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


METHODS
Prospective observational study.


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


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


METHODS
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.


CONCLUSIONS
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.
Murray
Noreen
N
St George Hospital, University of New South Wales, and University of Technology, Sydney, Kogarah, NSW, Australia.
Homer
Caroline S E
CS
Davis
Gregory K
GK
Curtis
Julie
J
Mangos
George
G
Brown
Mark A
MA
D000293:Adolescent; D000328:Adult; D003404:Creatinine / Q000652:urine; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis; D008875:Middle Aged; D011225:Pre-Eclampsia / Q000175:diagnosis; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000175:diagnosis; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis; D011295:Prenatal Care; D011446:Prospective Studies; D011507:Proteinuria; D011934:Reagent Strips; D016482:Urinalysis; D014552:Urinary Tract Infections / Q000175:diagnosis
D011934:Reagent Strips; D003404:Creatinine