Estimation of Protein / Creatinine Ration in Pre Eclampsia with Single Voided Urine Sample Compare with 24 Hours Urine Protein
Abstract
Background: Preeclampsia is characterized by hypertension and proteinuria with the onset after 20 weeks of gestation. Globally 14.5% of maternal death is due to preeclampsia with fetal complications. National Record of Family Health Division Nepal shows prevalence rate of preeclampsia as 8.5%. The gold standard 24 hours urine protein evaluation test is time consuming for the diagnosis of preeclampsia and can increase complications to mother and fetus. Instant diagnosis and prompt management is needed. Objective of this study was to determine the accuracy of urinary protein/creatinine (P/C) ratio test and correlate random urinary (P/C) ratio with twenty-four hours urinary protein in detecting preeclampsia.
Methods: A cross sectional study was carried out conveniently selecting 130 samples of preeclampsia from Obstetrics and Gynaecology Department of National Medical College Teaching Hospital, Birgunj, Nepal. Out of 130 samples all met the inclusion criteria. Both twenty-four hours urine protein and P/C ratio were performed for each case. Correlation between two tests and accuracy of the test was performed using SPSS V 16.
Results: This study showed protein creatinine ratio is as capable as 24 hours protein urine to diagnose pregnant mother with preeclampsia. Spot P/C ratio provides effortless result with high validity and reliability.
Conclusion: This study showed protein creatinine ratio is as capable as 24 hours protein urine to diagnose pregnant mother with preeclampsia. Spot P/C ratio provides effortless result with high validity and reliability.
Keywords: Preeclampsia, 24 hours urinary protein, Receiver Operator characteristic curve (ROC), Area under the curve (AUC)
Keywords:
Preeclampsia, 24 hours urinary protein, Receiver Operator characteristic curve (ROC), Area under the curve (AUC)
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References
1. Cunningham FG, Leveno KJ, Bloom SL, Hath JC,Gilstrap L, Wenstrom KD editors. Williams Obstetrics. 24th ed. Mc Graw-Hill.In: Hypertensive Disorders in Pregnancy. 2010:728-730
2. Steegers EA, Von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. The Lancet. 2010 Aug 21; 376(9741):631-44. https://doi.org/10.1016/S0140-6736(10)60279-6
3. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, Gülmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health. 2014 Jun 1; 2(6):e323-33. https://doi.org/10.1016/S2214-109X(14)70227-X
4. Pasha O, McClure EM, Saleem S, Tikmani SS, Lokangaka A, Tshefu A, Bose CL, Bauserman M, Mwenechanya M, Chomba E, Carlo WA. A prospective cause of death classification system for maternal deaths in low and middle‐income countries: results from the Global Network Maternal Newborn Health Registry. BJOG: An International Journal of Obstetrics & Gynaecology. 2018 Aug; 125(9):1137-43. https://doi.org/10.1111/1471-0528.15011
5. Pant PD, Suvedi BK, Pradhan A, Hulton L, Matthews Z. Improvements in maternal health in Nepal: Further analysis of the 2006 Nepal Demographic and Health Survey.
6. Sibai BM. Preeclampsia as a cause of preterm and late preterm (near-term) births. InSeminars in perinatology 2006; 30(1):16-19). WB Saunders. https://doi.org/10.1053/j.semperi.2006.01.008
7. Jansen MA, Pluymen LP, Dalmeijer GW, Groenhof TK, Uiterwaal CS, Smit HA, van Rossem L. Hypertensive disorders of pregnancy and cardiometabolic outcomes in childhood: A systematic review. European journal of preventive cardiology. 2019 May 27; 2047487319852716. https://doi.org/10.1177/2047487319852716
8. El-Sayed AA. Preeclampsia: A review of the pathogenesis and possible management strategies based on its pathophysiological derangements. Taiwanese Journal of Obstetrics and Gynecology. 2017 Oct 1; 56(5):593-8. https://doi.org/10.1016/j.tjog.2017.08.004
9. Jeyabalan A, Conrad KP. Renal function during normal pregnancy and preeclampsia. Front Biosci. 2007 Jan 1; 12(1):2425-37. https://doi.org/10.2741/2244
10. Montero N, Montero N, Soler MJ, Soler MJ, Pascual MJ, Pascual MJ, Barrios C, Márquez E, Rodríguez E, Berrada A, Riera M. Correlation between the protein/creatinine ratio in spot urine and 24-hour urine protein. Nefrología (English Edition). 2012 Jul 1; 32(4):494-501.
11. Rodriguez-Thompson D, Lieberman ES. Use of a random urinary protein-to-creatinine ratio for the diagnosis of significant proteinuria during pregnancy. American journal of obstetrics and gynecology. 2001 Oct 1; 185(4):808-11. https://doi.org/10.1067/mob.2001.117349
12. Al RA, Baykal C, Karacay O, Geyik PO, Altun S, Dolen I. Random urine protein-creatinine ratio to predict proteinuria in new-onset mild hypertension in late pregnancy. Obstetrics & Gynecology. 2004 Aug 1; 104(2):367-71. https://doi.org/10.1097/01.AOG.0000134788.01016.2a
13. GangaramR, OjwangPJ, MoodleyJ, MaharajD. Accuracy of urine dipstick as a screening test for proteinuria in hypertensive disorders of pregnancy. Hypertension in pregnancy. 2005; 24:117-23 https://doi.org/10.1081/PRG-200059849
14. Sultana MN, Majumder B, Rahman MJ, Moniruzzaman AM, Suja AM, Ali ME, et al. Dipstick Method versus Spot Urinary Protein Creatinine Ratio for Evaluation of Massive Proteinuria in Childhood Nephrotic Syndrome. Mymensingh Med J MMJ. 2018 Apr; 27(2):369-74.
15. Shah S, Sulthana P. A Comparative Study of Urine Dipstick and Urine Protein Creatinine Ratio with 24 Hour Urinary Protein in Estimation of Significant Proteinuria in Pre-Eclampsia. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861. 2019; 18(7):21-29
16. Wheeler TL, Blackhurst DW, Dellinger EH, Ramsey PS. Usage of spot urine protein to creatinine ratios in the evaluation of preeclampsia. Am J Obstet Gynecol. 2007 May 1; 196(5):465.e1-465.e4. https://doi.org/10.1016/j.ajog.2006.10.892
17. Ginsberg JM, Chang BS, Matarese RA, Garella S. Use of single voided urine samples to estimate quantitative proteinuria. New England Journal of Medicine. 1983 Dec 22; 309(25):1543-6. https://doi.org/10.1056/NEJM198312223092503
18. Jan, S., Javaid, C., & Firdous, N. Diagnostic accuracy of spot urinary protein/creatinine ratio for proteinurea in pregnancy induced hypertension. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2017 May, 6(5):2083. https://doi.org/10.18203/2320-1770.ijrcog20171981
19. Neithardt AB, Dooley SL, Borensztajn J. Prediction of 24-hour protein excretion in pregnancy with a single voided urine protein-to-creatinine ratio. American journal of obstetrics and gynecology. 2002 May 1; 186(5):883-6. https://doi.org/10.1067/mob.2002.123055
20. Bianco A, Stone J, Lynch L, Lapinski R, Berkowitz G, Berkowitz RL. Pregnancy outcome at age 40 and older. Obstet Gynecol. 1996 Jun; 87(6):917-22. https://doi.org/10.1016/0029-7844(96)00045-2
21. Ramos JG, Sass N, Costa SH. Preeclampsia. Revista Brasileira de Ginecologia e Obstetrícia/RBGO Gynecology and Obstetrics. 2017 Sep; 39(09):496-512. https://doi.org/10.1055/s-0037-1604471
22. Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ. 2005 Mar 12; 330(7491):565. https://doi.org/10.1136/bmj.38380.674340.E0
23. Bdolah Y, Elchalal U, Natanson-Yaron S, Yechiam H, Bdolah-Abram T, Greenfield C, Goldman-Wohl D, Milwidsky A, Rana S, Karumanchi SA, Yagel S. Relationship between nulliparity and preeclampsia may be explained by altered circulating soluble fms-like tyrosine kinase 1. Hypertension in pregnancy. 2014 May 1; 33(2):250-9. https://doi.org/10.3109/10641955.2013.858745
24. Berhe AK, Kassa GM, Fekadu GA, Muche AA. Prevalence of hypertensive disorders of pregnancy in Ethiopia: a systemic review and meta-analysis. BMC pregnancy and childbirth. 2018 Dec; 18(1):34. https://doi.org/10.1186/s12884-018-1667-7
25. Melese MF, Badi MB, Aynalem GL. Perinatal outcomes of severe preeclampsia/eclampsia and associated factors among mothers admitted in Amhara Region referral hospitals, North West Ethiopia, 2018. BMC research notes. 2019 Dec; 12(1):147. https://doi.org/10.1186/s13104-019-4161-z
26. Weiler J, Tong S, Palmer KR. Is fetal growth restriction associated with a more severe maternal phenotype in the setting of early onset pre-eclampsia? A retrospective study. PLoS One. 2011 Oct 28; 6(10):e26937. https://doi.org/10.1371/journal.pone.0026937
27. Özkara A, Kaya AE, Başbuğ A, Ökten SB, Doğan O, Çağlar M, et al. Proteinuria in preeclampsia: is it important? Ginekol Pol. 2018; 89(5):256-61 https://doi.org/10.5603/GP.a2018.0044
28. Valdés E, Sepúlveda-Martínez Á, Tong A, Castro M, Castro D. Assessment of Protein:Creatinine Ratio versus 24-Hour Urine Protein in the Diagnosis of Preeclampsia. Gynecol Obstet Invest. 2016; 81(1):78-83. https://doi.org/10.1159/000381773
29. Robert M, Sepandj F, Liston RM, Dooley KC. Random Protein-Creatinine Ratio for the Quantitation of Proteinuria in Pregnancy. Obstet Gynecol. 1997 Dec 1; 90(6):893-5. https://doi.org/10.1016/S0029-7844(97)00536-X
30. Durnwald C, Mercer B. A prospective comparison of total protein/creatinine ratio versus 24-hour urine protein in women with suspected preeclampsia. Am J Obstet Gynecol. 2003 Sep; 189(3):848-52. https://doi.org/10.1067/S0002-9378(03)00849-4
31. Shahbazian N, Hosseini-Asl F. A comparison of spot urine protein-creatinine ratio with 24-hour urine protein excretion in women with preeclampsia. Iran J Kidney Dis. 2008; 2(3):127-31.
32. Aggarwal N, Suri V, Soni S, Chopra V, Kohli HS. A Prospective Comparison of Random Urine Protein-Creatinine Ratio vs 24-hour Urine Protein in Women With Preeclampsia. Medscape J Med. 2008 Apr 22; 10(4):98.
33. Demirci O, Kumru P, Arınkan A, Ardıç C, Arısoy R, Tozkır E, et al. Spot protein/creatinine ratio in preeclampsia as an alternative for 24-hour urine protein. Balk Med J. 2015 Jan; 32(1):51-5. https://doi.org/10.5152/balkanmedj.2015.15447
34. Kucukgoz Gulec U, Sucu M, Ozgunen FT, Buyukkurt S, Guzel AB, Paydas S. Spot Urine Protein-to-Creatinine Ratio to Predict the Magnitude of 24-Hour Total Proteinuria in Preeclampsia of Varying Severity. J Obstet Gynaecol Can JOGC J Obstet Gynecol Can JOGC. 2017 Oct; 39(10):854-60 https://doi.org/10.1016/j.jogc.2017.04.035
35. Waugh J, Hooper R, Lamb E, Robson S, Shennan A, Milne F, Price C, Thangaratinam S, Berdunov V, Bingham J. Spot protein-creatinine ratio and spot albumin-creatinine ratio in the assessment of pre-eclampsia: a diagnostic accuracy study with decision-analytic model-based economic evaluation and acceptability analysis. Health technology assessment (Winchester, England). 2017 Oct; 21(61):1. https://doi.org/10.3310/hta21610
36. Obeid N, O'Kelly R, Saadeh FA. A comparison of spot urine protein-creatinine ratio with 24 hour urine protein excretion for prediction of proteinuria in preeclampsia. Res Rep Gynaecol Obstet. 2018; 2 (1):11-15
37. Montero N, Soler MJ, Pascual MJ, Barrios C, Márquez E, Rodríguez E, et al. Correlation between the protein/creatinine ratio in spot urine and 24-hour urine protein. Nefrol Publicacion Of Soc Espanola Nefrol. 2012 Jul 17; 32(4):494-501.
38. Bejjani L, Nedellec S, Taïeb J, Thervet E, Benachi A. [Spot urinary protein to creatinine ratio: Which role in preeclampsia diagnosis?]. J Gynecol Obstet Biol Reprod (Paris). 2015 Nov; 44(9):795-801. https://doi.org/10.1016/j.jgyn.2015.04.006
2. Steegers EA, Von Dadelszen P, Duvekot JJ, Pijnenborg R. Pre-eclampsia. The Lancet. 2010 Aug 21; 376(9741):631-44. https://doi.org/10.1016/S0140-6736(10)60279-6
3. Say L, Chou D, Gemmill A, Tunçalp Ö, Moller AB, Daniels J, Gülmezoglu AM, Temmerman M, Alkema L. Global causes of maternal death: a WHO systematic analysis. The Lancet Global Health. 2014 Jun 1; 2(6):e323-33. https://doi.org/10.1016/S2214-109X(14)70227-X
4. Pasha O, McClure EM, Saleem S, Tikmani SS, Lokangaka A, Tshefu A, Bose CL, Bauserman M, Mwenechanya M, Chomba E, Carlo WA. A prospective cause of death classification system for maternal deaths in low and middle‐income countries: results from the Global Network Maternal Newborn Health Registry. BJOG: An International Journal of Obstetrics & Gynaecology. 2018 Aug; 125(9):1137-43. https://doi.org/10.1111/1471-0528.15011
5. Pant PD, Suvedi BK, Pradhan A, Hulton L, Matthews Z. Improvements in maternal health in Nepal: Further analysis of the 2006 Nepal Demographic and Health Survey.
6. Sibai BM. Preeclampsia as a cause of preterm and late preterm (near-term) births. InSeminars in perinatology 2006; 30(1):16-19). WB Saunders. https://doi.org/10.1053/j.semperi.2006.01.008
7. Jansen MA, Pluymen LP, Dalmeijer GW, Groenhof TK, Uiterwaal CS, Smit HA, van Rossem L. Hypertensive disorders of pregnancy and cardiometabolic outcomes in childhood: A systematic review. European journal of preventive cardiology. 2019 May 27; 2047487319852716. https://doi.org/10.1177/2047487319852716
8. El-Sayed AA. Preeclampsia: A review of the pathogenesis and possible management strategies based on its pathophysiological derangements. Taiwanese Journal of Obstetrics and Gynecology. 2017 Oct 1; 56(5):593-8. https://doi.org/10.1016/j.tjog.2017.08.004
9. Jeyabalan A, Conrad KP. Renal function during normal pregnancy and preeclampsia. Front Biosci. 2007 Jan 1; 12(1):2425-37. https://doi.org/10.2741/2244
10. Montero N, Montero N, Soler MJ, Soler MJ, Pascual MJ, Pascual MJ, Barrios C, Márquez E, Rodríguez E, Berrada A, Riera M. Correlation between the protein/creatinine ratio in spot urine and 24-hour urine protein. Nefrología (English Edition). 2012 Jul 1; 32(4):494-501.
11. Rodriguez-Thompson D, Lieberman ES. Use of a random urinary protein-to-creatinine ratio for the diagnosis of significant proteinuria during pregnancy. American journal of obstetrics and gynecology. 2001 Oct 1; 185(4):808-11. https://doi.org/10.1067/mob.2001.117349
12. Al RA, Baykal C, Karacay O, Geyik PO, Altun S, Dolen I. Random urine protein-creatinine ratio to predict proteinuria in new-onset mild hypertension in late pregnancy. Obstetrics & Gynecology. 2004 Aug 1; 104(2):367-71. https://doi.org/10.1097/01.AOG.0000134788.01016.2a
13. GangaramR, OjwangPJ, MoodleyJ, MaharajD. Accuracy of urine dipstick as a screening test for proteinuria in hypertensive disorders of pregnancy. Hypertension in pregnancy. 2005; 24:117-23 https://doi.org/10.1081/PRG-200059849
14. Sultana MN, Majumder B, Rahman MJ, Moniruzzaman AM, Suja AM, Ali ME, et al. Dipstick Method versus Spot Urinary Protein Creatinine Ratio for Evaluation of Massive Proteinuria in Childhood Nephrotic Syndrome. Mymensingh Med J MMJ. 2018 Apr; 27(2):369-74.
15. Shah S, Sulthana P. A Comparative Study of Urine Dipstick and Urine Protein Creatinine Ratio with 24 Hour Urinary Protein in Estimation of Significant Proteinuria in Pre-Eclampsia. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861. 2019; 18(7):21-29
16. Wheeler TL, Blackhurst DW, Dellinger EH, Ramsey PS. Usage of spot urine protein to creatinine ratios in the evaluation of preeclampsia. Am J Obstet Gynecol. 2007 May 1; 196(5):465.e1-465.e4. https://doi.org/10.1016/j.ajog.2006.10.892
17. Ginsberg JM, Chang BS, Matarese RA, Garella S. Use of single voided urine samples to estimate quantitative proteinuria. New England Journal of Medicine. 1983 Dec 22; 309(25):1543-6. https://doi.org/10.1056/NEJM198312223092503
18. Jan, S., Javaid, C., & Firdous, N. Diagnostic accuracy of spot urinary protein/creatinine ratio for proteinurea in pregnancy induced hypertension. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2017 May, 6(5):2083. https://doi.org/10.18203/2320-1770.ijrcog20171981
19. Neithardt AB, Dooley SL, Borensztajn J. Prediction of 24-hour protein excretion in pregnancy with a single voided urine protein-to-creatinine ratio. American journal of obstetrics and gynecology. 2002 May 1; 186(5):883-6. https://doi.org/10.1067/mob.2002.123055
20. Bianco A, Stone J, Lynch L, Lapinski R, Berkowitz G, Berkowitz RL. Pregnancy outcome at age 40 and older. Obstet Gynecol. 1996 Jun; 87(6):917-22. https://doi.org/10.1016/0029-7844(96)00045-2
21. Ramos JG, Sass N, Costa SH. Preeclampsia. Revista Brasileira de Ginecologia e Obstetrícia/RBGO Gynecology and Obstetrics. 2017 Sep; 39(09):496-512. https://doi.org/10.1055/s-0037-1604471
22. Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ. 2005 Mar 12; 330(7491):565. https://doi.org/10.1136/bmj.38380.674340.E0
23. Bdolah Y, Elchalal U, Natanson-Yaron S, Yechiam H, Bdolah-Abram T, Greenfield C, Goldman-Wohl D, Milwidsky A, Rana S, Karumanchi SA, Yagel S. Relationship between nulliparity and preeclampsia may be explained by altered circulating soluble fms-like tyrosine kinase 1. Hypertension in pregnancy. 2014 May 1; 33(2):250-9. https://doi.org/10.3109/10641955.2013.858745
24. Berhe AK, Kassa GM, Fekadu GA, Muche AA. Prevalence of hypertensive disorders of pregnancy in Ethiopia: a systemic review and meta-analysis. BMC pregnancy and childbirth. 2018 Dec; 18(1):34. https://doi.org/10.1186/s12884-018-1667-7
25. Melese MF, Badi MB, Aynalem GL. Perinatal outcomes of severe preeclampsia/eclampsia and associated factors among mothers admitted in Amhara Region referral hospitals, North West Ethiopia, 2018. BMC research notes. 2019 Dec; 12(1):147. https://doi.org/10.1186/s13104-019-4161-z
26. Weiler J, Tong S, Palmer KR. Is fetal growth restriction associated with a more severe maternal phenotype in the setting of early onset pre-eclampsia? A retrospective study. PLoS One. 2011 Oct 28; 6(10):e26937. https://doi.org/10.1371/journal.pone.0026937
27. Özkara A, Kaya AE, Başbuğ A, Ökten SB, Doğan O, Çağlar M, et al. Proteinuria in preeclampsia: is it important? Ginekol Pol. 2018; 89(5):256-61 https://doi.org/10.5603/GP.a2018.0044
28. Valdés E, Sepúlveda-Martínez Á, Tong A, Castro M, Castro D. Assessment of Protein:Creatinine Ratio versus 24-Hour Urine Protein in the Diagnosis of Preeclampsia. Gynecol Obstet Invest. 2016; 81(1):78-83. https://doi.org/10.1159/000381773
29. Robert M, Sepandj F, Liston RM, Dooley KC. Random Protein-Creatinine Ratio for the Quantitation of Proteinuria in Pregnancy. Obstet Gynecol. 1997 Dec 1; 90(6):893-5. https://doi.org/10.1016/S0029-7844(97)00536-X
30. Durnwald C, Mercer B. A prospective comparison of total protein/creatinine ratio versus 24-hour urine protein in women with suspected preeclampsia. Am J Obstet Gynecol. 2003 Sep; 189(3):848-52. https://doi.org/10.1067/S0002-9378(03)00849-4
31. Shahbazian N, Hosseini-Asl F. A comparison of spot urine protein-creatinine ratio with 24-hour urine protein excretion in women with preeclampsia. Iran J Kidney Dis. 2008; 2(3):127-31.
32. Aggarwal N, Suri V, Soni S, Chopra V, Kohli HS. A Prospective Comparison of Random Urine Protein-Creatinine Ratio vs 24-hour Urine Protein in Women With Preeclampsia. Medscape J Med. 2008 Apr 22; 10(4):98.
33. Demirci O, Kumru P, Arınkan A, Ardıç C, Arısoy R, Tozkır E, et al. Spot protein/creatinine ratio in preeclampsia as an alternative for 24-hour urine protein. Balk Med J. 2015 Jan; 32(1):51-5. https://doi.org/10.5152/balkanmedj.2015.15447
34. Kucukgoz Gulec U, Sucu M, Ozgunen FT, Buyukkurt S, Guzel AB, Paydas S. Spot Urine Protein-to-Creatinine Ratio to Predict the Magnitude of 24-Hour Total Proteinuria in Preeclampsia of Varying Severity. J Obstet Gynaecol Can JOGC J Obstet Gynecol Can JOGC. 2017 Oct; 39(10):854-60 https://doi.org/10.1016/j.jogc.2017.04.035
35. Waugh J, Hooper R, Lamb E, Robson S, Shennan A, Milne F, Price C, Thangaratinam S, Berdunov V, Bingham J. Spot protein-creatinine ratio and spot albumin-creatinine ratio in the assessment of pre-eclampsia: a diagnostic accuracy study with decision-analytic model-based economic evaluation and acceptability analysis. Health technology assessment (Winchester, England). 2017 Oct; 21(61):1. https://doi.org/10.3310/hta21610
36. Obeid N, O'Kelly R, Saadeh FA. A comparison of spot urine protein-creatinine ratio with 24 hour urine protein excretion for prediction of proteinuria in preeclampsia. Res Rep Gynaecol Obstet. 2018; 2 (1):11-15
37. Montero N, Soler MJ, Pascual MJ, Barrios C, Márquez E, Rodríguez E, et al. Correlation between the protein/creatinine ratio in spot urine and 24-hour urine protein. Nefrol Publicacion Of Soc Espanola Nefrol. 2012 Jul 17; 32(4):494-501.
38. Bejjani L, Nedellec S, Taïeb J, Thervet E, Benachi A. [Spot urinary protein to creatinine ratio: Which role in preeclampsia diagnosis?]. J Gynecol Obstet Biol Reprod (Paris). 2015 Nov; 44(9):795-801. https://doi.org/10.1016/j.jgyn.2015.04.006
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Khatun T, Ghimire K, Alam S. Estimation of Protein / Creatinine Ration in Pre Eclampsia with Single Voided Urine Sample Compare with 24 Hours Urine Protein. JDDT [Internet]. 15Jun.2021 [cited 1May2024];11(3-S):35-7. Available from: https://jddtonline.info/index.php/jddt/article/view/4825
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