Abstracts / Pregnancy Hypertension: An International Journal of Women’s Cardiovascular Health 2 (2012) 240–339
Introduction: Postpartum haemorrhage is an important cause of maternal morbidity and mortality, uterine atony being responsible for most of the cases. Hypertensive disorders are supposed to increase the possibility of such complications, mainly when complicated by ‘‘abruptio placentae’’. The classical treatments for postpartum haemorrhage have been based on medications like oxytocin and misoprostol, but more recently a haemostatic uterine suture developed by Christopher B-Lynch has been indicated. Here, we describe our experience of performing such technique and investigate its results in patients complicated by hypertensive disorders. Objectives: Reporting a series of cases of postpartum haemorrhage treated with the B-Lynch suture. Methods: This is a descriptive study including 39 patients treated with the B-Lynch suture after postpartum haemorrhage related to uterine atony. The period evaluated was between January 2005 and February 2012. Intravascular oxytocin was routinely used in all cases, with doses changing from 20 to 60 IU. The suture material used was chromed catgut 1.0 mm. Results: The mode of delivery was cesarean-section in all cases. Five patients (12.8%) had hypertensive disorder as additional complication and one of these patients had abruptio placentae followed by development of Couvelaire uterus. Overall, the B-Lynch technique helped to control haemorrhage in all cases evaluated. Conclusion: We believe that the B-Lynch technique appears as an important procedure to be indicated in cases of postpartum haemorrhage. Therefore, we recommend that this technique should be tried to control such complications before deciding for other more aggressive procedures like hysterectomy. It seems that this treatment may be used in patients complicated by hypertensive disorders. Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.133
PP023 Unexpected random urinary protein: creatinine ratio results – Insights from clinician-laboratory medicine collaboration D.A. De Silva 1,2,*, C. Halstead 2, A.-M. Côté 3, Y. Sabr 1, P. von Dadelszen 1,4, L.A. Magee 5,6,7 (1 Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada, 2 Department of Pathology and Laboratory Medicine, Children’s and Women’s Health Centre of British Columbia and the University of British Columbia, Vancouver, Canada, 3 Department of Medicine, Université de Sherbrooke, Sherbrooke, Canada, 4 Child and Family Research Institute, Canada, 5 Department of Specialized Women’s Health, British Columbia Women’s Hospital and Health Centre, Canada, 6 Department of Medicine, University of British Columbia, Canada, 7 Child and Family Research Institute, University of British Columbia, Vancouver, Canada) Introduction: Proteinuria assessment is important in pregnancy, particularly in determining whether or not a woman has pre-eclampsia. The random protein to creatinine ratio
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(PrCr) has been recommended as a confirmatory test for dipstick proteinuria in pregnancy, defined as random PrCr 30 mg/mmol. However, it has been our clinical impression that women with normal pregnancy outcomes have fluctuating or persistently elevated PrCr values. Objectives: As the primary goal of proteinuria testing in pregnancy should be to identify women at increased risk of adverse outcomes, we sought to explore our clinical impression that an elevated PrCr is seen not infrequently in pregnancies with normal outcome. Methods: In this prospective cohort study, consecutive inpatients or outpatients (attending high-risk maternity clinics) were evaluated at a tertiary care facility. Random midstream urine samples were obtained as part of normal clinical care. Urine protein was measured using a pyrocatechol violet molybdate dye-binding method, and urine creatinine by an enzymatic method, both on an automated analyser (VitrosÒ 5.1 FS or VitrosÒ 5600, Ortho-Clinical Diagnostics, Rochester, NY) followed by PrCr calculation. Maternal and perinatal outcomes were abstracted from the hospital case notes. Results: 160 women (81.9% outpatients) were screened at one/more antenatal visits providing a total of 233 samples for analysis. Ninety one (39.1%) samples had a random PrCr 30 mg/mmol. This result was more common when urinary creatinine concentration was 2 mg/ mmol and 3 (2.6%) had an ACr >8 mg/mmol. If dilute samples were excluded, none of the remaining 61 samples had an ACr value >2 mg/mmol. Conclusion: Among a population of pregnant women attending primarily morning high-risk maternity clinics, urine is often dilute and urine albumin is often below the assay detection limit. This combination may result in uninterpretable ACr values if an ACr cut-off of 2 mg/mmol is used as the decision limit for proteinuria 0.3 g/d. ACr may be best performed on first voided (concentrated) urine if ACr is used to assess proteinuria in pregnancy.
Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.135
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PP025. Urinary dipstick proteinuria testing – Does automated strip analysis offer an advantage over visual testing? D.A. De Silva 1,2,*, C. Halstead 2, A.-M. Côté 3, Y. Sabr 1, P. von Dadelszen 1,4, L.A. Magee 5,6,7 (1 Department of Obstetrics and Gynaecology, University of British Columbia, Canada, 2 Department of Pathology and Laboratory Medicine, Children’s and Women’s Health Centre of British Columbia and the University of British Columbia, Vancouver, Canada, 3 Department of Medicine, Université de Sherbrooke, Sherbrooke, Canada, 4 Child and Family Research Institute, Canada, 5 Department of Specialized Women’s Health, British Columbia Women’s Hospital and Health Centre, Canada, 6 Department of Medicine, University of British Columbia, Canada, 7 Child and Family Research Institute, University of British Columbia, Vancouver, Canada) Introduction: The visual urinary test strip is widely accepted for screening for proteinuria in pregnancy, given the convenience of the method and its low cost. However, test strips are known to lack sensitivity and specificity. The 2010 NICE (National Institute for Health and Clinical Excellence) guidelines for management of pregnancy hypertension have recommended the use of an automated test strip reader to confirm proteinuria (http://nice.org.uk/CG107). Superior diagnostic test performance of an automated (vs. visual) method has been proposed based on reduced subjectivity. Objectives: To compare the diagnostic test properties of automated vs. visual read urine dipstick testing for detection of a random protein:creatinine ratio (PrCr) of 30 mg/mmol. Methods: In this prospective cohort study, consecutive inpatients or outpatients (obstetric medicine and high-risk maternity clinics) were evaluated at a tertiary care facility. Random midstream urine samples (obtained as part of normal clinical care) were split into two aliquots. The first underwent a point-of-care testing for proteinuria using both visual (Multistix 10SG, Siemens Healthcare Diagnostics, Inc., Tarrytown NY) and automated (Chemstrip 10A, Roche Diagnostics, Laval QC) test strips, the latter read by an analyser (Urisys 1100Ò, Roche Diagnostics, Laval QC). The second aliquot was sent to the hospital laboratory for analysis of urinary protein using a pyrocatechol violet molybdate dye-binding method, and urinary creatinine using an enzymatic method, both on an automated analyser (VitrosÒ 5,1 FS or VitrosÒ 5600, Ortho-Clinical Diagnostics, Rochester NY); random PrCr ratios were calculated in the laboratory. Following exclusion of dilute samples with urinary creatinine concentration
Introduction: Postpartum haemorrhage is an important cause of maternal morbidity and mortality, uterine atony being responsible for most of the cases. Hypertensive disorders are supposed to increase the possibility of such complications, mainly when complicated by ‘‘abruptio placentae’’. The classical treatments for postpartum haemorrhage have been based on medications like oxytocin and misoprostol, but more recently a haemostatic uterine suture developed by Christopher B-Lynch has been indicated. Here, we describe our experience of performing such technique and investigate its results in patients complicated by hypertensive disorders. Objectives: Reporting a series of cases of postpartum haemorrhage treated with the B-Lynch suture. Methods: This is a descriptive study including 39 patients treated with the B-Lynch suture after postpartum haemorrhage related to uterine atony. The period evaluated was between January 2005 and February 2012. Intravascular oxytocin was routinely used in all cases, with doses changing from 20 to 60 IU. The suture material used was chromed catgut 1.0 mm. Results: The mode of delivery was cesarean-section in all cases. Five patients (12.8%) had hypertensive disorder as additional complication and one of these patients had abruptio placentae followed by development of Couvelaire uterus. Overall, the B-Lynch technique helped to control haemorrhage in all cases evaluated. Conclusion: We believe that the B-Lynch technique appears as an important procedure to be indicated in cases of postpartum haemorrhage. Therefore, we recommend that this technique should be tried to control such complications before deciding for other more aggressive procedures like hysterectomy. It seems that this treatment may be used in patients complicated by hypertensive disorders. Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.133
PP023 Unexpected random urinary protein: creatinine ratio results – Insights from clinician-laboratory medicine collaboration D.A. De Silva 1,2,*, C. Halstead 2, A.-M. Côté 3, Y. Sabr 1, P. von Dadelszen 1,4, L.A. Magee 5,6,7 (1 Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada, 2 Department of Pathology and Laboratory Medicine, Children’s and Women’s Health Centre of British Columbia and the University of British Columbia, Vancouver, Canada, 3 Department of Medicine, Université de Sherbrooke, Sherbrooke, Canada, 4 Child and Family Research Institute, Canada, 5 Department of Specialized Women’s Health, British Columbia Women’s Hospital and Health Centre, Canada, 6 Department of Medicine, University of British Columbia, Canada, 7 Child and Family Research Institute, University of British Columbia, Vancouver, Canada) Introduction: Proteinuria assessment is important in pregnancy, particularly in determining whether or not a woman has pre-eclampsia. The random protein to creatinine ratio
253
(PrCr) has been recommended as a confirmatory test for dipstick proteinuria in pregnancy, defined as random PrCr 30 mg/mmol. However, it has been our clinical impression that women with normal pregnancy outcomes have fluctuating or persistently elevated PrCr values. Objectives: As the primary goal of proteinuria testing in pregnancy should be to identify women at increased risk of adverse outcomes, we sought to explore our clinical impression that an elevated PrCr is seen not infrequently in pregnancies with normal outcome. Methods: In this prospective cohort study, consecutive inpatients or outpatients (attending high-risk maternity clinics) were evaluated at a tertiary care facility. Random midstream urine samples were obtained as part of normal clinical care. Urine protein was measured using a pyrocatechol violet molybdate dye-binding method, and urine creatinine by an enzymatic method, both on an automated analyser (VitrosÒ 5.1 FS or VitrosÒ 5600, Ortho-Clinical Diagnostics, Rochester, NY) followed by PrCr calculation. Maternal and perinatal outcomes were abstracted from the hospital case notes. Results: 160 women (81.9% outpatients) were screened at one/more antenatal visits providing a total of 233 samples for analysis. Ninety one (39.1%) samples had a random PrCr 30 mg/mmol. This result was more common when urinary creatinine concentration was 2 mg/ mmol and 3 (2.6%) had an ACr >8 mg/mmol. If dilute samples were excluded, none of the remaining 61 samples had an ACr value >2 mg/mmol. Conclusion: Among a population of pregnant women attending primarily morning high-risk maternity clinics, urine is often dilute and urine albumin is often below the assay detection limit. This combination may result in uninterpretable ACr values if an ACr cut-off of 2 mg/mmol is used as the decision limit for proteinuria 0.3 g/d. ACr may be best performed on first voided (concentrated) urine if ACr is used to assess proteinuria in pregnancy.
Disclosure of interest: None declared. doi:10.1016/j.preghy.2012.04.135
255
PP025. Urinary dipstick proteinuria testing – Does automated strip analysis offer an advantage over visual testing? D.A. De Silva 1,2,*, C. Halstead 2, A.-M. Côté 3, Y. Sabr 1, P. von Dadelszen 1,4, L.A. Magee 5,6,7 (1 Department of Obstetrics and Gynaecology, University of British Columbia, Canada, 2 Department of Pathology and Laboratory Medicine, Children’s and Women’s Health Centre of British Columbia and the University of British Columbia, Vancouver, Canada, 3 Department of Medicine, Université de Sherbrooke, Sherbrooke, Canada, 4 Child and Family Research Institute, Canada, 5 Department of Specialized Women’s Health, British Columbia Women’s Hospital and Health Centre, Canada, 6 Department of Medicine, University of British Columbia, Canada, 7 Child and Family Research Institute, University of British Columbia, Vancouver, Canada) Introduction: The visual urinary test strip is widely accepted for screening for proteinuria in pregnancy, given the convenience of the method and its low cost. However, test strips are known to lack sensitivity and specificity. The 2010 NICE (National Institute for Health and Clinical Excellence) guidelines for management of pregnancy hypertension have recommended the use of an automated test strip reader to confirm proteinuria (http://nice.org.uk/CG107). Superior diagnostic test performance of an automated (vs. visual) method has been proposed based on reduced subjectivity. Objectives: To compare the diagnostic test properties of automated vs. visual read urine dipstick testing for detection of a random protein:creatinine ratio (PrCr) of 30 mg/mmol. Methods: In this prospective cohort study, consecutive inpatients or outpatients (obstetric medicine and high-risk maternity clinics) were evaluated at a tertiary care facility. Random midstream urine samples (obtained as part of normal clinical care) were split into two aliquots. The first underwent a point-of-care testing for proteinuria using both visual (Multistix 10SG, Siemens Healthcare Diagnostics, Inc., Tarrytown NY) and automated (Chemstrip 10A, Roche Diagnostics, Laval QC) test strips, the latter read by an analyser (Urisys 1100Ò, Roche Diagnostics, Laval QC). The second aliquot was sent to the hospital laboratory for analysis of urinary protein using a pyrocatechol violet molybdate dye-binding method, and urinary creatinine using an enzymatic method, both on an automated analyser (VitrosÒ 5,1 FS or VitrosÒ 5600, Ortho-Clinical Diagnostics, Rochester NY); random PrCr ratios were calculated in the laboratory. Following exclusion of dilute samples with urinary creatinine concentration
