Diagnostic value of combination of urinary calcium to creatinine ratio, roll-over test and BMI in early diagnosis of pre-eclampsia

Abstract

Introduction: Preeclampsia is a common complication of pregnancy and one of the most major causes of maternal and perinatal mortality. Therefore, prediction of pre-eclampsia would help achieving strict midwifery care. Several biophysical and biochemical tests have been investigated for early detection of preeclampsia. However, none of them has shown accuracy and simplicity necessary to predict preeclampsia. The purpose of this study is to use a combination of tests for early prediction of preeclampsia. Methods: In this prospective study, 400 nulliparous women between 28 and 32 weeks of gestation referred to healthy centers of Tabriz during 2007 were enrolled. At first, weight, height, blood pressure on left position and supine position was measured and their urine samples were collected for calcium and creatinin measurement. These women were followed until delivery time. Data were analyzed by descriptive statistic test (mean, SD and distribution), ROC diagram, t-test and SPSS 13 software.. Results: From the total of 400 women, 23 women developed pre-eclampsia. According to ROC diagram,urinary calcium/creatinin ratio was less than 0.068 and showed sensitivity 35% and 93% specificity in prediction of pre-eclampsia. Sensitivity and specificity of BMI of higher than 28.88 were 61% and 92%, respectively. Roll-over test higher than 20 mmHg had a 52% sensitivity and 95% specificity. 17% sensitivity and 99/5% specificity appeared when all tests were positive. Conclusion: Combination of these three tests shows a high specificity despite a low sensitivity in rule-out of pre-eclampsia. Thus, applying combination of three tests is recommended to midwives and health care providers.