Combination Of Spot Urine Protein-Creatinine Ratio and Uterine Artery Doppler in Predicting Preeclampsia in Ibadan: A Prospective Cohort Study.

Abstract

Background: Early prediction and prompt antenatal surveillance of preeclampsia has the potential to improve overall feto-maternal outcome. A combination of ≥2 biomarkers have the potential to increase the probability of deriving suitable predictive algorithms. Objective: To combine spot urine protein-creatinine ratio (UPCR) and uterine artery (UA) doppler velocimetry to predict the development of preeclampsia. Methods: This was a prospective cohort study of 110 healthy pregnant women 16 to 20 weeks gestation recruited consecutively February to May 2020, from the Antenatal clinic of the University College Hospital, Ibadan. Samples were collected for spot urine-protein creatinine ratio were taken and UA Doppler velocimetry was conducted at 20 weeks. Abnormalities in UA Doppler parameters (A notch in the uterine artery, RI > 0.7 and PI > 1.4) were interpreted and an abnormal general Doppler result was reported. Participants were followed up until they developed preeclampsia or delivered. Chi-square test was used to compare categorical variables, and the student’s t-test for means. The performance of the screening tests was evaluated. The ROC curves were generated to evaluate the efficiency of the combination of UPCR and UA doppler parameters in predicting preeclampsia, calculating the area under the curve. The level of statistical significance was set at a p-value 35.5mg/mmol had a test sensitivity (62.5%), specificity (100%), PPV (100%), NPV (97.06%) and an accuracy of 97.20%. Results: The prevalence of preeclampsia from the study was 7.48%. The combined biomarkers (UPCR + UA doppler parameters) had an improved sensitivity of 87.5% and a predictive accuracy of 99.07%. The area under the curve (AUC) for the combined parameters was 0.999 (95% CI, 0.997- 1.000). Conclusion: A combination of spot UPCR and UA Doppler parameters in the early second trimester is a useful screening tool for the prediction of preeclampsia.