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Optimal practice review: recommendation reminders detail

Recommendation reminder 4: Routine assessment of proteinuria is not recommended.

Guidance:Postnatal care
Date issued:July 2006

Postnatal care refers to the care of women and their babies in the first 6–8 weeks after birth. Because each woman and baby has different needs, every postnatal contact is different.

Postnatal care is primarily about providing a supportive environment in which a woman, her baby and the wider family can begin their new life together. For most women and babies the postnatal period is uncomplicated. But postnatal care is also about being able to ensure that the mother and baby are recovering normally after the birth and being able to quickly identify and deal with any problems should they occur.

The majority of postnatal care takes place in the woman’s home and is likely to include routine clinical examination and observation of the woman and her baby, routine infant screening to detect potential disorders, support for infant feeding and ongoing provision of information and support.

Pre-eclampsia is a condition that can occur during pregnancy or just after the delivery of a baby. Women with pre-eclampsia develop high blood pressure and other symptoms such as headaches accompanied by changes in vision, nausea, vomiting or feeling faint. Pre-eclampsia is also associated with more protein than usual in the urine (proteinuria). Therefore if women have high blood pressure and other symptoms of pre-eclampsia they need to be referred immediately for further investigations, which are likely to involve assessment of proteinuria.

It is important to note that women with pre-eclampsia that started before or during labour would have a different postnatal management plan from healthy women receiving routine postnatal care, which was the focus of the NICE guideline on postnatal care. When reviewing the evidence on the core care that every healthy woman should be offered during the first 6–8 weeks after the birth, the NICE Guideline Development Group (GDG) did not find any evidence to support routine assessment of proteinuria in practice during the postnatal period.

In addition, the available evidence suggested that proteinuria assessment would not be the best way to identify pre-eclampsia in postnatal women (which the guideline recommends should be assessed by taking one blood pressure measurement within 6 hours of the birth and by asking women about signs or symptoms of pre-eclamapsia).

Furthermore, given the rapid turnover of women in postnatal hospital wards, other practical considerations such as when proteinuria assessment should be carried out and over how many days or weeks mean that a recommendation of routine proteinuria assessment would be very difficult to implement. Therefore NICE does not recommend the routine assessment of proteinuria in the postnatal care of healthy women.

This page was last updated: 12 November 2009

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.