Is routine urine dip stick testing justified in asymptomatic women in early pregnancy?

Jonathan Gaughran, Bethany Chung, Tom Lyne, Nuhaat Syeda, Daniel Field, Judith Hamilton


Background: Routine urinalysis is commonly performed in early pregnancy units (EPUs) based on historic evidence that bacteriuria is linked to pyelonephritis, pre-term birth, mid trimester loss and low birth weight. Aim was to assess the cost and diagnostic yield of routine urinalysis in asymptomatic women in early pregnancy. A secondary outcome was the birth outcomes for women with proven bacteriuria.

Methods: Retrospective review of all urinalysis performed over 12 month period in a tertiary EPU and analysis of pregnancy outcomes in the proven bacteriuria group.

Results: 10,490 urinalyses performed at a cost of £40,385.50. 1162 (11%) positive urine dips; 68 (0.6%) nitrite positive. 179 microscopy, culture and sensitivity performed at a cost of £2593.71. Of the 179, 65 were culture positive giving a proven bacteriuria rate of 0.6%. The most common pathogen was E-Coli. There were no recorded episodes of pyelonephritis and no statistical significance in the pre-term birth, mid trimester loss or low birth weight rate in the culture positive versus culture negative group.

Conclusions: The cost associated with routine urinalysis is significant and the diagnostic yield is extremely low. We did not identify an association between bacteriuria and adverse pregnancy outcomes. As such, urinalysis should only be performed in symptomatic/ high risk patients presenting to the EPU.


Bacteriuria, Early pregnancy, Low birth weight, Miscarriage, Premature, Urinalysis

Full Text:



NICE. Guideline (NG 109): Urinary tract infection (lower): antimicrobial prescribing 2018. Available at Accessed on 23 June 2020.

Smaill FM, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev. 2015;8:CD000490.

Glaser AP, Schaeffer AJ. Urinary tract infection and bacteriuria in pregnancy. Urol Clin North Am. 2015;42:547-60.

Patterson TF, Andriole VT. Detection, significance, and therapy of bacteriuria in pregnancy. Update in the managed health care era. Infect Dis Clin North Am. 1997;11:593-608.

NICE. Guideline (CG 62): Antenatal care for uncomplicated pregnancies 2019. Available at Accessed on16 June 2020.

Bonkat G, Bartoletti RR, Bruyere F, Cai T, Geerlings SE, Koves B, et al. Guideline on urological infection. Available at https:// uroweb. org/ wp-content/ uploads/EAU-Guidelines-on-Urological-infections-2019.pdf. Accessed on 18 June 2020.

Kazemier BM, Koningstein FN, Schneeberger C, Ott A, Bossuyt PM, Miranda E, et al. Maternal and neonatal consequences of treated and untreated asymptomatic bacteriuria in pregnancy: a prospective cohort study with an embedded randomised controlled trial. Lancet Infect Dis. 2015;15(11):1324-33.

Wingert A, Pillay J, Sebastianski M, Gates M, Featherstone R, Shave K, et al. Asymptomatic bacteriuria in pregnancy: systematic reviews of screening and treatment effectiveness and patient preferences. BMJ Open. 2019;9:e021347.

Little P, Turner S, Rumsby K, Warner G, Moore, M, Lowes JA, et al. Developing clinical rules to predict urinary tract infection in primary care settings: sensitivity and specificity of near patient tests (dipsticks) and clinical scores. British J General Practice. 2006;56(529):606-12.

Brown MA, Holt JL, Mangos GJ, Murray N, Curtis J, Homer C. Microscopic hematuria in pregnancy: Relevance to pregnancy outcome. Am J Kidney Dis. 2005;45(4):667-73.

NICE. Guideline 45 Routine preoperative testing for elective surgery. Available at https:// www. Accessed on 19 June 2020.

Wilson JMG, Jungner G. Principles and practice of screening for disease. World Health Organisation; 1968. Available at http:// www. who. int/bulletin/volumes/86/4/07-050112BP.pdf. Accessed on 20 June 2020.

Rowińska MJ, Małyszko J, Wieliczko M. Urinary tract infections in pregnancy: old and new unresolved diagnostic and therapeutic problems. Arch Med Sci. 2015;11(1):67-77.

Gravett MG, Rubens CE, Nunes TM. GAPPS review group global report on preterm birth and stillbirth (2 of 7): discovery science. BMC Pregnancy Childbirth. 2010;10(1):1-26.

Sheiner E, Mazor E, Levy A. Asymptomatic bacteriuria during pregnancy. J Matern Fetal Neonat Med. 2009;22:423-7.

Beck S, Wojdyla D, Say L, Betran AP, Merialdi M, Requejo HJ, et al. The worldwide incidence of preterm birth: a systematic review of maternal mortality and morbidity. Bull World Health Organ. 2010;88:31-8.

Tommy’s. Premature birth statistics. Available at Accessed on 19 October 2020.

Saleh P, Noshad H, Mallah F, Ramouz A. Acute pyelonephritis in pregnancy and the outcomes in pregnant patients. Arch Clin Infect Dis. 2015;10(3):e28886.

Delft S, Goedhart A, Spigt M, Pinxteren B, Wit N, Hopstaken R. Prospective, observational study comparing automated and visual point-of-care urinalysis in general practice. BMJ Open. 2016;6:e011230.

Widerstöm M, Wiström J, Ferry S, Karlsson C, Monsen T. Molecular epidemiology of Staphylococcus saprophyticus isloalted from women with uncomplicated community acquired urinary tract infection. J Clin Microbiol. 2007;45:1561-4.

Kenyon S, Pike K, Jones DR, Brocklehurst P, Marlow N, Salt A, et al. Childhood outcomes after prescription of antibiotics to pregnant women with spontaneous preterm labour: 7-year follow-up of the ORACLE II trial. Lancet. 2008;372:1319-27.

Russel AR, Murch SH. Could peripartum antibiotics have delayed health consequences for the infant? BJOG. 2006;113:758-65.

Chu C, Lowder JL. Diagnosis and treatment of urinary tract infections across age groups. Am J Obst Gynecol. 2019;1:40-51.