The importance of urinary protein excretion during conservative management of severe preeclampsia.
OBJECTIVE
We determined the natural course of urinary protein excretion during conservative management of severe preeclampsia and investigated whether changes in urinary protein excretion can predict maternal or perinatal outcome.


METHODS
We reviewed the medical charts of 66 women with severe preeclampsia which was managed conservatively before 32 weeks of gestation and who had at least two 24-hour urinary protein determinations 4 or more days apart after admission.


RESULTS
Fifty-nine (89%) of 66 women had an increase in proteinuria during conservative management of severe preeclampsia. The median increase in protein excretion after admission was 660 mg/24 hours (range-4580 to 18,960 mg/24 hours). Patients were divided into two groups. The first group (n = 24) had an increase in 24-hour urinary protein excretion of > or = 2 gm; the second group (n = 42) had a 24-hour urinary protein excretion that decreased (n = 7) or increased by < 2 gm (n = 35). There were no cases of eclampsia or stillbirth in either group. The rate of HELLP (hemolysis, elevated liver enzyme levels, low platelet counts) syndrome, abruptio placentae, cesarean delivery because of fetal distress, 5-minute Apgar scores < or = 6, and the admission-to-delivery intervals were all similar in the two groups.


CONCLUSIONS
Proteinuria increases in most women with severe preeclampsia managed conservatively. No differences in maternal or fetal outcomes were found between pregnancies with marked increases in proteinuria and those with modest or no increases.
Schiff
E
E
Department of Obstetrics and Gynecology, University of Tennessee, Memphis 38103, USA.
Friedman
S A
SA
Kao
L
L
Sibai
B M
BM
D000328:Adult; D005260:Female; D006801:Humans; D011225:Pre-Eclampsia / Q000628:therapy* / Q000652:urine; D011247:Pregnancy; D011507:Proteinuria / Q000150:complications*