112 Massive proteinuria in superimposed preeclampsia significantly increased the maternal organ involvements

• Published in: Pregnancy hypertension 2016-07, Vol.6 (3), p.233-234
• Main Author: Nakamoto, Osamu
• Format: Article
• Language: English
• Subjects: Cardiovascular; Obstetrics and Gynecology
• ISSN: 2210-7789
• DOI: 10.1016/j.preghy.2016.08.194

Introduction It is recently recognized that the amount of proteinuria is not mainly contributed to the prognosis of preeclampsia or superimposed preeclampsia [1]. Thus the severity of proteinuria tends to be unimportant and unreliable criteria for the management of preeclamptic disease. On the other hand, it is reported that preeclampsia with greater proteinuria was easy to lead the complication of the adverse maternal outcomes [2]. We now studied how the amount of proteinuria is correlated to the maternal complications especially in superimposed preeclampsia. Methods The retrospective observational study according to the standard clinical management of preeclampsia was performed in 56 pregnant cases of superimposed preeclampsia. All cases were hospitalized for the management of preeclamptic conditions and should terminate the pregnancy in the state of uncontrollable severe high blood pressure, massive proteinuria (over 10 g/day), the complications of the maternal organ involvements such as HELLP syndrome or fetal jeopardy conditions. The urinary protein was evaluated by the daily urinary collection, or spot urine/creatinine ratio. Univariate and multivariate logistic regression analysis were conducted how the obstetric features such as the severity of blood pressure, proteinuria, or the onset of disease could correlate to these organ involvements. Statistical analysis was performed using with SPSS v21. Result 25 (43.9%) cases complicated with any maternal organ involvements were observed in 59 cases. The involvements of HELLP syndrome, thrombocytopenia, or elevated liver enzymes (HELLP related disorders) were observed in 19 cases (33.3%), and those of maternal CNS disorders such as eclampsia was 2 cases (3.5%). Proteinuria over 3 g/day were correlated to any of maternal organ involvements (adjusted Odds ratio 2.86, 95%CI 0.63–13.02, p = 0.18), and more the onset of diastolic high BP under 28 weeks gestation correlated significantly (aOR 4.57, 95%CI 0.86–24.22, p = 0.07) . No relations between the maternal organ involvements and high blood pressure in superimposed preeclampsia. HELLP related disorders tended more correlation to high proteinuria of 3–8 g/day (aOR 4.30 95%CI 0.93–19.80, p = 0.06), 8–12 g/day (aOR 3.74, 95%CI 0.63–22.32, p = 0.15), and showed significantly high correlation to proteinuria over 12 g/day (aOR 12.678, 95%CI 1.53–105.2, p = 0.02). Conclusion 59 cases of superimposed preeclampsia showed high rate of any of the maternal organ involv