Maternal and Neonatal Outcomes in Preeclampsia With and Without Proteinuria

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Nephrology in Pregnancy

Background:

• Preeclampsia is a leading cause of maternal and neonatal morbidity and mortality.
• Proteinuria is a common, though not essential, clinical finding in preeclampsia, with its prognostic value debated.
• Current guidelines acknowledge proteinuria's association with adverse outcomes, but its precise role requires further clarification.

Purpose of the Study:

• To investigate the correlation between the presence of proteinuria and maternal/neonatal outcomes in preeclampsia.
• To compare maternal and neonatal complications in women with preeclampsia with and without proteinuria.
• To assess the prognostic significance of proteinuria in preeclampsia management.

Main Methods:

• A prospective observational study involving 600 women with preeclampsia (≥24 weeks gestation).
• Participants were divided into two groups: Group A (preeclampsia with proteinuria, urine dipstick ≥2+) and Group B (preeclampsia without proteinuria).
• Maternal and neonatal outcomes were evaluated, including end-organ involvement and uteroplacental insufficiency, with statistical analysis using t-tests and chi-square/Fisher's exact tests.

Main Results:

• Group A (with proteinuria) exhibited significantly higher overall maternal complications (96.3% vs 70.3%), including eclampsia, abruptio placenta, and HELLP syndrome.
• Group A also showed significantly higher overall neonatal complications (44.6% vs 23.9%), with increased rates of stillbirths and intrauterine growth restriction (IUGR).
• Group B (without proteinuria) had higher rates of intrauterine deaths (IUD) and neonatal intensive care unit (NICU) admissions, indicating significant risks even without proteinuria.

Conclusions:

• Proteinuria is a significant marker associated with increased neonatal complications and poorer maternal outcomes in preeclampsia.
• However, proteinuria is not the sole determinant; other factors like systemic organ involvement and comorbidities are crucial for predicting outcomes.
• Non-proteinuric preeclampsia can still involve severe biochemical derangements and management challenges, necessitating thorough clinical evaluation beyond proteinuria assessment.