Initial Workup for Hematuria in Pregnancy

Initial Assessment

The American College of Radiology recommends beginning with a thorough history, physical examination, urinalysis, and serologic testing before any imaging, to rule out common benign causes specific to pregnancy, such as urinary tract infection and gynecologic bleeding 3, 4
Ultrasound of the kidneys and bladder is the recommended first-line imaging for evaluation of hematuria in pregnancy, with more comprehensive workup deferred until after delivery once benign causes have been excluded, as recommended by the American College of Radiology 1, 2

The incidence of asymptomatic microhematuria in pregnant women is similar to non-pregnant women, approximately 20%, according to the American College of Radiology 1
The risk of malignancy in pregnant women with hematuria is low, as stated by the American College of Radiology 1, 2

The initial laboratory evaluation for microhematuria in pregnancy should include complete urinalysis with microscopic examination, as recommended by the American College of Radiology 3
Ultrasound of kidneys and bladder is the recommended initial imaging modality, which avoids radiation exposure to the fetus and can identify most structural abnormalities of the urinary tract, according to the American College of Radiology 1, 2
MRU without IV contrast may be reasonable in select cases, as stated by the American College of Radiology 5, 6
CT, CTU, and MRI with IV contrast should be avoided due to fetal radiation exposure or uncertain effects of gadolinium, as recommended by the American College of Radiology 1, 6, 2

The American College of Radiology recommends avoiding unnecessary radiation exposure during pregnancy, and ultrasound should be the first imaging modality 1, 2
Gadolinium-based contrast agents should be avoided during pregnancy due to uncertain fetal effects, as stated by the American College of Radiology 5, 6