Established diagnostic criteria accept new hypertension after 20 weeks with other evidence of organ involvement, such as raised liver enzymes, low platelets, renal impairment, neurological symptoms or placental dysfunction, even when urinary protein is absent.
Proteinuria is therefore one feature among several and its amount does not define severity. Where a woman has new hypertension and a headache, epigastric pain or abnormal bloods, a negative dipstick should not end the assessment.
- A negative urine dipstick does not exclude pre-eclampsia.
- Check blood count, liver enzymes and creatinine when hypertension is new after 20 weeks.
- Ask about headache, visual symptoms and upper abdominal pain at every visit.
- Use a quantitative urine test rather than dipstick alone when a result will change management.
Why it matters
Relying on a dipstick can delay recognition of pre-eclampsia in women without proteinuria.
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