hour urine collection is predictive of adverse maternal or perinatal outcomes. PIERS was conducted as a continuous quality improvement project in three sites using predetermined guidelines for the initial assessment and ongoing surveillance of women admitted to hospital with suspected or con rmed preeclampsia.…”

mentioning

confidence: 99%

PIERS Proteinuria: Relationship With Adverse Maternal and Perinatal Outcome

Payne¹,

Côté²,

Hutcheon³

et al. 2011

Journal of Obstetrics and Gynaecology Canada

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Objective: To examine the ability of three different proteinuria assessment methods (urinary dipstick, spot urine protein:creatinine ratio [Pr/Cr], and 24-hour urine collection) to predict adverse pregnancy outcomes Methods:We performed a prospective multicentre cohort study, PIERS (Preeclampsia Integrated Estimate of RiSk), in seven academic tertiary maternity centres practising expectant management of preeclampsia remote from term in Canada, New Zealand, and Australia Eligible women were those admitted with preeclampsia who had at least one antenatal proteinuria assessment by urinary dipstick, spot urine Pr/Cr ratio, and/or 24-hour urine collection Proteinuria assessment was done either visually at the bedside (by dipstick) or by hospital clinical laboratories for spot urine Pr/Cr and 24-hour urine collection We calculated receiver operating characteristic area under the curve (95% CI) for each proteinuria method and each of the combined adverse maternal outcomes (within 48 hours) or adverse perinatal outcomes (at any time) Models with AUC ≥ 070 were considered of interest Analyses were run for all women who had each type of proteinuria assessment and for a cohort of women ("ALL measures") who had all three proteinuria assessmentsResults: More women were proteinuric by urinary dipstick (≥ 2+, 614%) than by spot urine Pr/Cr (≥ 30g/mol, 504%) or 24-hour urine collection (≥ 03g/d, 347%) Each proteinuria measure evaluated had some discriminative power, and dipstick proteinuria (categorical) performed as well as other methods No single method was predictive of adverse perinatal outcome Conclusion:The measured amount of proteinuria should not be used in isolation for decision-making in women with preeclampsia Dipstick proteinuria performs as well as other methods of assessing proteinuria for prediction of adverse events

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“…[13][14][15][16] Although some of these studies reported that heavy proteinuria increases adverse maternal outcomes including reoperation, blood transfusion, acute renal failure, and thrombocytopenia, 13,14) others suggest that the extent of proteinuria is not associated with adverse maternal outcomes. 15,16) The present study found 24-h urine protein level to be an independent risk factor for bleeding events. The extent of proteinuria, which may reflect renal endothelial damage, may also reflect vascular vulnerability, which can lead to bleeding events.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for bleeding complications of postoperative prophylactic anticoagulation therapy after cesarean section in preeclampsia cases

Tsujimoto

Hyodo

Sunagawa

et al. 2018

Hypertens Res Pregnancy

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Aim: This study aimed to identify risk factors for bleeding complications of postoperative prophylactic anticoagulation after cesarean section in preeclampsia cases. Methods: A total of 68 cases of preeclampsia or superimposed preeclampsia at a tertiary perinatal center in Tokyo between 2012 and 2017 were recruited for this study. Bleeding complications were defined as subcutaneous, subfascial, or intraperitoneal hematoma detected by ultrasonography or computed tomography. Associations of clinical and laboratory data with bleeding complications were assessed by univariate and multivariate analyses. Results: Bleeding complications were recorded in nine cases: subcutaneous hematoma in four cases, subfascial hematoma in four cases, and intraperitoneal hematoma in one case. Univariate analysis revealed preoperative platelet count and 24-h urine protein level to be associated with bleeding complications. Moreover, multivariate logistic regression analysis revealed preoperative platelet count (odds ratio, 0.867; 95% confidential interval, 0.756-0.994; P = 0.04) and 24-h urine protein level (odds ratio, 1.498; 95% confidential interval, 1.031-2.176; P = 0.03) to be independent risk factors for bleeding complications. Conclusion: Preoperative platelet count and 24-h urine protein level may help to identify patients at increased risk for bleeding complications.Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a leading cause of maternal morbidity and mortality in Japan.1) Not only pregnancy itself, but other factors during pregnancy and postpartum increase the risk of VTE. Among these, cesarean section is one of the most important risk factors.2) In Japan, the incidences of DVT and PE after cesarean section are 0.04% and 0.06%, respectively, and cesarean section increases the risk of developing DVT and PE by 5-and 22-fold, respectively.2,3) As cesarean section has become more common in Japan, preventing VTE after the procedure is becoming all the more important.Preeclampsia, a clinical entity included in hypertensive disorders of pregnancy (HDP), is characterized by hypertension, proteinuria, and multiple organ complications. Although the exact pathogenesis of preeclampsia is still unknown, it is thought to involve endothelial dysfunction resulting from an imbalance of pro-angiogenic and anti-angiogenic factors.4) As maternal endothelial damage activates the coagulation system, cesarean section in preeclampsia may increase the risk of VTE. 5) Consideration of prophylactic anticoagulation therapy for women with preeclampsia after cesarean section is recommended by the guidelines of the Japan Society of Obstetrics and Gynecology (JSOG) and 1 Hypertension Research in Pregnancy

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Perinatal outcomes in preeclampsia that is complicated by massive proteinuria

Cited by 96 publications

References 9 publications

Preeclampsia: A review of the evidence

Preeclampsia: A review of the evidence

PIERS Proteinuria: Relationship With Adverse Maternal and Perinatal Outcome

Risk factors for bleeding complications of postoperative prophylactic anticoagulation therapy after cesarean section in preeclampsia cases

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