The positive outcomes observed support a conservative approach to disease management.

Untreated urinary tract infection can have devastating maternal and neonatal effects. Thus, routine screening for bacteriuria is advocated. This study was designed to evaluate the diagnostic accuracy of the rapid dipstick test to predict urinary tract infection in pregnancy with the gold standard of urine microscopy, culture and sensitivity acting as the control. The urine dipstick test uses the leucocyte esterase, nitrite and test for protein singly and in combination. The result of the dipstick was compared with the gold standard, urine microscopy, culture and sensitivity using confidence interval for proportions. The reliability and validity of the urine dipstick was also evaluated. Overall, the urine dipstick test has a poor correlation with urine culture (p = 0.125, CI 95%). The same holds true for individual components of the dipstick test. The overall sensitivity of the urine dipstick test was poor at 2.3%. Individual sensitivity of the various components varied between 9.1% for leucocyte esterase and the nitrite test to 56.8% for leucocyte esterase alone. The other components of the dipstick test, the test of nitrite, test for protein and combination of the test (leucocyte esterase, nitrite and proteinuria) appear to decrease the sensitivity of the leucocyte esterase test alone. The ability of the urine dipstick test to correctly rule out urinary tract infection (specificity) was high. The positive predictive value for the dipstick test was high, with the leucocyte esterase test having the highest positive predictive value compared with the other components of the dipstick test. The negative predictive value (NPV) was expectedly highest for the leucocyte esterase test alone with values higher than the other components of the urine dipstick test singly and in various combinations. Compared with the other parameters of the urine dipstick test, singly and in combination, leucocyte esterase appears to be the most accurate (90.25%). The dipstick test has a limited use in screening for asymptomatic bacteriuria. The leucocyte esterase test component of the dipstick test appears to have the highest reliability and validity. The other parameters of the dipstick test decreases the reliability and validity of the leucocyte esterase test. A positive test merits empirical antibiotics, while a negative test is an indication for urine culture. The urine dipstick test if positive will also be useful in follow-up of patient after treatment of urinary tract infection. This is useful in poor resource setting especially in the third world where there is a dearth of trained personnel and equipment for urine culture.

The presence of protein in hypertensive disorders of pregnancy is a sign of a worsening condition and thus requires early intervention to prevent adverse consequences. Accurate assessment of proteinuria in patients with pre-eclampsia will ensure prompt and timely intervention to reduce or prevent the maternal and perinatal morbidity and mortality associated with pre-eclampsia. This study compared the reliability and validity of the more rapid diagnostic tests, such as the dipstick, 2-h and 12-h protein estimations with the 24-h protein. The result of the dipstick, 2-h and 12-h urine were also compared with the 24-h urine results using confidence interval (CI) for proportions with a value of p < 0.05 considered significant (CI 95%). When compared with the gold standard, there was a high degree of correlation between the 2-h (p = 0.244, CI 95%) and 12-h (p < 0.0255, CI 95%) with the 24-h sample in the quantification of proteinuria in women with pre-eclampsia. The most sensitive and specific test was the 12-h protein estimation, (89%) and (93%), respectively. The least sensitive and specific test was the dipstick test; (81%) and (47%), respectively. The 12-h protein estimation test had the highest positive predictive value (84%). The 12-h protein test also had the lowest false positive rate (12%) and false negative rates (11%), respectively. The most accurate test was the 12-h protein estimation (88%). The dipstick tests were however much cheaper and the results were faster. It is recommended that routine rapid quantisation of proteinuria in patients with pre-eclampsia be done using either the 2-h or 12-h urine sample.

Despite the 3.9 % prevalence, routine screening for hepatitis C virus infection in pregnancy is unjustified. Risk-based screening using locally prevailing risk factors with antenatal monitoring and postpartum treatment of women with hepatitis C antibodies is recommended.

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