Protein:creatinine ratio (PCR) and albumin:creatinine ratio (ACR) were both shown to have high specificity and high sensitivity at the chosen thresholds (30 mg/mmol and 8 mg/mmol respectively), and therefore either could be used depending on local availability. The committee agreed that using both tests together did not have any additional diagnostic benefit. There was some evidence that using the first morning urine void in assessment of proteinuria can lead to lower diagnostic accuracy, and so the committee recommended against using this. As PCR and ACR show very high diagnostic accuracy, they should be used in place of 24-hour urine collection, which is awkward for women and could delay identification of proteinuria. However, there are rare occasions when it might be more appropriate to use 24-hour collection (for example, women with renal complications), and so the committee agreed it should not be ruled out entirely. There was good evidence that a PCR of 30 mg/mmol had good diagnostic accuracy, showing high sensitivity and specificity and should be used as the threshold for significant proteinuria. However, the committee recommended retesting for results above 30 mg/ mmol if there is still diagnostic uncertainty (for example, the woman has no other clinical signs or symptoms of pre-eclampsia) because there is large variation in protein excretion during the day and from day to day. The committee agreed that this would prevent women being diagnosed with pre-eclampsia on the basis of a single raised PCR result. Evidence from a single study showed high sensitivity and specificity for an ACR result of 8 mg/mmol to diagnose proteinuria. However, the committee were also aware of further results from a large, UK-based study, which provided further evidence for the efficacy of a threshold of 8 mg/mmol in the diagnosis of severe pre-eclampsia. 