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  • Writer's pictureHands and Hearts Birth

#AskTheMidwifeMonday: Urine Tests

Updated: Oct 25, 2022

This week we had a question about the urine stick test done at each visit.

There's been so controversy over the urine stick test. I get it. It's not easy aligning a little cup around that belly, it's a short term view to conditions in the body, etc.

But it's also a useful tool we use as midwives, showing us hydration levels, potential issues such as UTI or other bacterial presence, etc.

What we collect is a "mid stream specimen" where we look at color clarity and any odor present.

Color: usual results are going to be pale like straw, ranging to a deep amber color. Typically, the darker the color the less hydration in the body, but certain foods and drugs can have an affect on coloring as well.

Clarity: clear, cloudy, or turbid. Cloudiness can be from things like mucus, sperm, high levels of white blood cells, or bacteria that is present. A frothy appearance indicates high concentrations of protein present.

Odor: fresh urine rarely has an offensive odor. If there is fishy or ammonia smell, this may indicate a urine infection. An acetone smell can indicate ketones in the urine or ketosis. Some strong flavored foods can also produce an 'off' odor.

A standar dipstick urinalysis used by many midwives will cover several areas. These tests include things that are normal and abnormal in the urine, and to what degree they exist at this time. Some things we look at are blood, bilirubin, urobilinogen, nitrites, leukocytes, protein, specific gravity, ketones, glucose, and PH levels.

Many times we leave the urine test for you to handle. As a midwife, we are on this pregnancy with you and work to educate you along the way so you are better able to make your best choices. By taking on the responsibility of checking your own urine at each visit, you learn how to monitor your body's journey. You can learn which fluids are not providing adequate hydration, how much protein is in your diet (or How little you're consuming). You see the effects of optimal and poor diet choices and learn how these affect your pregnancy health.

So let's talk about what these little urine strips tell us!

Blood: urine doesn't normally contain blood. We will often see this pad of the strip change color due to a color Bleed from another pad on the strip. On rare occasions it can show up in the presence of an underlying concern, and would refer you out to another Provider to do additional testing.

Bilirubin and Urobilinogen: bilirubin is a chemical produced whe red blood cells are broken down. It is transported in the blood to the liver, processed and excreted into the guy as bile. In the gut, bacterial changes transform the bilirubin into urobilinogen, which can be normal in urine (bilirubin is not). Bilirubin on the stick is often due to temperature changes and the age of the test strips, but it can also be an indicator of a breakdown in red blood cells not being effectively removed by the liver, as in the case of gall stones.

Nitrites: also not typical in the urine, these are usually associated with the presence of bacteria that converts nitrate into nitrite. This can be in the presence of a UTI. Approximately half of all tested urine contains some level of bacteria even when the nitrites are showing as negative.

Leukocytes: are typically associated with a UTI but they can also show on the strip due to recent sexual activity. In the absence of that, a high reading would indicate the need for further testing and another clean catch would be collected and sent out for testing.

Protein: healthy moms aren't spilling protein into their urine that is detected by a urine strip so we pay attention to it when we see it. If the proteins are large enough to pass thru the glomerular filtration barrier this would indicate proteinuria. Typical reasons in pregnancy for this is diabetes and preeclampsia. We would do a 24 hour collection and send that for additional testing.

Ketones: chemical formed during this abnormal breakdown of fat are not normally notes in the urine during pregnancy. A discussion of diet and current health concerns, such as poorly controlled diabetes, hyperemesis/vomiting, dieting/fasting, types and amounts of foods normally eaten will help us understand why this is happening.

Glucose: while this can show up with the use of corticosteroids, it is most often seen in pregnancy when mom has gestational or uncontrolled diabetes.

PH: the measure of acidity in the urine, with a reading of 5.0-8.0 being considered the normal range. This reading is also affected by high protein diets where a more vegetarian style diet will result in lower readings. A high reading can also indicate UTI.

Specific Gravity: the relative density of your urine, an indicator of hydration levels. Dilution is affected by the amounts and types of fluid intake, as well as diseases such as diabetes, kidney disease and endocrine disorders.

Urine test strips are simply a tool that allows us to see a snapshot of this moment in pregnancy. Abnormal readings aren't necessarily worrisome on a single reading, but our goal is to be proactive with care so we always investigate a little farther when there's concern. By sharing this information with you you're better equipped to see how everyday choices like drink and food options can affect your pregnancy and overall health.

While I am a Midwife, the topics presented here are for educational purposes only and should be discussed with your own Care Provider. These posts are teaching tools

designed to help you learn how to make informed choices throughout your pregnancy journey and childbearing season. Nothing contained in this blog post or on the website is to be considered the sharing of medical advice. Always discuss your concerns and questions with your chosen Provider.

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