The article by Dr Barry Walters on severe pre-eclampsia and maternal death in O&G Magazine Vol 15 No 1 Autumn 2013 is timely. Dr Walters rightly highlights the often unpredictable and fulminating nature of pre-eclampsia.
I believe the question of urinalysis by dipstick for protinuria in pregnancy needs revisiting.
RANZCOG no longer recommends urine screening in uncomplicated pregnancies. However, it remains vague about whether to test the patient who has generalised oedema, but whose blood pressure is normal. I have recently been involved in the cases of two young primigravid patients who developed fulminating pre-eclampsia over a short period of time. At their antenatal visits a few days earlier both had generalised oedema. Because the blood pressure was normal, the urine was not tested for protein.
When admitted, both patients had severe hypertension and gross proteinuria. One patient died from a cerebrovascular accident. The other had a craniotomy and clot evacuation and survived, but with considerable neurological deficit.
I admit that had both patients’ urine been tested for protein at their last antenatal visit the test may have been negative. We will never know. However, as Dr Walters points out, unless we use all our monitoring skills, the diagnosis of pre-eclampsia is often made too late for effective treatment. Dipstick testing of urine for protein is a simple and inexpensive test. Surely, if it saves one life or prevents a number of cases of fulminating pre-eclampsia it is worthwhile.