HULA : habitual urinalysis is a laborious activity

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Objectives: The objective was to determine whether routine urinalysis in the antenatal period facilitates diagnosis of pre-eclampsia. The research question was: can routine urinalysis during pregnancy be discontinued in women with normal results of dipstick urinalysis and microscopy at the first antenatal visit? Design: A prospective observational study was undertaken. 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. Research Variables: The primary outcome was a diagnosis of hypertension (gestational hypertension, pre-eclampsia, or pre-eclampsia superimposed on chronic hypertension). Other variables were proteinuria, haematuria, parity, past history of preeclampsia, renal disease, diabetes mellitus and multiple pregnancy. Results: Thirty-five women had dipstick proteinuria at their first antenatal visit. In 25 (25/35) of these women, further dipstick proteinuria was detected during pregnancy, and two (2/35) 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. 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, were more likely to have a urinary tract infection diagnosed during pregnancy than women with a normal result, however, the numbers were small. Conclusion: This study suggests that urinalysis can be omitted from the routine antenatal care of Tow risk’ women, provided that urinalysis and microscopy is conducted on a carefully collected mid stream specimen of urine at the booking visit.
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