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Hypertension in pregnancy - Management
How do I manage women with new proteinuria without hypertension after 20 weeks' gestation?
If the woman is over 20 weeks' gestation and has new proteinuria but no hypertension:
- If she has symptoms of pre-eclampsia, arrange same-day hospital assessment.
- If there are no symptoms of pre-eclampsia:
- Consider possible urinary tract infection (UTI).
- If there is 1+ protein: if the woman has symptoms of a UTI, or the dipstick test is positive for nitrite or is positive for both leukocyte esterase and blood, make a working diagnosis of UTI and manage appropriately. Urine should be sent for culture and sensitivity. Ensure follow up within 1 week and reassess. For detailed information on the diagnosis and management of UTI, see the CKS topic on Urinary tract infection (lower) - women.
- If there is 2+ protein or more on dipstick testing: even if the woman has symptoms of a UTI or the dipstick test is positive for nitrite, or is positive for both leukocyte esterase and blood, seek same day specialist advice.
- If there is no evidence of a UTI:
- If there is 1+ protein on dipstick testing of urine, review 1 week later. If proteinuria is persistent, seek specialist advice.
- If there is 2+ protein or more on dipstick testing, seek same day specialist advice.
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