Estimation of proteinuria as a predictor of complications of pre-eclampsia: a systematic review

Background Proteinuria is one of the essential criteria for the clinical diagnosis of pre-eclampsia. Increasing levels of proteinuria is considered to be associated with adverse maternal and fetal outcomes. We aim to determine the accuracy with which the amount of proteinuria predicts maternal and fetal complications in women with pre-eclampsia by systematic quantitative review of test accuracy studies. Methods We conducted electronic searches in MEDLINE (1951 to 2007), EMBASE (1980 to 2007), the Cochrane Library (2007) and the MEDION database to identify relevant articles and hand-search of selected specialist journals and reference lists of articles. There were no language restrictions for any of these searches. Two reviewers independently selected those articles in which the accuracy of proteinuria estimate was evaluated to predict maternal and fetal complications of pre-eclampsia. Data were extracted on study characteristics, quality and accuracy to construct 2 × 2 tables with maternal and fetal complications as reference standards. Results Sixteen primary articles with a total of 6749 women met the selection criteria with levels of proteinuria estimated by urine dipstick, 24-hour urine proteinuria or urine protein:creatinine ratio as a predictor of complications of pre-eclampsia. All 10 studies predicting maternal outcomes showed that proteinuria is a poor predictor of maternal complications in women with pre-eclampsia. Seventeen studies used laboratory analysis and eight studies bedside analysis to assess the accuracy of proteinuria in predicting fetal and neonatal complications. Summary likelihood ratios of positive and negative tests for the threshold level of 5 g/24 h were 2.0 (95% CI 1.5, 2.7) and 0.53 (95% CI 0.27, 1) for stillbirths, 1.5 (95% CI 0.94, 2.4) and 0.73 (95% CI 0.39, 1.4) for neonatal deaths and 1.5 (95% 1, 2) and 0.78 (95% 0.64, 0.95) for Neonatal Intensive Care Unit admission. Conclusion Measure of proteinuria is a poor predictor of either maternal or fetal complications in women with pre-eclampsia

Momentum Flux Spectra of a Mountain Wave Event Over New Zealand

During the Deep Propagating Gravity Wave Experiment (DEEPWAVE) 13 July 2014 research flight over the South Island of New Zealand, a multiscale spectrum of mountain waves (MWs) was observed. High‐resolution measurements of sodium densities were available from ~70 to 100 km for the duration of this flight. A comprehensive technique is presented for obtaining temperature perturbations, T′, from sodium mixing ratios over a range of altitudes, and these T′ were used to calculate the momentum flux (MF) spectra with respect to horizontal wavelengths, λH, for each flight segment. Spectral analysis revealed MWs with spectral power centered at λH of ~80, 120, and 220 km. The temperature amplitudes of these MWs varied between the four cross‐mountain flight legs occurring between 6:10UT and 9:10UT. The average spectral T′ amplitudes near 80 km in altitude ranged from 7–13 K for the 220 km λH MW and 4–8 K for the smaller λH MWs. These amplitudes decayed significantly up to 90 km, where a critical level for MWs was present. The average MF per unit mass near 80 km in altitude ranged from ~13 to 60 m²/s² across the varying spectra over the duration of the research flight and decayed to ~0 by 88 km in altitude. These MFs are large compared to zonal means and highlight the importance of MWs in the momentum budget of the mesosphere and lower thermosphere at times when they reach these altitudes