Background: The albumin to creatinine ratio have been proposed as alternative methods for the assessment of proteinuria in pre-eclampsia, as they are simpler and more convenient than 24-hour urine collection. The present study has been objectively conducted to determine the diagnostic accuracy of albumin to creatinine ratio compared to 24 hour urine collection for the detection of significant proteinuria in patients with suspected pre-eclampsia, and their ability to predict adverse outcomes for mother and baby. Methods: The study was carried out at the Department of Obstetrics and Gynaecology at SMGS Hospital, Government Medical College, Jammufor a period of one year w.e.f October 2014 to September 2015. A total of 100 patients as per inclusion criteria of the study were included in the study after an approval was obtained from the Institute Ethics Committee. Results: The spot urinary albumin-creatinine ratio (ACR) had an AUC of 0.836 with a 95% CI of 0.64-1.00, indicating that it is a moderately good predictor of 0.3 gm/24 hour of protein excretion. The sensitivity was 88.5%, which suggests that the test can detect 88.5% of patients with 0.3 gm/24 hour of protein excretion. And the specificity ACR was 75%, indicating that the test can correctly identify 75% of patients without 0.3 gm/24 hour of protein excretion. Conclusion: The spot urinary albumin-creatinine ratio (ACR) is a useful tool in distinguishing between mild and severe preeclampsia, with a high statistical significance. It is a moderately good predictor of 0.3 gm/24 hour of protein excretion, with high sensitivity and specificity for correctly identifying patients with and without significant proteinuria.