interpret proteinuria measurements for pregnant women in the context of a full clinical review of symptoms, signs and other investigations for pre-eclampsia
use an automated reagent-strip reading device for dipstick screening for proteinuria in pregnant women in secondary care settings
if dipstick screening is positive (1+ or more), use albumin:creatinine ratio or protein:creatinine ratio to quantify proteinuria in pregnant women
do not use first morning urine void to quantify proteinuria in pregnant women
do not routinely use 24-hour urine collection to quantify proteinuria in pregnant women
if using protein:creatinine ratio to quantify proteinuria in pregnant women:
use 30 mg/mmol as a threshold for significant proteinuria
if the result is 30 mg/mmol or above and there is still uncertainty about the diagnosis of pre-eclampsia, consider re-testing on a new sample, alongside clinical review
if using albumin:creatinine ratio as an alternative to protein:creatinine ratio to diagnose pre-eclampsia in pregnant women with hypertension:
use 8 mg/mmol as a diagnostic threshold
if the result is 8 mg/mmol or above and there is still uncertainty about the diagnosis of pre-eclampsia, consider re-testing on a new sample, alongside clinical review
NICE have defined pre-eclampsia as (1):
new onset of hypertension (over 140 mmHg systolic or over 90 mmHg diastolic) after 20 weeks of pregnancy and the coexistence of 1 or more of the following new-onset conditions:
proteinuria (urine protein:creatinine ratio of 30mg/mmol or more or albumin:creatinine ratio of 8mg/mmol or more, or at least 1 g/litre [2+] on dipstick testing) or
other maternal organ dysfunction:
renal insufficiency (creatinine 90 micromol/litre or more, 1.02 mg/100 ml or more)
liver involvement (elevated transaminases [alanine aminotransferase or aspartate aminotransferase over 40 IU/litre] with or without right upper quadrant or epigastric abdominal pain)
neurological complications such as eclampsia, altered mental status, blindness, stroke, clonus, severe headaches or persistent visual scotomata
haematological complications such as thrombocytopenia (platelet count below 150,000/microlitre), disseminated intravascular coagulation or haemolysis
uteroplacental dysfunction such as fetal growth restriction, abnormal umbilical artery doppler waveform analysis, or stillbirth
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