OBJECTIVES:
The primary objective of this study is to determine predictive values of decreasing urinary calcium to creatinine ratio (CCR) and microalbuminuria for preeclampsia from a spot urine sample, in asymptomatic pregnant women between 20 to 24 weeks of gestation in order to recommend it as screening test.
METHODS:
Urinary calcium creatinine ratio and microalbumin was determined in a spot urine sample in 200 asymptomatic pregnant women between 20-24 weeks of gestation, who attended the antenatal OPD for routine antenatal care at RSRM Lying in Hospital, Chennai and followed till delivery. The results were analyzed by Chi- square test and Fisher-exact test to find the significant association of findings of preeclampsia and calcium-creatinine ratio and microalbuminuria. Area under Receiver Operator Curve (ROC) was used to find the predictive values of CCR at less than or equal to 0.04 and microalbuminuria > 30-300 mg/L for pre-eclampsia.
RESULTS:
From this study it was found that CCR had a sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of 73.1%, 97.7%, 82.6% and 96% respectively with a statistical accuracy of 94.5% and p value of <0.001 (strongly significant). It was found to be a good test for prediction of preeclampsia. Microalbuminuria had sensitivity, specificity, PPV and NPV of 61.5 %, 88%, 38.1% and 93.7% respectively with a statistical accuracy of 82% and p value of <0.001 (strongly significant) and was found to be only a fair test for prediction of preeclampsia.
CONCLUSION:
CCR < 0.04 in a spot urine sample being a good test for prediction of preeclampsia can be recommended as a screening test for preeclampsia in all asymptomatic pregnant women. Urine microalbumin, when used alone cannot be used as screening test. Many more trials are needed to recommend it as a screening test