by expert on call (297 Posts), Wed Jul 13, 2005 10:44 pm
Expert Answer #2:
There are two questions here. Should routine screening be performed at each visit, and should the patient asking the question have been screened. The simple answer is the second. Yes, a high risk patient near term with a blood pressure of 145/88 mm Hg should have her urine checked, and most would hospitalize her if proteinuria was detected. With a history of eclampsia she has a 20% chance of repeat preeclampsia/eclampsia, any many an eclamptic has convulsed with pressures at the levels noted here, and some times without the "classic" warning signs. Also we are not told of her earlier in gestation values, but if they were substantially lower it is hard to imagine why protein was not checked.
The first question is harder to answer for two reasons. Although the dipstick is considered the hallmark of a prenatal visit, and proteinuria is known to precede the blood pressure rise in preeclampsia, I am unaware of good outcome data in this area. We do know that qualitative dipstick testing has a high false positive and false negative incidence, especially for readings of 1+ but even for 2+, and that doing timed collections, or protein/creatinine ratios on single voided urines on all patients would be quite expensive in health care costs to yield terms, but quantitative dipstick apparatuses that will give albumin/creatinine ratios during a clinic visit and at low cost are not far away. In the meantime I would stay with the time honored dipstick.
Finally, urine glucose need not always be checked (as noted in one response) as many gravidas with normal glucose tolerance spill sugar in their urine, some to the tune of a few grams a day. But the ketone determination is very useful to the clinician, as a clue to adequate carbohydrate intake (I believe!)
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