Prediction of preeclampsia by a combination of maternal spot urinary protein-creatinine ratio and uterine artery doppler

Rupali Modak, Amitrajit Pal, Amitava Pal, Mrinal K. Ghosh


Background: Preeclampsia (PE) is heterogeneous disorder. The aim of the study was to observe the role of a spot urinary protein - creatinine ratio (UPCR) and uterine artery doppler velocimetry measured between 20-24 weeks of gestation in prediction of preeclampsia.

Methods: Prospective observational study conducted on 120 pregnant mothers with singleton pregnancy between 20-24 weeks of gestational age in two tertiary teaching hospitals in eastern India. A spot urinary protein creatinine ratio (UPCR) was determined in a mid- stream urine sample and estimation of protein was done by immunoturbidimetric micro albumin method and creatinine by modified Jaffe’s method. Doppler velocimetry was also determined at 20-24 weeks of gestation. A notch in uterine artery, unilateral or bilateral; or RI > 0.7 and PI of > 1.45 were considered to have an abnormal result. Women were followed-up and relationship between variables was assessed by Chi- square test.

Results: Women who subsequently developed preeclampsia had significantly higher UPCR (median 44.8 mg/mmol) when compared with women of unaffected groups (median 26.6 mg/mmol). The optimum spot urinary UPCR to predict preeclampsia was 35.5 mg/mmol and the cut-off value >35.5 mg/mmol had a test sensitivity (80%), specificity (94.06%), PPV (66.76%) and NPV (96.94%).The area under curve (AUC) of spot UPCR in ROC curve was  0.949 (95% CI,0.891 - 1.000). For predicting preeclampsia, the mean uterine artery RI had to be >0.7 having sensitivity (60%), specificity (97.03%), PPV (75%) and NPV (94.23%). The area under curve (AUC) was 0.856 (95% CI, 0.742 - 0.971).

Conclusions: Second trimester UA doppler is a useful screening test for prediction of preeclampsia. This test works best when combined with a spot UPCR and accuracy of both the methods for prediction of preeclampsia was 92.24%.


Pre-eclampsia, Prediction, Urinary protein-creatinine ratio, Uterine artery doppler

Full Text:



Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Mathews TJ, Osterman MJ. The prevalence of preeclampsia in our study is 12.93% which is comparable to the incidence of 4-18% in developing countries. Births: final data for 2008. Natl Vital Stat Rep. 2010;59(1):3-71.

Khan KS, Wojdyla D, Say L, Gulmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: a systematic review. Lancet. 2006;367:1066-74.

Mak A, Cheung MW, Cheak AA, Ho RC. Combination of heparin and aspirin is superior to aspirin alone in enhancing live births in patients with recurrent pregnancy loss and positive anti-phospholipid antibodies: a meta-analysis of randomized controlled trials and meta regression. Rheumatol. 2011;49:281-8.

Levine RJ, Lam C, Qian C, Yu KF, Maynard SE, Sachs BP, et al. Soluble endoglin and other circulating anti angiogenic factors in preeclampsia. N Engl J Med. 2006;355:992-1005.

Young BC, Levine RJ, Karumanchi SA. Pathogenesis of preeclampsia. Annu Rev Pathol. 2010;5:173-92.

Khan F, Belch JJ, Macleod M, Mires G. Change in endothelial function precedes the clinical disease in women in whom preeclampsia develops. Hyper. 2005;46:1123-8.

Robert M, Sepandj F, Liston RM, Dooley KC. Random protein creatinine ratio for the quantification of proteinuria in pregnancy. J Obstet Gynecol.1997;90:893-5.

Razieh D, Mahdyeh M, Saedeh A, Reza NM. Uterine artery doppler sonography in predicting preeclampsia and IUGR at 14-16-week gestation. World Applied Scien. 2013;22(2):197-201.

Toal M, Keating S, Machin G, Dodd J, Adamson SL, Windrim RC, et al. Determinants of adverse perinatal outcome in high risk women with abnormal uterine artery doppler images. Am J Obstet Gynecol. 2008; 19:330.e1-330-e7.

Kozer E, Costei AM, Boskovie R, Nulman I, Nifkar S, Koren G. Effects of aspirin consuming during pregnancy on pregnancy outcomes: meta-analysis. Birth Defects Res Part B Dev Reprod Toxicol. 2013;68(1):70-84.

Baweja S, Kent A, Masterson R, Roberts S, McMahon LP. Prediction of preeclampsia in early pregnancy by estimating the spot urinary albumin: creatinine ratio using high performance liquid chromatography. BJOG. 2011;118(9):1126-32.

Fatema K, Khatun M, Akter S, Ali L. Role of urinary albumin in the prediction of preeclampsia. Faridpur Med Coll J. 2011;6(1):14-8.

Mishra VV, Goyal PA, Priyankur R, Choudhary S, Aggarwal RS, Gandhi K, et al. Evaluation of spot urinary albumin - creatinine ratio as screening tool in prediction of preeclampsia in early pregnancy. J Obstet Gynecol India. 2017;67(6):405-8.

Sahoo K, Saha P, Bhairagond S, Raj RV. The role of uterine artery doppler sonography in predicting preeclampsia at 14-20 weeks of gestation. Int J Sci Res. 2016;5:37-47.

Barati M, Shahbazian N, Ahmadi L, Masihi S. Diagnostic evaluation of uterine artery doppler sonography for the prediction of adverse pregnancy outcomes. J Res Med Sci. 2014;19(6):515-9.

Konchak PS, Bernstein IM, Capeless EL, Uterine artery doppler velocimetry in the detection of adverse outcomes in women with unexplained elevated maternal serum alpha-fetoprotein levels. Am J Obstet Gynecol.1995;173:1115-9.

Bhattacharrya SK, Kundu S, Kabiraj SP. Prediction of preeclampsia by midtrimester uterine artery Doppler velocimetry in high-risk or low risk- women. J Obstet Gynecol India. 2012;62(3);297-300.