12/11/05

**Q. Should a urine test be performed on every pregnant patient each
prenatal visit?**

A. No, routine urine testing in pregnancy is very insensitive and
non-specific. See details

"....it is a tradition at our clinic that every woman has to go to the
lab to leave a urine specimen before she goes to every
appointment.....these tests are performed to rule out pre-eclampsia,
diabetes, and asymptomatic urine infections....."

Routine prenatal urine testing may be a 'tradition', but it is both an
insensitive and non-specific method to detect pre-eclampsia, diabetes
and asymptomatic urine infections. I suggest your clinic change to
targeted urine screening. Targeted urine screening will save unnecessary
and ineffective testing, as well as improve the patient flow in your
clinic.

Let us now look at:

Screening for pre-eclampsia

Screening for gestational diabetes

Screening for asymptomatic urinary tract infections

**[\# 1 Pre-eclampsia]{.underline}**

Urinary protein dipstick values do not correlate well with 24-hour
urinary collection protein excretion values in hypertensive pregnant
women (Meyer, Kuo, Waugh). In one systematic review including six
studies, the posttest probability for urine dipstick of
![](media/image1.png){width="8.333333333333333e-2in"
height="9.236111111111112e-2in"}1+ for predicting 24-hour urine protein
excretion ![](media/image1.png){width="8.333333333333333e-2in"
height="9.236111111111112e-2in"}300 mg ranged from 53 to 86 percent, and
was 23 to 40 percent when the dipstick was negative or trace (Waugh).
Thus, a negative dipstick does not necessarily exclude significant
proteinuria while many women with positive tests do not have it.
However, urine dipstick values of 3+ and 4+ are more helpful as, in one
series, all but 9 percent of patients with these dipstick values
excreted at least 3.5 g of protein per day (Meyer).

A. ACOG does not recommend routine urine dipstick screening because it
is not "reliable and cost-effective" (ACOG Practice Bulletin No. 33)

>  

" ***Are there effective methods for identifying women at risk for
preeclampsia?***

No single screening test for preeclampsia has been found to be reliable
and cost-effective (35--37). Uric acid is one of the most commonly used
tests but it has a positive predictive value of only 33% and has not
proved useful in predicting preeclampsia (38). Doppler velocimetry of
the uterine arteries was reported not to be a useful test for screening
pregnant women at low risk for preeclampsia (35, 39). "

***The following recommendations are based on limited or inconsistent
scientific evidence (Level B):***

Practitioners should be aware that although various laboratory tests may
be useful in the management of women with preeclampsia, to date there is
no reliable predictive test for preeclampsia.

>  

B. ACOG says you can use urine testing for following pts with
[diagnosed]{.underline} chronic hypertension, but that is different than
screening all patients. (ACOG Practice Bulletin No. 29)

Even in known hypertensive patients they don't recommend random dipstick
urines though, rather they discuss a 24 hour urine, a 2 hour urine, or
P:C ratio

>   

"Periodic measurement of urine protein may be useful in detecting
worsening renal disease or the development of superimposed preeclampsia
(28). It has been reported that the random protein- creatinine ratio may
be useful for the quantitation of proteinuria during pregnancy. The
correlation coefficient between this ratio and the 24-hour urine total
protein was 0.94 (29). Investigators also reported high sensitivity and
specificity between the protein/creatinine ratio from a single urine
sample and proteinuria of 300 mg or greater in a 24-hour specimen."

More from ACOG - Guidelines for Perinatal Care

#1 Urine dipstick protein screening is also not mentioned as a mainstay
of prenatal practice' in the most recent Guidelines for Perinatal Care,
5^th^ Edition, American College of Obstetricians and Gynecologists,
2002.  In fact, the routine screening UA each visit is not mentioned at
all

For Pre-eclamsia, please refer to pages 172 -175

#2 According to ACOG there is a role for urine testing, it just isn't
effective on all patients every visit. Just like the 1989 PHS Expert
Panel, ACOG recommends initial urine to test for asymptomatic bacteriuia
at the first prenatal visit

For Routine Antepartum Care, please refer to page 90

C. Canadian Task Force on the Periodic Health Examination

Measurable proteinuria usually occurs late in the course of the illness
and therefore is not useful for early detection.\<2\> However, screening
for bacteriuria in pregnancy is recommended at 12 to 16 weeks (see
Chapter 9). In a prospective study of women between 24 and 34 weeks of
gestation, a urine albumin concentration ³11 mcg/L had a sensitivity of
50% in predicting subsequent preeclampsia.\<11\> The conventional
dipstick test is unreliable in detecting the moderate and highly
variable elevations in albumin that occur early in the course of
preeclampsia but it can help ascertain the diagnosis when it is
present.\<12\>

>  

D. USPSTF

The same recommendations and references were used as the Canadian group
above, plus this additional reference

[Irgens-Moller
L](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term="Irgens-Moller+L"%5BAuthor%5D),
[Hemmingsen
L](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term="Hemmingsen+L"%5BAuthor%5D),
[Holm
J](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term="Holm+J"%5BAuthor%5D).
Diagnostic value of microalbuminuria in pre-eclampsia. Clin Chim Acta.
1986 Jun 30;157(3):295-8

E.

Caring for Our Future: The Content of Prenatal Care - A Report of the
Public Health Service Expert Panel on the Content of Prenatal Care. 1989
U.S. Department of Health and Human Service. NIH Publication No. 90-3182
Reprinted 1990

Look at Table 5-1.

UAs are for the preconception visit only and a urine bacterial screen is
for the first prenatal visit only. As with all the major professional
organizations, the PHS Expert Panel recommends BP measurement for
screening for hypertensive disease

F. Here is a systematic look at this evidence from Alto, 2005

METHODS: We searched Medline (1966-2004), the Cochrane review, AHRQ
National Guideline Clearinghouse, the Institute for Clinical Systems
Improvement, and Google, searching for studies on proteinuria or
glycosuria in pregnancy. The reference list of each article reviewed was
examined for additional studies, but none were identified. We found 6
studies investigating glycosuria as a predictor for gestational diabetes
mellitus, or proteinuria as a predictor for preeclampsia (1 examined
both). Because every study used different dipstick methods of
determining results, or definitions of abnormal, each was evaluated
separately.

RESULTS: Glycosuria is found at some point in about 50% of pregnant
women; it is believed to be due to an increased glomerular filtration
rate. The renal threshold for glucose is highly variable and may lead to
a positive test result for glycosuria despite normal blood sugar. High
intake of ascorbic acid or high urinary ketone levels may result in
false-positive results. Four published studies assessed the value of
glycosuria as a screen for gestational diabetes. All used urine
dipsticks. Three of the 4 most likely overestimate the sensitivity of
glycosuria for predicting gestational diabetes.

CONCLUSIONS: Routine dipstick screening for protein and glucose at each
prenatal visit should be abandoned. Women who are known or perceived to
be at high risk for gestational diabetes or preeclampsia should continue
to be monitored closely at the discretion of their clinician.

**So then....how should you screen for pre-eclampsia?**

## Screening for Pre-clampsia

-Screening for preeclampsia is recommended for all pregnant women at the
first prenatal

visit and throughout the remainder of pregnancy.

-To screen for preeclampsia, measure an upright sitting blood pressure
after a 10 minute rest. The BP should be repeated in a similar manner
4-6 hours later to confirm the diagnosis. (see below)

-There is no role for universal urine dipstick testing to screen for
preeclampsia in routine

prenatal care.

[Method of measuring blood pressure in pregnancy]{.underline}

The diastolic blood pressure is that pressure at which the sound
disappears (Korotkoff phase V).

To reduce inaccurate readings, an appropriate size cuff should be used
(length 1.5 times upper arm circumference or a cuff with a bladder that
encircles 80% or more of the arm). The blood pressure level should be
taken with the patient in an upright position, after a 10-minute or
longer rest period.

For patients in the hospital, the blood pressure can be taken with
either the patient sitting up or in the left lateral recumbent position
with the patient\'s arm at the level of the heart. The patient should
not use tobacco or caffeine for 30 minutes preceding the measurement
Although validated electronic devices can be used, a mercury
sphygmomanometer is preferred because it is the most accurate device

[Guidelines for Urine Protein Screening during Pregnancy]{.underline}

Urine screening for pre-clampsia and gestational diabetes has a very
poor sensitivity and specifics. In conjunction with the PHS Expert Panel
on the Content of Prenatal Care we suggest:

Urine analysis and culture and sensitivity at the first visit, then
repeat urine dipstick only if

-   BP greater then 140/90 mm Hg or

> mean arterial pressure greater than 105 mm Hg

-   Symptoms of pre-clampsia

-   Multiple gestation

-   Symptoms of UTI

-   Chronic hypertension listed on problem list or currently on
    hypertension medication.

**[#2 Gestational diabetes]{.underline}**

Although measuring urine glucose may be much easier than measuring blood
glucose, it has potential errors that limit its accuracy as a reflection
of glycemic control and is rarely used. Detection of glucose on a
semi-quantitative urine dipstick (anything regarded as trace positive or
more) or Clinitest tablets is a fairly specific but insensitive means of
screening for type 2 diabetes. The high rate of false-negative results
suggests that the urine dipstick is not adequate as a screening test.

See also Alto 2005

Extensive literature exists on the most common method for GDM screening
in the U.S., e.g., two-step method. Please consult the Indian Health CME
/ CEU module**,** Diabetes in Pregnancy: Screening and Diagnosis for
those details. <http://www.ihs.gov/MedicalPrograms/MCH/M/DP01.asp#top>

**[\# 3 Asymptomatic urine infections]{.underline}**

"....but won't we miss all the asymptomatic urine infections if we don't
perform a complete 9 panel urine dipstick for leukocyte esterase and
nitrites..."

Actually, no the multi-panel dipstick (rapid enzymatic) is a poor test
when performed routinely on all pregnant patients, plus it is somewhat
difficult to obtain a clean catch urine in progressing pregnancies.

Screening for asymptomatic bacteriuria is standard practice at the
[first]{.underline} prenatal visit. Re-screening is generally not
performed in low risk women, but can be considered in women at high risk
for infection (e.g., presence of urinary tract anomalies, hemoglobin S,
or preterm labor).

Multiple studies have been performed to assess whether rapid screening
tests, such as dipstick, enzymatic screen, reagent strip, or
interleukin-8, might have comparable sensitivity, specificity, and
predictive value to urine culture for the detection of asymptomatic
bacteriuria in pregnant women.

These methods do not come close to urine culture in terms of sensitivity
and specificity and should not be used. In addition, cultures are useful
in guiding therapy. This can be particularly important in pregnancy
where the number of safe treatment alternatives is reduced. (References
below\*)

2 issues

[Routine care:]{.underline}

There should be an initial culture done at the initial visit and none
thereafter unless the pt has specific sx, e.g., UTI, PTL, etc...

[In OB Triage:]{.underline}

If a patients presents with UTI symptoms, or preterm contractions or
actual preterm labor, etc... then yes those patients should have a CCUA

If your facility has a very high rate of pyelonephritis that is
associated with poor obstetric outcomes, then that should be very
obvious with a Quality Assurance review by diagnosis, e.g.,
pyelonephitis, urosepsis, etc....

**Summary**

Reliance on routine dipstick urine testing to diagnose pre-eclampsia,
diabetes, and asymptomatic urinary tract infections is fraught with
difficulties. The basic modality is both insensitive and non-specific.
In addition, it is difficult to obtain an actual clean catch specimen on
every visit from increasing gravid women. Here are better approaches for
screening

-Gestational diabetes with oral glucose screening

-Pre-eclampsia with BP

-Asx bacteriuria with a culture at the first visit

In the meantime, I suggest your precious health care resources be used
elsewhere. It will also help the flow of your prenatal visit not to have
each patient have to get unnecessary urine that then has to be run your
otherwise busy staff.

**Additional Resources**

Guidelines for Management of Hypertensive Disorders in Pregnancy

<http://www.ihs.gov/NonMedicalPrograms/nc4/Documents/HYPERT12004.doc>

**Diabetes Mellitus in Pregnancy Screening and Management Guidelines**

<http://www.ihs.gov/MedicalPrograms/MCH/w/documents/DMPreg102504_000.doc>

**Hypertension in Pregnancy: Mild Pre-eclampsia - Indian Health CME /
CEU module**

<http://www.ihs.gov/MedicalPrograms/MCH/M/HP01.cfm>

**Diabetes in Pregnancy: Screening and Diagnosis - Indian Health CME /
CEU module**

<http://www.ihs.gov/MedicalPrograms/MCH/M/DP01.asp#top>

**Urinary tract infections and asymptomatic bacteriuria in pregnancy,
UpToDate**

[[http://www.uptodateonline.com/application/topic.asp?file=uti_infe/7516&type=A&selectedTitle=3\~102]{.underline}](http://www.uptodateonline.com/application/topic.asp?file=uti_infe/7516&type=A&selectedTitle=3~102)

Caring for Our Future: The Content of Prenatal Care - A Report of the
Public Health Service Expert Panel on the Content of Prenatal Care. 1989
U.S. Department of Health and Human Service. NIH Publication No. 90-3182
Reprinted 1990

[Rosen
MG](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term="Rosen+MG"%5BAuthor%5D),
[Merkatz
IR](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term="Merkatz+IR"%5BAuthor%5D),
[Hill
JG](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term="Hill+JG"%5BAuthor%5D).
Caring for our future: a report by the expert panel on the content of
prenatal care. Obstet Gynecol. 1991 May;77(5):782-7.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=2014096&dopt=Abstract>

**Other Resources**

1**.) Pre-eclampsia**

[Alto
WA](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term="Alto+WA"%5BAuthor%5D).
No need for glycosuria/proteinuria screen in pregnant women. [J Fam
Pract.](javascript:AL_get(this, 'jour', 'J Fam Pract.');) 2005
Nov;54(11):978-83.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16266604&query_hl=1>

Kuo VS; Koumantakis G; Gallery ED. Proteinuria and its assessment in
normal and hypertensive pregnancy. Am J Obstet Gynecol 1992
Sep;167(3):723-8.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1530030>

Meyer NL; Mercer BM; Friedman SA; Sibai BM. Urinary dipstick protein: a
poor predictor of absent or severe proteinuria. Am J Obstet Gynecol 1994
Jan;170(1 Pt 1):137-41

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8296815&dopt=MEDLINE>

Waugh JJ; Clark TJ; Divakaran TG; Khan KS; Kilby MD. Accuracy of
urinalysis dipstick techniques in predicting significant proteinuria in
pregnancy. Obstet Gynecol 2004 Apr;103(4):769-77.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=15051572&dopt=Abstract>

Diagnosis and management of preeclampsia and eclampsia. ACOG Practice
Bulletin No. 33. American College of Obstetricians and Gynecologists.
Obstet Gynecol 2002;99:159--167

[[http://www.acog.org/publications/educational_bulletins/pb033.cfm]{.underline}](http://www.acog.org/publications/educational_bulletins/pb033.cfm)

 

Chronic Hypertension in Pregnancy. ACOG Practice Bulletin No. 29.
American College of Obstetricians and Gynecologists. Obstet Gynecol
2001; 98:177-185

[[http://www.acog.org/publications/educational_bulletins/pb029.cfm]{.underline}](http://www.acog.org/publications/educational_bulletins/pb029.cfm)

Reference number

28 vans W, Lensmeyer JP, Kirby RS, Malnory ME, Broekhuizen FF. Two-hour
urine collection for evaluating renal function correlates with 24-hour
urine collection in pregnant patients. J Matern Fetal Med
2000;9:233--237 (Level II-3)

29 Robert M, Sepandj F, Liston RM, Dooley KC. Random protein-creatinine
ratio for the quantitation of proteinuria in pregnancy. Obstet Gynecol
1997;90:893--895 (Level II-2)

30 Ramos JG, Martins-Costa SH, Mathias MM, Guerin YL, Barros EG. Urinary
protein/creatinine ratio in hypertensive pregnant women. Hypertens
Pregnancy 1999;18: 209--218 (Level II-3)

Beaulieu M.D. Prevention of preeclampsia. In: Canadian Task Force on the
Periodic Health Examination. [**[Canadian Guide to Clinical Preventive
Health
Care]{.underline}**](http://www.hc-sc.gc.ca/hppb/healthcare/pubs/clinical_preventive/index.html).
Ottawa: Health Canada, 1994; 136-43.

Reference number

2\. Chesley LC: History and epidemiology of preeclampsia-eclampsia.
*Clin Obstet Gynecol* 1984; 27: 801-820

11\. Rodriguez MH, Masaki DI, Mestman J, *et al*: Calcium/creatinine
ration and microalbuminuria in the prediction of preeclampsia. *Am J
Obstet Gynecol* 1988; 159: 1452-1455

12\. Sibai BM: Pitfalls in diagnosis and management of preeclampsia. *Am
J Obstet Gynecol* 1988; 159: 1-5

Here is the whole USPSTF document, search for 'urine'

[[http://www.ahrq.gov/clinic/2ndcps/preeclam.pdf]{.underline}](http://www.ahrq.gov/clinic/2ndcps/preeclam.pdf)

Specifically

[Irgens-Moller
L](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term="Irgens-Moller+L"%5BAuthor%5D),
[Hemmingsen
L](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term="Hemmingsen+L"%5BAuthor%5D),
[Holm
J](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term="Holm+J"%5BAuthor%5D).
Diagnostic value of microalbuminuria in pre-eclampsia. Clin Chim Acta.
1986 Jun 30;157(3):295-8

[[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=3731490&query_hl=14]{.underline}](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=3731490&query_hl=14)

Guidelines for Perinatal Care, 5^th^ Edition, American College of
Obstetricians and Gynecologists, 2002. 

**2.) Diabetes in Pregnancy**

American Diabetes Association. Urine glucose and ketone determinations.
Diabetes Care 1995; 18 Suppl 1:20.

Andersson DK; Lundblad E; Svardsudd K A model for early diagnosis of
type 2 diabetes mellitus in primary health care. Diabet Med 1993
Mar;10(2):167-73.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8458195&query_hl=3>

**3.) Urinary Tract**

-Millar L; DeBuque L; Leialoha C; Grandinetti A; Killeen J Rapid
enzymatic urine screening test to detect bacteriuria in pregnancy.
Obstet Gynecol 2000 Apr;95(4):601-4.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10725497&query_hl=28>

CONCLUSION: The Uriscreen enzymatic screening test had inadequate
sensitivity for rapid screening for bacteriuria in pregnancy.

-McNair RD; MacDonald SR; Dooley SL; Peterson LR Evaluation of the
centrifuged and Gram-stained smear, urinalysis, and reagent strip
testing to detect asymptomatic bacteriuria in obstetric patients. Am J
Obstet Gynecol 2000 May;182(5):1076-9.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10819832&query_hl=30>

CONCLUSIONS: Centrifugation with Gram stain of a urine specimen offers
excellent sensitivity but very poor specificity compared with
microscopic urinalysis for the detection of asymptomatic bacteriuria and
is not an acceptable screening test in an obstetric population. The
false-negative rates of urinalysis (19.4%) and reagent strip testing
(52.8%) preclude these from being excellent screening tests for
asymptomatic bacteriuria. Given the potential sequelae of undiagnosed
asymptomatic bacteriuria in an obstetric population, we conclude that
urine cultures should be used for all pregnant patients to detect
asymptomatic bacteriuria.

-Shelton SD; Boggess KA; Kirvan K; Sedor F; Herbert WN Urinary
interleukin-8 with asymptomatic bacteriuria in pregnancy. Obstet Gynecol
2001 Apr;97(4):583-6.

<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11275031&query_hl=32>

CONCLUSION: Urinary interleukin-8 is not an acceptable screening method
for asymptomatic bacteriuria in pregnancy because it fails to detect 30%
of women with this condition.

\-[Teppa
RJ](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term="Teppa+RJ"%5BAuthor%5D),
[Roberts
JM](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term="Roberts+JM"%5BAuthor%5D).
The uriscreen test to detect significant asymptomatic bacteriuria during
pregnancy. J Soc Gynecol Investig. 2005 Jan;12(1):50-3\
[[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15629672&query_hl=2]{.underline}](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15629672&query_hl=2)

CONCLUSION: The Uriscreen test had inadequate sensitivity for rapid
screening of bacteriuria in pregnancy.

-Millar L; DeBuque L; Leialoha C; Grandinetti A; Killeen J Rapid
enzymatic urine screening test to detect bacteriuria in pregnancy.
Obstet Gynecol 2000 Apr;95(4):601-4.

[[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10725497&query_hl=28]{.underline}](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10725497&query_hl=28)

CONCLUSION: The Uriscreen enzymatic screening test had inadequate
sensitivity for rapid screening for bacteriuria in pregnancy.

\-[Chongsomchai
C](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term="Chongsomchai+C"%5BAuthor%5D),
[Piansriwatchara
E](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term="Piansriwatchara+E"%5BAuthor%5D),
[Lumbiganon
P](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term="Lumbiganon+P"%5BAuthor%5D),
[Pianthaweechai
K](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term="Pianthaweechai+K"%5BAuthor%5D).Screening
for asymptomatic bacteriuria in pregnant women: urinalysis versus urine
culture. J Med Assoc Thai. 1999 Apr;82(4):369-73.

[[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10410499&query_hl=2]{.underline}](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10410499&query_hl=2)\
Because of its low sensitivity and the possible consequences of ABU,
simple urinalysis should not be used as a screening test for ABU.

\-[Robertson
AW](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term="Robertson+AW"%5BAuthor%5D),
[Duff
P](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Search&term="Duff+P"%5BAuthor%5D).The
nitrite and leukocyte esterase tests for the evaluation of asymptomatic
bacteriuria in obstetric patients. Obstet Gynecol. 1988 Jun;71(6 Pt
1):878-81\
[[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=3285267&query_hl=2]{.underline}](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=3285267&query_hl=2)

We conclude that neither the nitrite test nor the leukocyte esterase
test alone is a sensitive enough screening test to detect asymptomatic
bacteriuria in obstetric patients.

9/4/05njm

Revised 12/11/05 njm