To explore the correlation between urinary protein:creatinine ratio and 24-h excretion of protein, we studied 149 women referred to a day assessment unit for investigations for suspected preeclampsia. Paired samples were obtained for measurement of urinary protein:creatinine ratio and 24-h protein excretion. Collection of a 24-h urine sample was validated by the daily creatinine excretion. The outcome measure was proteinuria of 300 mg/day or more. Inaccurate 24-h collection was observed in 17% of women. All women (n = 56) with a protein:creatinine ratio >60 mg/mM had significant proteinuria. No woman with protein:creatinine ratio <18 mg/mM (n = 20) had significant proteinuria. We recommend that a dual cut-off should be used for excluding and "ruling in" the diagnosis of significant proteinuria. A 24-h urine collection should be used only for urinary protein:creatinine ratio values between 18 and 60 mg/mM in the detection of significant proteinuria.

Using laboratory reference ranges, B₁₂ deficiency is inappropriately diagnosed and treated in pregnancy. We aim to define reference ranges for ferritin, folate, haemoglobin and B₁₂ in a pregnant population with advancing gestation. A total of 190 women participated in a cross-sectional study, 113 in the 1st and 77 in the 3rd trimester. All variables studied except red cell folate, decreased significantly from the 1st to the 3rd trimester. A total of 34% (64/190) of women were found to have 'low' B₁₂ as defined by traditional ranges. In women with anaemia and apparent B₁₂ deficiency, co-existing ferritin deficiency was demonstrated. All women with 'low' B₁₂ levels were invited to attend postnatally for re-testing. A total of 28% (18/64) attended, in whom all B₁₂ levels spontaneously increased. The use of gestation specific reference ranges for haematological variables may reduce inappropriate diagnosis of B₁₂ deficiency. In most women with apparent low B₁₂ levels and anaemia, ferritin deficiency was demonstrated. Therefore iron should be the initial management therapy.

ABSTRACT

Previous cesarean performed for failure to progress and Asian/African ethnic origin were associated with unsuccessful VBAC. The performance of a previous prediction model was inferior.

Objective Using laboratory reference ranges, B12 deficiency is inappropriately diagnosed and treated in pregnancy. The authors aim to define reference ranges for ferritin, folate, haemoglobin and B12 in a pregnant population with advancing gestation. Design A cross-sectional study was performed between May 2008 and January 2009. Setting Ayrshire Maternity Unit and peripheral clinics within Ayrshire and Arran. Methods After obtaining informed consent, venesection was performed at booking and 34 weeks in healthy pregnant women. Information regarding demographic details, dietary influences and use of supplements was obtained. Patients with ‘low’ B12 in the absence of anaemia and/or macrocytosis were not treated and invited to return for postnatal review. Results 190 women participated, 113 in the first and 77 in the third trimester. All variables studied except red cell folate, decreased significantly from the first to third trimester. 34% (64/190) of women were found to have ‘low’ B12 as defined by traditional ranges. In women with anaemia and apparent B12 deficiency, coexisting ferritin deficiency was demonstrated. All B12 levels spontaneously increased postnatally. Conclusion The authors propose that use of gestation specific reference ranges for haematological variables, as defined by this study, would reduce inappropriate diagnosis of B12 deficiency. In most women with apparent low vitamin B12 levels and anaemia, ferritin deficiency was demonstrated and therefore iron should be the initial management therapy.