IJCRR - 8(5), March, 2016
ACCURACY OF SERUM URIC ACID IN PREDICTING COMPLICATIONS OF PRE-ECLAMPSIA
Author: A. Ramana Priya, K. Jeyapriya, N. S. Kannan
Introduction: Pre-eclampsia, is a pregnancy-specific syndrome that occurs after mid gestation comprising of gestational hypertension with significant proteinuria. If not treated properly will lead to maternal and foetal complications. Aims: To study the accuracy of serum uric acid in predicting complications of pre-eclampsia and its effect on pregnancy outcome. Methods: Sixty pregnant women at term gestation with diagnosis of pre-eclampsia were included in our study after informed consent. For all patients included in the study all routine investigations including serum uric acid were done and recorded. All the patients were followed up until delivery and all maternal and foetal events were recorded. All complications of pre-eclampsia both maternal and foetal were statistically analysed to prove the predictive value of serum uric acid levels. Results: 18.3% of mothers were between the age group 18-21 years, 26.7% were between 22-25 years, 28.3% were between 26-29 years, and 26.7% were above 30 years. 83.4% of 60 mothers were primi para, 8.3% were para 2, and 8.3% were para 3. The difference in the first minute APGAR in the high risk and no risk category was not statistically significant at p value of 0.1798. The difference in the 5th minute APGAR in the high risk and no risk category was statistically significant at p value of 0.001. 4 out of 42 women (9.52%) with serum uric acid ≥6mg/dl had maternal complications and 7 out of 18 women with serum uric acid <6mg/dl had maternal complications (p value = 0.01) which is statistically significant. Considering less than 2.5 Kg as low birth weight, serum uric acid levels of more than 5.5 are associated with significant low birth weight (p value of 0.01) which is statistically significant. Conclusion: Our study with a sample size of 60 has proved that serum uric acid is statistically significant predictor (p value 0.01) of foetal complications of pre-eclampsia even though not of maternal complications (p value 0.42).
Keywords: Gestational hypertension, Eclampsia, HELLP syndrome, Maternal death, Intrauterine growth restriction, Foetal distress, Perinatal death
A. Ramana Priya, K. Jeyapriya, N. S. Kannan. ACCURACY OF SERUM URIC ACID IN PREDICTING COMPLICATIONS OF PRE-ECLAMPSIA International Journal of Current Research and Review. 8(5), March, 13-21
1. Roberts JM, Pearson G, Cutler J, Lindheimer M. Summary of the NHLBI Working Group on Research on Hypertension During Pregnancy. Hypertension 2003;41:437-45.
2. Carelton H, F.A., Flores R. Remote prognosis of pre-eclampsia in women 25 years old and younger. Am J Obstet Gynecol, 1988; 159:156-60.
3. ACOG. ACOG Practice Bulletin: Diagnosis and Management of Preeclampsia and Eclampsia: The American College of Obstetricians and Gynecologists Number 33. Jan 2002.
4. von Dadelszen P, Payne B, Li J, et al. Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the full PIERS model. Lancet. 2011 Jan 15. 377(9761):219- 27.
5. Gabbe. Obstetrics: Normal and Problem Pregnancies. Hypertension. 5th ed. Churchill Livingstone, An Imprint of Elsevier; 2007.
6. Hughes EC (ed): Obstetric-gynecologic terminology. Philadelphia, Davis, 1972, pp 422-3
7. MacGillivray, I. Pre-Eclampsia. The Hypertensive Disease of Pregnancy. WB Saunders, Philadelphia, PA; 1983 p17
8. Davey DA, MacGillivray I. The classification and definition of the hypertensive disorders of pregnancy. Am J Obstet Gynecol. 1988 Apr 30;158(4):892-8.
9. Redman CW, Beilin LJ, Bonnar J, Wilkinson RH. Plasma-urate measurements in predicting fetal death in hypertensive pregnancy. Lancet. 1976;1:1370-1373
10. Stone JL, Lockwood CJ, Berkowitz GS, Alvarez M, Lapinski R, Berkowitz RL. Risk factors for severe preeclampsia. Obstet Gynecol. 1994;83:357-361
11. Roberts JM, Bodnar LB, Lain KY, Hubel CA, Markovic N, Ness RB, Powers RW. Uric acid is as important as proteinuria in identifying fetal risk in women with gestational hypertension. Hypertension. 2005;46:1263-1269.
12. Parrish M, Griffin M, Morris R, Darby M, Owens MY, Martin JN. Hyperuricemia facilitates the prediction of maternal and perinatal adverse outcome in patients with severe/superimposed preeclampsia. J Matern Fetal Neonatal Med. 2010;23:1541-1545.
13. Laughon SK, Catov J, Powers RW, Roberts JM, Gandley RE. First trimester uric acid and adverse pregnancy outcomes. Am J Hypertens. 2011;24:489-495.
14. Paula LG, da Costa BE, Poli de Figuereido GE, Antonello IC. Does uric acid provide information about maternal condition and fetal outcome in pregnant women with hypertension Hypertens Pregnancy. 2008;27:413-420
15. Yalamati P, Bhongir AV, Betha K, Verma R, Dandge S. Relationship of serum uric acid, serum creatinine and serum cystatin C with maternal and fetal outcomes in rural Indian pregnant women. International journal of reproduction, contraception, obstetrics and gynecology. 2015;4(5):1505-1510. doi:10.18203/2320- 1770.ijrcog20150737.
16. Lind T, Godfrey KA, Otun H, Philips PR. Changes in serum uric acid concentrations during normal pregnancy. Br J Obstet Gynaecol. 1984 Feb;91(2):128-32.
17. Lopez-Espinoza, I, Dhar, H, Humphreys, S, Redman, CWG. Urinary albumin excretion in pregnancy. Br J Obstet Gynaecol. 1986;93:176-181.
18. Sibai, BM, Rodriguez, JJ. Preeclampsia: diagnosis and management. in: Principles and Practice of Medical Therapy in Pregnancy. 2nd ed. Appleton and Lange, Norwalk; 1992:871-879.
19. O’sullivan JB, Francis JO, Kantor N. Comparison of a colorimetric (automated) with an enzymatic (manual) uric acid procedure. Clin Chem. 1965 Mar;11:427-35.
21. Klackar, H.M., J. Biol Chem. 167:429 (1947).
22. Praetorius, E., Poulson, H., Scand. J. Clin. Invest. 5:273 (1953).
23. Macgillivray I, Some observations on the incidence of pre-eclampsia. J Obstet Gynaecol Br Emp. 1958 Aug;65(4):536-9
24. Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. Bmj. 2005 Mar 10;330(7491):565.
25. Sahijwani D, Desai A, Oza H, Kansara V, Ninama P, Maheshwari K, Soni C, Padhiyar B. Serum Uric Acid as a Prognostic Marker of Pregnancy induced Hypertension. Journal of South Asian Federation of Obstetrics and Gynaecology JSAFOG. 2012 Sep;4(3):130-3.
26. Liedholm H, Montan S, Åberg A. Risk grouping of 113 patients with hypertensive disorders during pregnancy, with respect to serum urate, proteinuria and time of onset of hypertension. Acta Obstet Gynecol Scand 1984;63(S118):43-8.
27. Thangaratinam S, Ismail KM, Sharp S, Coomarasamy A, Khan KS. Accuracy of serum uric acid in predicting complications of pre-eclampsia: a systematic review. Br J Obstet Gynaecol: An International Journal of Obstetrics and Gynaecology. 2006 Apr 1;113(4):369-78.
28. Yassaee F. Hyperuricemia and perinatal outcomes in patients with severe preeclampsia. Iran J Med Sci 2003;28:198-9.
29. Williams KP, Galerneau F. The role of serum uric acid as a prognostic indicator of the severity of maternal and fetal complications in hypertensive pregnancies. J Obstet Gynaecol Can 2002;24:628–32.
30. D’Anna R, Baviera G, Scilipoti A, Leonardi I, Leo R. The clinical utility of serum uric acid measurements in pre-eclampsia and transient hypertension in pregnancy. Panminerva Med 2000;42:101–3.
31. Martin JN Jr, May WL, Magann EF, Terrone DA, Rinehart BK, Blake P-G. Early risk assessment of severe preeclampsia: admission battery of symptoms and laboratory tests to predict likelihood of subsequent significant maternal morbidity. Am J Obstet Gynecol 1999;180:1407-14.
32. Odendaal HJ, Pienaar ME. Are high uric acid levels in patients with early pre-eclampsia an indication for delivery S Afr Med J 1997;87:213-18.