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Jones C, Jakubowski BE, Stevens R, Roberts N, McManus RJ, Tucker KL. The diagnostic Accuracy of Visual versus automated dipstick proteinuria testing in Pregnancy: A systematic review and Meta-Analysis. Pregnancy Hypertens 2024; 35:73-81. [PMID: 38262144 DOI: 10.1016/j.preghy.2024.01.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of point-of-care (POC) tests for detecting proteinuria in pregnant women. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE and EMBASE databases were searched from inception to 13 November 2020. ELIGIBILITY CRITERIA AND DATA ANALYSIS Included studies measured the sensitivity and specificity ofPOC proteinuria testing compared to laboratory reference standards (protein-creatinine ratio (PCR), 24-hour urine collection). Bivariate meta-analyses determined pooled sensitivity and specificity. Random-effects inverse-variance model determinedheterogeneity. MAIN OUTCOME MEASURES The primary outcome was overall sensitivity and specificity, stratified by method of POC testing and reference standard. Secondary outcomes were sensitivity and specificity within thesubgroupstest brand, reference standard, and hypertension status. RESULTS 1078 studies were identified, 17 studies comprising 23 comparisons were included. The meta-analysis included 13 studies with 19 comparisons. Pooled sensitivity and specificity of visual dipsticks against PCR was 72 % (95 % CI: 56 % to 84 %) and 92 % (95 % CI: 76 % to 98 %), respectively. Pooled sensitivity and specificity of visual dipsticks against 24-hour collection was 69 % (55 % to 80 %) and 70 % (51 % to 84 %), respectively. Pooled sensitivity and specificity for automated readers against PCR was 73 % (53 % to 86 %) and 91 % (83 % to 95 %), respectively. Pooled sensitivity and specificity of automated readers against 24-hour collection was 65 % (42 % to 83 %) and 82 % (46 % to 96 %), respectively. CONCLUSION Visual dipsticks have comparable accuracy to automated readers, yet are notadequate as a rule-out test for proteinuria. Proteinuria POC testing maybe beneficial inantenatal care when repeatfollow-up tests are performed. PROSPERO Registration Number: CRD42021231914.
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Affiliation(s)
- C Jones
- Nuffield Department of Primary Health Care Sciences, University of Oxford, UK
| | - B E Jakubowski
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course and Population Sciences, Kings College London, UK
| | - R Stevens
- Nuffield Department of Primary Health Care Sciences, University of Oxford, UK
| | - N Roberts
- Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course and Population Sciences, Kings College London, UK
| | - R J McManus
- Nuffield Department of Primary Health Care Sciences, University of Oxford, UK
| | - K L Tucker
- Nuffield Department of Primary Health Care Sciences, University of Oxford, UK.
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Sentilhes L, Schmitz T, Arthuis C, Barjat T, Berveiller P, Camilleri C, Froeliger A, Garabedian C, Guerby P, Korb D, Lecarpentier E, Mattuizzi A, Sibiude J, Sénat MV, Tsatsaris V. [Preeclampsia: Guidelines for clinical practice from the French College of Obstetricians and Gynecologists]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:3-44. [PMID: 37891152 DOI: 10.1016/j.gofs.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To identify strategies to reduce maternal and neonatal morbidity related to preeclampsia. MATERIAL AND METHODS The quality of evidence of the literature was assessed following the GRADE® method with questions formulated in the PICO format (Patients, Intervention, Comparison, Outcome) and outcomes defined a priori and classified according to their importance. An extensive bibliographic search was performed on PubMed, Cochrane, EMBASE and Google Scholar databases. The quality of the evidence was assessed (high, moderate, low, very low) and recommendations were formulated as a (i) strong, (ii) weak or (iii) no recommendation. The recommendations were reviewed in two rounds with external reviewers (Delphi survey) to select the consensus recommendations. RESULTS Preeclampsia is defined by the association of gestational hypertension (systolic blood pressure≥140mmHg and/or diastolic blood pressure≥90mmHg) and proteinuria≥0.3g/24h or a Proteinuria/Creatininuria ratio≥30mg/mmol occurring after 20 weeks of gestation. Data from the literature do not show any benefit in terms of maternal or perinatal health from implementing a broader definition of preeclampsia. Of the 31 questions, there was agreement between the working group and the external reviewers on 31 (100%). In general population, physical activity during pregnancy should be encouraged to reduce the risk of preeclampsia (Strong recommendation, Quality of the evidence low) but an early screening based on algorithms (Weak recommendation, Quality of the evidence low) or aspirin administration (Weak recommendation, Quality of the evidence very low) is not recommended to reduce maternal and neonatal morbidity related to preeclampsia. In women with preexisting diabetes or hypertension or renal disease, or multiple pregnancy, the level of evidence is insufficient to determine whether aspirin administration during pregnancy is useful to reduce maternal and perinatal morbidity (No recommendation, Quality of the evidence low). In women with a history of vasculo-placental disease, low dose of aspirin (Strong recommendation, Quality of the evidence moderate) at a dosage of 100-160mg per day (Weak recommendation, Quality of the evidence low), ideally before 16 weeks of gestation and not after 20 weeks of gestation (Strong recommendation, Quality of the evidence low) until 36 weeks of gestation (Weak recommendation, Quality of the evidence very low) is recommended. In a high-risk population, additional administration of low molecular weight heparin is not recommended (Weak recommendation, Quality of the evidence moderate). In case of preeclampsia (Weak recommendation, Quality of the evidence low) or suspicion of preeclampsia (Weak recommendation, Quality of the evidence moderate, the assessment of PlGF concentration or sFLT-1/PlGF ratio is not routinely recommended) in the only goal to reduce maternal or perinatal morbidity. In women with non-severe preeclampsia antihypertensive agent should be administered orally when the systolic blood pressure is measured between 140 and 159mmHg or diastolic blood pressure is measured between 90 and 109mmHg (Weak recommendation, Quality of the evidence low). In women with non-severe preeclampsia, delivery between 34 and 36+6 weeks of gestation reduces severe maternal hypertension but increases the incidence of moderate prematurity. Taking into account the benefit/risk balance for the mother and the child, it is recommended not to systematically induce birth in women with non-severe preeclampsia between 34 and 36+6 weeks of gestation (Strong recommendation, Quality of evidence high). In women with non-severe preeclampsia diagnosed between 37+0 and 41 weeks of gestation, it is recommended to induce birth to reduce maternal morbidity (Strong recommendation, Low quality of evidence), and to perform a trial of labor in the absence of contraindication (Strong recommendation, Very low quality of evidence). In women with a history of preeclampsia, screening maternal thrombophilia is not recommended (Strong recommendation, Quality of the evidence moderate). Because women with a history of a preeclampsia have an increased lifelong risk of chronic hypertension and cardiovascular complications, they should be informed of the need for medical follow-up to monitor blood pressure and to manage other possible cardiovascular risk factors (Strong recommendation, Quality of the evidence moderate). CONCLUSION The purpose of these recommendations was to reassess the definition of preeclampsia, and to determine the strategies to reduce maternal and perinatal morbidity related to preeclampsia, during pregnancy but also after childbirth. They aim to help health professionals in their daily clinical practice to inform or care for patients who have had or have preeclampsia. Synthetic information documents are also offered for professionals and patients.
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Affiliation(s)
- Loïc Sentilhes
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France.
| | - Thomas Schmitz
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, Paris, France
| | - Chloé Arthuis
- Service d'obstétrique et de médecine fœtale, Elsan Santé Atlantique, 44819 Saint-Herblain, France
| | - Tiphaine Barjat
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Saint-Etienne, Saint-Etienne, France
| | - Paul Berveiller
- Service de gynécologie-obstétrique, centre hospitalier intercommunal de Poissy St-Germain, Poissy, France
| | - Céline Camilleri
- Association grossesse santé contre la pré-éclampsie, Paris, France
| | - Alizée Froeliger
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - Charles Garabedian
- Service de gynécologie-obstétrique, University Lille, ULR 2694-METRICS, CHU de Lille, 59000 Lille, France
| | - Paul Guerby
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Toulouse, Toulouse, France
| | - Diane Korb
- Service de gynécologie-obstétrique, hôpital Robert-Debré, AP-HP, Paris, France
| | - Edouard Lecarpentier
- Service de gynécologie-obstétrique, centre hospitalier intercommunal de Créteil, Créteil, France
| | - Aurélien Mattuizzi
- Service de gynécologie-obstétrique, centre hospitalier universitaire de Bordeaux, Bordeaux, France
| | - Jeanne Sibiude
- Service de gynécologie-obstétrique, hôpital Louis-Mourier, AP-HP, Colombes, France
| | - Marie-Victoire Sénat
- Service de gynécologie-obstétrique, hôpital Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Vassilis Tsatsaris
- Maternité Port-Royal, hôpital Cochin, GHU Centre Paris cité, AP-HP, FHU PREMA, Paris, France
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Harrison TG, Tonelli M. Measuring albuminuria or proteinuria: does one answer fit all? Kidney Int 2023; 104:904-909. [PMID: 37652205 DOI: 10.1016/j.kint.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/30/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023]
Abstract
Measurement of proteinuria is critical for diagnosing and monitoring kidney disease. A variety of measures are available to clinicians and can identify all urinary proteins (proteinuria) or urine albumin alone (albuminuria). Proteinuria and albuminuria can be measured in either a random urine sample or a timed urine collection (often over 24 hours). Although an international guideline advocates the use of the urinary albumin-to-creatinine ratio for most purposes, this measure is not universally available worldwide and historically has been more costly than alternatives. In addition, there may be important differences in accuracy between the albumin-to-creatinine ratio and others based on magnitude of albuminuria, sex, and certain clinical contexts. In this mini review, we review recommendations from international guidelines and discuss specific contexts where the optimal measure of proteinuria is unclear and, in some situations, controversial. We discuss the evidence supporting current recommendations for choice of measure, including the clinical settings of glomerulonephritis, transplantation, and pregnancy. We also discuss how patient sex and cost may impact this decision.
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Affiliation(s)
- Tyrone G Harrison
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Tan CY, Zhou Y, Zhao HY, Liang L, Yang XF, Mo ZJ. Establishment, verification, and application of concentration intervals corresponding to dipstick grades for urinary protein. Clin Chim Acta 2023; 548:117500. [PMID: 37500032 DOI: 10.1016/j.cca.2023.117500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND To address the situation that the accuracy of concentration intervals (CI) corresponding to dipstick grades is not given by the manufacturers or literature, we developed a method that determined reasonable dipstick grades with concentration intervals (GCIs) based on the percent agreement (PA) and discussed the GCI application to comparability among currently dipstick tests. METHODS By comparing the results of 2 dipstick tests (iChem and KU-500) with the quantitative test (AU5800), the GCIs were verified and established based on the PAs, which were calculated and used as an indicator of GCI's accuracy. The overlap (percent) between the 2 GCIs with the same grade (2 dipstick devices), was calculated and used to evaluate the agreement between their test results. RESULTS After verification and adjustment, the GCI and PA combinations for iChem Velocity were as follows: - (<0.1 g/l, 85 %), ± (0.1-0.3 g/l, 66 %), 1+ (0.3-1 g/l, 78 %), 2+ (1-3 g/l, 74 %), 3+ (3-6 g/l, 77 %), and 4+ (≥6 g/l, 84 %). The determined GCI and PA combinations for KU-500 were: - (<0.1.2 g/l, 75 %), ± (0.12-0.5 g/l, 63 %), 1+ (0.5-1.2 g/l, 69 %), 2+ (1.2-3.2 g/l, 76 %), and 3+ (≥3.2 g/l, 82 %). The GCI overlaps between the 2 dipstick devices were - (83 %), ± (45 %), 1+ (56 %), 2+ (82 %), and 3+ or ≥3+ (94 %). The overall overlap was 72 %. Since the overlaps ± (45 %) and 1+ (56 %) were within the overlap reject limit for any grade (70 %), and the overall overlap (72 %) was within the overall overlap reject limit (80 %), the test results of the 2 devices were not comparable. CONCLUSIONS GCIs can be verified and established correctly based on PAs, and industry standards for dipstick tests can be established based on GCIs and PAs. Comparability between dipstick devices, historical data, and literature data can be roughly determined based on the overlap.
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Affiliation(s)
- Chun-Yan Tan
- Department of Clinical Laboratory, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan RD, Nanning, Guangxi 530021, China
| | - Ying Zhou
- Precision Clinical Laboratory, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan RD, Nanning, Guangxi 530021, China
| | - Hong-Ying Zhao
- Department of Clinical Laboratory, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan RD, Nanning, Guangxi 530021, China
| | - Li Liang
- Department of Clinical Laboratory, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan RD, Nanning, Guangxi 530021, China
| | - Xia-Fang Yang
- Department of Clinical Laboratory, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan RD, Nanning, Guangxi 530021, China
| | - Zhi-Jiang Mo
- Department of Pharmacy, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, 6 Taoyuan RD, Nanning, Guangxi 530021, China.
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Olayinka L, Garnett E, Burnett B, Devaraj S. Comparison of random urine protein/creatinine ratio with 24-hour urine protein in suspected pre-eclampsia. Pract Lab Med 2023; 36:e00316. [PMID: 37649542 PMCID: PMC10462489 DOI: 10.1016/j.plabm.2023.e00316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 09/01/2023] Open
Abstract
Introduction Proteinuria is one of the classical criteria for the diagnosis of pre-eclampsia. The gold standard remains the measurement of 24-h urine protein which is time consuming and prone to preanalytical errors. Random urine protein creatinine ratio (UPCR) is endorsed by clinical practice guidelines as a faster alternative. The aim of this study was to evaluate the correlation between the 24-h urine protein excretion and UPCR in the identification of proteinuria in suspected preeclamptic patients. Method A total of 51 women with suspected pre-eclampsia from the maternal fetal clinic of our institution were retrospectively studied. The correlation between the UPCR in random urine samples and protein excretion in the 24-h urine collection was determined by Deming Regression analysis and Pearson correlation on EP evaluator and SPSS respectively. Result There was a significant positive correlation between the numerical values obtained by 24-h urine protein and the UPCR (R = 0.88, P < 0.001). Concordance analysis showed 81.1% positive agreement for proteinuria between methods (>300 mg/24hr and >0.3) and 71.4% negative agreement. The clinical sensitivity and specificity of the UPCR was 74% and 69% respectively. Conclusion Overall, UPCR was well correlated with 24-h urine protein and could be an effective and compliant screening tool to indicate proteinuria in preeclamptic patients.
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Affiliation(s)
- Lily Olayinka
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
- Section of Clinical Chemistry, Division of Laboratory Medicine, Department of Pathology, Texas Children's Hospital, Houston, TX, 77030, USA
| | - Emily Garnett
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
- Section of Clinical Chemistry, Division of Laboratory Medicine, Department of Pathology, Texas Children's Hospital, Houston, TX, 77030, USA
| | - Brian Burnett
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Sridevi Devaraj
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, 77030, USA
- Section of Clinical Chemistry, Division of Laboratory Medicine, Department of Pathology, Texas Children's Hospital, Houston, TX, 77030, USA
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Singh J, Kaur M, Rasane P, Kaur S, Kaur J, Sharma K, Gulati A. Nutritional management and interventions in complications of pregnancy: A systematic review. Nutr Health 2023:2601060231172545. [PMID: 37128673 DOI: 10.1177/02601060231172545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Background: Pregnancy, also known as the "gestation period" which lasts for 37-40 weeks, has been marked as the period of "physiological stress" in a woman's life. A wide range of symptoms, from nausea to ectopic pregnancy, are usually aligned with risk factors like abortion, miscarriage, stillbirth, etc. An estimated total of 15% of total pregnant women face serious complications requiring urgent attention for safe pregnancy survival. Over the past decades, several changes in the environment and nutrition habits have increased the possibility of unfavourable changes during the gestation phase. The diagnostic factors, management and nutritional interventions are targeted and more emphasis has been laid on modifying or managing the nutritional factors in this physiologically stressed phase. Aims: This review focuses on dietary modifications and nutritional interventions for the treatment of complications of pregnancy. Nutritional management has been identified to be one of the primary necessities in addition to drug therapy. It is important to set a healthy diet pattern throughout the gestation phase or even before by incorporating key nutrients into the maternal diet. Methods: The published literature from various databases including PubMed, Google Scholar and ScienceDirect were used to establish the fact of management and treatment of complications of pregnancy. Results: The recommendations of dietary supplements have underlined the concept behind the eradication of maternal deficiencies and improving metabolic profiles. Conclusion: Therefore, the present review summarises the dietary recommendations to combat pregnancy-related complications which are necessary in order to prevent and manage the same.
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Affiliation(s)
- Jyoti Singh
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Mansehaj Kaur
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Prasad Rasane
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Sawinder Kaur
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Jaspreet Kaur
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
| | - Kartik Sharma
- International Center of Excellence in Seafood Science and Innovation (ICE-SSI), Faculty of Agro-Industry, Prince of Songkla University, Hat Yai, Thailand
| | - Amisha Gulati
- Department of Food Technology and Nutrition, School of Agriculture, Lovely Professional University, Phagwara, Punjab, India
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Jakubowski BE, Stevens R, Wilson H, Lavallee L, Brittain L, Crawford C, Hodgkinson J, Hinton L, Mackillop L, Chappell LC, McManus RJ, Tucker KL. Cross-sectional diagnostic accuracy study of self-testing for proteinuria during hypertensive pregnancies: The UDIP study. BJOG 2022; 129:2142-2148. [PMID: 35412672 PMCID: PMC9790635 DOI: 10.1111/1471-0528.17180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 03/04/2022] [Accepted: 03/28/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine the accuracy of self-testing for proteinuria during pregnancy. DESIGN Diagnostic accuracy study. SETTING Antenatal clinics, maternity assessment units and inpatient wards at three hospital sites. POPULATION OR SAMPLE 345 pregnant women. METHODS Pregnant women self-tested in-clinic for urinary protein using visually read dipsticks with samples then sent for laboratory estimation of the spot protein-creatinine ratio (PCR) (primary reference test). Secondary index tests included testing by antenatal healthcare professionals and an automated colorimetric reader. MAIN OUTCOME MEASURES Sensitivity, specificity, negative predictive value, positive predictive value and likelihood ratios were calculated for self-testing (primary index test) along with healthcare professional and colorimetric testing compared to the primary reference test (PCR). RESULTS 335/345 (97%) had sufficient data to be included in the analysis. Self-testing had a sensitivity of 0.71 (95% confidence interval [CI] 0.62-0.79) and a specificity of 0.89 (95% CI 0.84-0.92) compared to PCR. Sensitivity and specificity of testing by healthcare professionals and the colorimetric reader were similar: sensitivity 0.73 (95% CI 0.64-0.80) and 0.78 (95% CI 0.69-0.85), respectively; specificity 0.88 (95% CI 0.82-0.92) and 0.83 (95% CI 0.78-0.88), respectively. CONCLUSION Pregnant women can visually read a dipstick for urinary protein with similar accuracy to antenatal healthcare professionals. Automated colorimetric testing was not significantly different, in contrast to some previous studies. Self-testing has the potential to form part of a self-monitoring regime in pregnancy.
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Affiliation(s)
| | - Richard Stevens
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Hannah Wilson
- Department of Women and Children's HealthKing's College LondonLondonUK
| | - Layla Lavallee
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Lesley Brittain
- Birmingham Women and Children's HospitalNHS Foundation TrustOxfordUK
| | - Carole Crawford
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - James Hodgkinson
- Institute of Applied Health Research, Murray Learning Centre, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
| | - Lisa Hinton
- THIS Institute, University of Cambridge, Clifford Allbutt Building, Cambridge Biomedical CampusCambridgeUK
| | - Lucy Mackillop
- Nuffield Department of Women's and Reproductive HealthUniversity of OxfordOxfordUK
| | - Lucy C. Chappell
- Department of Women and Children's HealthKing's College LondonLondonUK
| | - Richard J. McManus
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
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Abstract
Hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, and eclampsia, are a worldwide health problem. Hypertensive disorders of pregnancy affect more than 10% of pregnancies and are associated with increased mortality and morbidity for both mother and fetus. Although patients' outcomes and family's experience will always be the primary concern regarding hypertensive complications during pregnancy, the economic aspect of this disease is also worth noting. Compared with normotensive pregnancies, those related with hypertension resulted in an excess increase in hospitalization and healthcare cost. Hence, the focus of this review is to analyze hypertensive disorders of pregnancy and to present practical tips with clear instructions for the clinical management of hypertensive disorders of pregnancy. This overview offers a detailed approach from the diagnosis to treatment and follow-up of a pregnant women with hypertension, evidence based, to support these instructions.
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