The Effect Of 24-hour Urine Protein In Evaluate Condition Of Patients With Severe Preeclampsia

Objective: We analyzed whether the quantitative test of 24-hour urine protein have the correlation for predicting maternal and neonatal complications and outcomes in severe preeclampsia pregnant women.Our aim is to evaluate the condition of pregnant women,prevent and slow the disease progression in severe preeclampsia and improve the outcomes of mother and child.Materials and Methods: The clinical data of 152 patients with severe preeclampsia were analyzed retrospectively,who being treated and deliveried in the First Affiliated Hospital of Dalian Medical University during January 2011 to December 2015.Use the pregnant women and their newborn babies as the research object.With the amount of 24-hour urine protein(2g,5g and 10g)before terminate pregnancy as a cut-off point,The patients were divided into four groups.Patients were classified as group A(<2g/24h)in 49 cases,group B(2.0~4.9g/24h)in 39 cases,group C(5~10g/24h)in 28 cases,and group D(>10g/24h)in 36 cases.The group of D is known as massive proteinuria.We use T test,analysis of variance,chi-square or Fisher's exact probability methods to analyze the four groups of patients for general condition,laboratory indexes,as well as maternal and neonatal outcomes and complications.Results:(1)The comparison of general conditions in four groups of pregnant women: The average age of the 152 cases was 30.16�4.45 years old.The proportion of primipara was 82.9%,the incidence of early-onset severe preeclampsia was 32.2%.There were significant differences among four groups in gestational weeks at admission and the incidence of gestational weeks less than 34 weeks at admission(P<0.05),but there were no statistically significant differences in other indicators including age,primipara,delivery times,the highest systolic blood pressure,the highest diastolic blood pressure,and treatment days(P>0.05).With the increase of24-hour urine protein,the gestational week at admission was decreased while the incidence of early-onset severe preeclampsia(gestational weeks less than 34 weeks at admission)was increased.Patients of group D had smaller gestational weeks,and mostly were early-onset severe preeclampsia.(2)The comparison of laboratory indexes in four groups of pregnant women before delivery: There were significant differences among four groups in blood urea nitrogen,creatinine and serum albumin(P<0.05),but there were no statistically significant differences in uric acid,ALT,AST,LDH and PLT(P>0.05).Compared with other three groups,group D had the highest blood urea nitrogen.Compared with patients whose urinary protein level was less than 5g/24 h,group D had lower serum albumin.The patients whose urinary protein level was more than 5g/24 h had higher bloodcreatinine than patients whose urinary protein level was less than 2g/24 h,all of the differences were of statistical significance(P<0.05).(3)The comparison of pregnant outcomes in four groups of pregnant women: There were significant differences among four groups in the incidence of hypoalbuminemia and ascites(P<0.05),with the increase of24-hour urine protein,the incidence of hypoalbuminemia and ascites was also increased,and there were significant differences between group D and group A,group D and group B,group C and group A(P<0.05).Patients with complications(such as HELLP syndrome,hypoalbuminemia,ascites,heart failure and neonatal asphyxia)had higher 24-hour urine protein than those without such complications,all of the differences were of statistical significance(P<0.05).The incidence of one or more pregnant complications was significantly higher in group D(80.6%)compared with other three groups(group A 32.7%,group B 46.2%,group C 64.3%),there were significant differences between group D and group A,group D and group B(P<0.05).There were no maternal death among all the patients.(4)The comparison of neonatal outcomes in four groups of pregnant women: The average age of neonatal gestational week at birth of four groups were 37.27�3.15 w,36.07�2.67 w,35.72�2.79 w,34.4�2.81 w.The incidence of FGR was 15.8%(24/152),the incidence of premature birth was54.1%(80/148),neonatal transfer rate was 37.2%(55/148).There were significant differences among four groups in gestational week at birth,FGR,premature birth,low birth weight infant,the neonatal transfer rate and birth weight(P<0.05),but there were no statistically significant differences in stillbirth,fetal distress,neonatal asphyxia and 1 minute Apgar score(P>0.05).With the increase of the 24-hour urine protein,the incidence of preterm birth,low birth weight infant and neonatal transfer rate were increased,while the neonatal gestational week at birth and birth weight were gradually decreased.There were statistically significant differences between group D and group A(P<0.05).Group D had the highest incidence of premature birth(80%),the incidence of low birth weight infant(79.4%),neonatal transfer rate(62.9%)and neonatal asphyxia rate(8.6%)among the four groups.Conclusion:(1)The level of 24-hour urine protein is closely related to the condition of pregnant women,as well as related to maternal and neonatal prognosis,which can reflect the incidence of maternal and neonatal complications and adverse pregnant outcomes to a certain extent.(2)The level of 24-hour urine protein has some effects on serum albumin.Detection on 24-hour urine protein of severe preeclampsia patients has an important significance in improving maternal and neonatal outcome.(3)In clinical,the optimal treatment time for patients might be delayed if we only wait for the emergence of proteinuria.So we should combined with other laboratory indexes and patients' symptoms to comprehensively judge patients' condition.To achieve early discovery,early intervention and early treatment on patients with severe preeclampsia,we should give them individual management and treatment.