uric acid levels

[expert@preeclampsia.org]

I have been a Labor and Delivery nurse for 12 years and have seen a recent shift in how some of our docs diagnose preeclamsia. A couple of our docs have been basing their induction decisions mainly on the uric acid level.

We have had several women with chronic borderline BPs, 138-140/85-90, occasionally these women have had 1 or 2 slightly elevated BPs in the office. When they arrive in our triage area for evaluation and NST their BPs are almost alway less than they were in the office (our policy is to place the pt in a slightly reclining postion, place monitor, allow the pt about 5 minutes of rest THEN take the BP). We then draw labs. The pts in question most often have labs that show normal AST, ALT, platelets and little or no proteinurea, uric acid levels range from 3-6. They occasionally have mild edema, but deny visual changes and epigastric pain. BPP with NST is usually 10, with an occasional 8.

I am not questioning management/induction for pts who clearly have preeclamsia, AEB: lab values(including uric acid), repeatedly elevated BPs, non reactive NSTs or othe sx. I am only asking your opinion on those with slightly elevate BPs, normal test findings and 1 elevated (usually >4) uric acid level. In your opionion is there a uric acid level that, in spite of all other findings, would indicate the need for immediate intervention? I have researched this and while I've read the studies that indicate uric acid levels can be predictive, I'm at a loss to find one that indicated immediate intervention.

Thank you for taking the time to read my question and I hope to see a response.

[expert@preeclampsia.org]

This will be one of my shortest answers in a long time. NO!

Uric acid levels in pregnant women developing hypertension has a very very poor predictive value for determining if the patient has preeclampsia. No matter what the cause of the de novo hypertension, uric acid has no role regarding decisions to intervene (that here I suppose meant ending the pregnancy), Such decisions are based solely on maternal or fetal jeopardy (aptly suggested by the nurse below as poorly controlled blood pressure, signs of “HELLP”, fetal testing like the BPP etc.). Finally, there are many things other than preeclampsia that can affect renal urate handling, and quite a variance in normal range including genetic and racial factors to boot. Thus, there is no “level” to intervene, If blood pressure is reasonable, no promontory neurological, liver, or hematological signs, the pregnancy should proceed regardless of the urate.