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The clinical utility of routine urinalysis in pregnancy: a prospective study

Noreen Murray, Caroline S E Homer, Gregory K Davis, Julie Curtis, George Mangos and Mark A Brown
Med J Aust 2002; 177 (9): 477-480.

Summary

Objectives: To determine whether routine urinalysis in the antenatal period facilitates diagnosis of pre-eclampsia. Can routine urinalysis during pregnancy be discontinued in women with normal results of dipstick urinalysis and microscopy at the first antenatal visit?

Design: Prospective observational study.

Setting: A metropolitan public hospital and a private hospital in Sydney (NSW).

Participants: One thousand women were enrolled at their first antenatal visit (March to November 1999), and 913 completed the study.

Outcome measures: The primary outcome was a diagnosis of de novo hypertension (gestational hypertension, pre-eclampsia, or pre-eclampsia superimposed on chronic hypertension).

Results: Thirty-five women had dipstick proteinuria at their first antenatal visit. In 25 (71%) of these women, further dipstick proteinuria was detected during pregnancy, and two (6%) were diagnosed with pre-eclampsia. Of the 867 without dipstick proteinuria at the first visit, 338 (39%) had dipstick proteinuria (> 1+) at some time during pregnancy. There were no statistically significant differences in the proportion of women with and without dipstick proteinuria at their first visit who developed hypertension during pregnancy. Only six women developed proteinuria before the onset of hypertension. Women who had an abnormal result of a midstream urine test at their first visit, compared with women with a normal result, were more likely to have a urinary tract infection diagnosed during pregnancy; however, the numbers were small.

Conclusion: In the absence of hypertension, routine urinalysis during pregnancy is a poor predictor of pre-eclampsia. Therefore, after an initial screening urinalysis, routine urinalysis could be eliminated from antenatal care without adverse outcomes for women.

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  • Noreen Murray1
  • Caroline S E Homer2
  • Gregory K Davis3
  • Julie Curtis4
  • George Mangos5
  • Mark A Brown6

  • St George Hospital, University of New South Wales, and University of Technology, Sydney, Kogarah, NSW.

Correspondence: homerc@sesahs.nsw.gov.au

Acknowledgements: 

We would like to thank the midwives who were involved in the recruitment of women and the routine urine testing. We also thank Teresa Baldassarre for her assistance with data entry.

This study was primarily funded by the Midwifery Practice and Research Centre, a National Health and Medical Research Council Centre of Excellence in Hospital-based Research.

Competing interests:

None identified.

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