ObstetricsTier 2Topic

Urine dipstick in pregnancy

Role

Routine antenatal screening tool assessing protein, blood, leucocytes, nitrites, glucose, ketones at each visit
Screens for pre-eclampsia (proteinuria), asymptomatic bacteriuria/UTI, and (less reliably) glycosuria

Poor sensitivity/specificity for proteinuria compared with formal quantification - false positives from contamination or concentrated urine, false negatives with dilute urine
Dipstick protein reacts predominantly with albumin and is a semi-quantitative, concentration-dependent estimate, not a reliable quantitative measure

Dipstick proteinuria (>=1+) should prompt formal quantification - urine protein:creatinine ratio or a 24-hour collection - not used alone to diagnose pre-eclampsia
Nitrites + leucocyte esterase positive -> send a midstream urine culture; treat asymptomatic bacteriuria in pregnancy (unlike in non-pregnant adults), given the risk of progression to pyelonephritis and preterm birth
Glycosuria is a poor correlate of glucose control in pregnancy (the lower renal threshold is physiological) - not used to diagnose or monitor GDM

Proteinuria -> UPCR/24h urine +/- BP recheck +/- pre-eclampsia bloods if hypertensive
Positive nitrites/leucocytes -> treat asymptomatic bacteriuria even without symptoms (amoxicillin/cephalexin/nitrofurantoin depending on trimester and sensitivities)

Asymptomatic bacteriuria - untreated, progresses to pyelonephritis in up to 30% of pregnant women (versus much lower rates if treated)

A single dipstick abnormality is a trigger for further testing, not a diagnosis in itself - this is the main exam point

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