Can having a uti affect pregnancy
Urinary tract infections (UTIs) in pregnancy - symptoms, causes
Urinary tract infections (UTIs) in pregnancy - symptoms, causes | Pregnancy Birth and Baby beginning of content5-minute read
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What is a urinary tract infection?
A urinary tract infection (UTI) is an infection of the urinary system. UTIs are the most common bacterial infection that women develop during pregnancy. They can occur in different parts of the urinary tract, including the bladder (cystitis), urethra (urethritis) or kidneys (pyelonephritis). Sometimes when a UTI develops and bacteria are detected in the urinary tract, you may not have any symptoms of an infection. This is known as asymptomatic bacteriuria.
While anyone can get a UTI, they are much more common in women than men and they are also more likely to occur in the very young and the elderly.
What are the symptoms of UTIs during pregnancy?
Common symptoms of a UTI during pregnancy are similar to those that you might experience at any other time, and include:
- a burning sensation when you pass urine
- feeling the urge to urinate more often than usual
- urinating before you reach the toilet (‘leaking’ or incontinence)
- feeling like your bladder is full, even after you have urinated
- urine that looks cloudy, bloody or is very smelly
- pain above the pubic bone
- fever
Sometimes the first sign of an infection is a faint prickly sensation when you pass urine. If the infection is more advanced and has moved up to the kidneys, you may also experience fever with a particularly high temperature, back pain and vomiting.
What are the common causes of UTIs?
Your urinary tract is normally free of bacteria. If bacteria enter the tract and multiply, they can cause a UTI. There are several factors that increase the risk of developing an infection:
- Infection with common bacteria in your gut, usually from faeces (poo) can contaminate your urinary tract
- Being sexually active increases the risk of bacteria moving around the genital area and entering the urinary tract
- If you have weak pelvic floor muscles your bladder might not empty completely, which can lead to an infection
- Women with diabetes are at increased risk of developing a UTI since the sugar in their urine may cause bacteria to multiply
Are UTIs a risk during pregnancy?
During pregnancy, many changes occur in your body that increase your risk of developing a UTI, including changes to the make-up of your urine and immune system.
As your baby grows, there is also an increase in the pressure on your bladder, which can reduce the flow of your urine and lead to an infection.
UTIs can affect women whether they are pregnant or not. However, pregnant women are more likely to develop repeated or more severe infections. Up to 1 in 10 pregnant women will have a UTI but not have any symptoms at all.
Is there a risk to my baby?
Having a UTI during pregnancy can increase your risk of developing high blood pressure, and your baby may be born early and smaller than usual. For this reason, even if you don’t have any symptoms, it is important to treat a UTI as soon as possible.
How are UTIs diagnosed?
UTIs are diagnosed by taking a urine sample which is checked in a laboratory for bacteria. Your doctor may also perform a physical examination if they think you have an infection.
All pregnant women are offered a urine test, usually at their first antenatal visit or soon after. You may need to repeat the urine test if you have a history of UTIs; have symptoms of a UTI; have a contaminated sample or if your doctor thinks you are at high risk of developing a UTI.
If you have frequent UTIs, you may also need additional tests such as an ultrasound of your kidneys.
How are UTIs treated during pregnancy?
When you have a UTI, it is important to drink plenty of water to flush out the urinary tract. UTIs are treated with antibiotics that are safe in pregnancy. Your doctor will select the right antibiotic, based on your infection and the type of bacteria found in your urine sample.
Can I prevent UTIs?
You can lower your risk of developing a UTI during pregnancy by:
- drinking plenty of fluids, especially water
- quickly treating any vaginal infection that may occur, including thrush or a sexually transmitted infection
- avoiding becoming constipated
Some women have also found the following tips helpful:
- urinate immediately after sex
- don’t delay going to the toilet — go as soon as you feel the need
- wipe from the front to the back after going to the toilet
- wear cotton underwear
When should I see my doctor?
See your midwife or doctor if you have any symptoms of a UTI.
It’s important not to delay treatment since infections develop quickly, and can affect both you and your baby.
More information
UTIs are very common during pregnancy, and are best treated early. If you notice the symptoms of an infection, seek medical advice from your doctor, midwife or pharmacist.
For more information on UTIs, visit the Kidney Health Australia page on UTIs.
Sources:
Government of South Australia (Urinary Tract Infection in Pregnancy), Jean Hailes (Urinary Tract Infections), Kidney Health Australia (Factsheet: Urinary Tract Infections), Government of Western Australia North Metropolitan Health Service (Urinary Tract Infection in Pregnant Women)Learn more here about the development and quality assurance of healthdirect content.
Last reviewed: August 2021
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UTI in pregnancy: Causes, risks, and treatments
Urinary tract infections, or UTIs, are common, and women can often experience them during pregnancy. Left untreated, a UTI can pose a serious health risk to a pregnant woman and a developing fetus.
This article outlines the possible causes of a UTI in pregnancy, as well as the potential risks. We also provide information on how to prevent and treat UTIs.
A UTI is an infection in any part of the urinary system, including the bladder and kidneys. Research suggests it is common for pregnant women to get UTIs.
According to one study from the Centers for Disease Control and Prevention (CDC), 8% of pregnant women experience a UTI.
Share on PinterestA frequent need to urinate is a common symptom of a UTI.
During pregnancy, the uterus expands for the growing fetus. This expansion puts pressure on the bladder and the ureters. The ureters are the tubes that carry urine from the kidneys to the bladder.
The urine is also less acidic and contains more proteins, sugars, and hormones during pregnancy. This combination of factors increases the risk of a UTI occurring.
Women are also susceptible to UTIs during and after giving birth. During labor, there is an increased risk of bacteria entering the urinary tract. After giving birth, a woman may experience bladder sensitivity and swelling, which can make a UTI more likely.
A person who has a UTI may experience the following symptoms:
- urgent or frequent need to urinate
- burning sensation when urinating
- cloudy or strong smelling urine
- blood in the urine
- pain in the lower back, abdomen, and sides
People should tell their doctor straight away if they have blood in their urine, as this can be a sign of another condition.
In some cases, the bacterial infection causing a UTI can spread to the kidneys. A person who has a kidney infection may experience the following symptoms:
- back pain
- fever
- chills
- nausea and vomiting
If people have these symptoms, they should see their doctor immediately. Kidney infections can be serious and require immediate medical treatment.
Pregnant women should see their doctor if they have any symptoms of a UTI. Without treatment, a UTI can cause serious complications.
A 3-day course of antibiotics may be necessary to treat a UTI during pregnancy. A doctor may prescribe one of the following antibiotics:
- amoxicillin
- ampicillin
- cephalosporins
- nitrofurantoin
- trimethoprim-sulfamethoxazole
The American College of Obstetricians and Gynecologists (ACOG) advise that pregnant women avoid nitrofurantoin and trimethoprim-sulfamethoxazole during the first trimester. These antibiotics can cause birth abnormalities if a person takes them at this stage of their pregnancy.
According to a 2015 review, studies show that both nitrofurantoin and trimethoprim-sulfamethoxazole are generally safe during the second and third trimesters. However, taking either antibiotic in the final week before delivery may increase the risk of jaundice in newborns.
If pregnant women develop a kidney infection during pregnancy, they will need treatment in the hospital. This treatment will involve antibiotics and intravenous fluids.
A short course of antibiotics is unlikely to cause any harm to a developing fetus. Research suggests that the benefits of taking antibiotics to treat a UTI far outweigh the risks of leaving a UTI without treatment.
Women who are pregnant and have symptoms of a UTI should see a doctor. As well as medical treatment, they may also wish to try the following at home to help speed up recovery:
- Drinking plenty of water: Water dilutes urine and helps flush bacteria out of the urinary tract.
- Drinking cranberry juice: According to a 2012 review, cranberries contain compounds that may help to stop bacteria from attaching to the lining of the urinary tract.
This action helps to prevent and eliminate infection. - Urinating when the urge arises: This helps bacteria pass out of the urinary tract more quickly.
- Taking certain supplements: A 2016 study found that a combination of vitamin C, cranberries, and probiotics may help to treat recurrent UTIs in women.
Some women may choose the above treatments as an alternative to antibiotics. However, they should always consult their doctor before doing so. A doctor will monitor a pregnancy regularly to check the effectiveness of natural treatments and ensure a UTI does not worsen.
Without treatment, UTIs can cause serious complications during pregnancy. Complications may include:
- kidney infection
- premature birth
- sepsis
A baby born to a woman with an untreated UTI may also have a low birth weight at delivery.
If a UTI spreads to the kidneys, this can cause further complications, such as:
- anemia
- high blood pressure, or hypertension
- preeclampsia
- breakdown of red blood cells, or hemolysis
- low blood platelet count, or thrombocytopenia
- bacteria in the bloodstream, or bacteremia
- acute respiratory distress syndrome
In some cases, an infection may pass on to the newborn baby, causing a rare but severe complication.
Attending screenings for UTIs during pregnancy and getting prompt treatment when one occurs can help prevent these complications.
The following tips may help to reduce a person’s likelihood of getting a UTI:
- drink plenty of water
- drink unsweetened cranberry juice or take cranberry pills
- wash carefully around the genitals and anus
- pass urine whenever the urge arises, and at least every 2–3 hours
- urinate before and after having sex
Pregnant women will usually attend a screening to check for UTIs in their early pregnancy. These checks are an important step in helping to prevent UTI infections or detecting them early.
UTIs are common, and some women may experience them during pregnancy.
Women who have symptoms of a UTI during pregnancy should see their doctor immediately. Without treatment, UTIs can cause serious complications for a pregnant woman and the developing fetus. Prompt intervention can help to prevent these complications.
Routine pregnancy checks help detect the early signs of a UTI.
Urinary tract infections vs pregnancy: treatment and prevention
Summary. Urinary tract infections are one of the most common complications in pregnant women, which can lead to serious consequences not only for the expectant mother, but also for the child. When managing pregnant women with diseases of the urinary system, it is extremely important to choose the right and, most importantly, safe therapeutic tactics. What drugs are safe during pregnancy? What obstetric and therapeutic tactics are most effective for kidney diseases in pregnant women? What diagnostic methods are best used for asymptomatic bacteriuria, acute cystitis and pyelonephritis? Professor 9 spoke about this in her speech0003 Olga Grishchenko , Head of the Department of Perinatology, Obstetrics and Gynecology of the Kharkov Medical Academy of Postgraduate Education during the training workshop for gynecologists "Actual Guidelines of Gynecology, Reproductology, Obstetrics", held on March 29, 2019 in Kharkov.
The event was organized by the MedExpert Group of Companies together with the National Medical University named after A.A. Bogomolets and National Medical Academy of Postgraduate Education named after P.L. Shupyk.
Urgency of the problem
Urinary tract infections (UTIs) are the most common bacterial infections in outpatient practice, they take the 2nd place, second only to respiratory tract infections. According to statistics, 50% of women in the world have an episode of UTI at least once in their lives, of which 25–40% experience a relapse of the disease within 6–12 months. Every year, about 10% of women develop acute cystitis, and pyelonephritis remains the leading cause of hospitalization during pregnancy for non-obstetric indications.
In the presence of UTI in pregnant women, the risk of preterm labor and rupture of amniotic fluid, chorioamnionitis increases, premature or functionally immature children are born, and the level of perinatal mortality increases.
In the structure of UTI, asymptomatic bacteriuria is observed in 4-9.5% of pregnant women, acute pyelonephritis - in 12-25%, chronic pyelonephritis - in 33%, glomerulonephritis, urolithiasis - in 0.1-0.2%.
Risk factors and pregnancy
As a rule, infections, self-medication or improper treatment, asymptomatic bacteriuria, frequent UTIs in combination with inflammatory diseases (colpitis), lifestyle and nutrition can affect the occurrence of pathology of the urinary system.
Pregnant women have an increased risk of diseases of the urogenital tract. A high level of progesterone leads to the development of hypotension, hypokinesia, dyskinesia of the ureters and pyelocaliceal system. In turn, the uterus compresses the ureter, high intra-abdominal pressure occurs, especially in primiparas. During pregnancy, the renal pelvis enlarges, the growing uterus squeezes the ureter more and more, the outflow of urine from the kidneys becomes difficult, the urine stagnates, bacteria multiply in it, and inflammation easily occurs.
Infectious agents can enter the bladder by ascending (with inflammatory diseases of the urethra), descending (most often with tuberculous kidney damage), hematogenous (if there is a purulent focus in other parts of the body) and lymphogenic (with diseases of the genital organs) by.
Classification of UTIs in pregnant women
UTIs in pregnant women include asymptomatic bacteriuria, lower urinary tract infections (acute and recurrent cystitis) and upper urinary tract infections (acute pyelonephritis, chronic pyelonephritis in remission, exacerbation, latent course).
Cystitis in pregnancy: course, diagnosis
Cystitis is an inflammation of the bladder wall, one of the most common urological diseases, as a rule, its cause is an infection. Symptoms of cystitis in women are manifested in the form of frequent urination, cramps and pain when urinating, pulling sensations in the lower abdomen, weakness, fatigue, irritability, blood in the urine, cloudy urine, pus or yellow spots on the underwear.
Normally, urination is not accompanied by pain. In women, painful urination can be caused by diseases of the bladder, urethra, or vagina. So, pain in the bladder, as a rule, is felt in the area of the womb, it can increase during urination or, conversely, decrease when the bladder is empty. Urethral pain associated with urination is felt by the patient directly in the urethra and is usually aggravated by urination. Urine entering the vaginal opening can cause pain if it is inflamed. Inflammation of the urethra is most often characterized by a bacterial nature and requires additional examination and treatment.
Primary diagnosis of cystitis involves an examination by specialized specialists (urologist, nephrologist, gynecologist), as well as taking an anamnesis and establishing possible causes of the disease (hypothermia, unprotected intercourse, taking medications, the presence of concomitant diseases).
Laboratory tests include a urinalysis for Nechiporenko cultures (helps identify the pathogen), a general urinalysis (allows you to identify erythrocytes, leukocytes, protein in the urine; the urine itself may be cloudy with an admixture of blood or pus), a general blood test (allows you to identify a picture inflammatory process, it is possible to increase the erythrocyte sedimentation rate (ESR), leukocytosis).
Among instrumental methods, ultrasound examination (ultrasound) of the bladder, ureteroscopy and cystoscopy (in case of violation of the passage of urine) are used.
Asymptomatic bacteriuria during pregnancy
Asymptomatic bacteriuria during pregnancy is dangerous for both mother and fetus, against its background, 25% of women develop acute pyelonephritis. According to the World Health Organization, about 8% of women report asymptomatic bacteriuria, 15-57% of women with untreated asymptomatic bacteriuria develop symptoms of a UTI (acute cystitis or pyelonephritis). Therapy of this disease during pregnancy reduces the risk of developing acute UTIs, preterm birth, and low birth weight.
Diagnosis of asymptomatic bacteriuria can be established by detecting 10 5 CFU/ml of one bacterial strain or 10 2 CFU/ml of uropathogen Escherichia coli field of view in the absence of clinical manifestations of UTI.
It should be remembered that the risk of this pathology is most real from the 9th to the 17th week of pregnancy.
The only reliable method for diagnosing asymptomatic bacteriuria is the method of urine culture.
In accordance with Ukrainian and international guidelines for asymptomatic bacteriuria, oral antibiotic therapy with a single dose of fosfomycin trometamol is recommended.
Pyelonephritis: diagnosis
Pyelonephritis is an infectious and inflammatory disease of the kidneys of bacterial etiology with a primary and predominant lesion of the interstitium and tubular apparatus. The incidence of pyelonephritis during pregnancy reaches 33%, mortality - 3.5%, maternal mortality from kidney disease in the structure of extragenital pathology is 8-10%, the incidence of gestational pyelonephritis is 11.5%.
Primary pyelonephritis in pregnant women is difficult to treat, may be accompanied by fever, chills, nausea, vomiting, pain in the lumbar region, the appearance of pyuria, bacteriuria. As a rule, the right kidney is affected more often than the left one, with expansion of the pelvicalyceal system (according to ultrasound).
In acute pyelonephritis, the mandatory research methods are a general urinalysis (in 2 portions) 1 time in 7 days, a Nechiporenko urinalysis, a general and biochemical blood test, a bacteriological urinalysis, ultrasound of the kidneys and bladder, daily proteinuria, a biochemical blood test , blood pressure monitoring, urologist consultation. Additional research methods - computed tomography without contrast or excretory urogram, nuclear magnetic resonance imaging - are carried out exclusively for strict, sometimes vital, indications.
It should be remembered that dysuria in primary acute cystitis with a body temperature of 38 ° C and chills may indicate acute ascending pyelonephritis. A sharp dysuric syndrome is characteristic of the associated cystitis during exacerbation of chronic pyelonephritis. Urinary syndrome (proteinuria, leukocyturia, hematuria, etc.) may periodically disappear with a unilateral process and ureter occlusion; therefore, serial urine tests are necessary.
The degree of leukocyturia does not always correspond to the severity of the inflammatory process. A single urine culture gives at least 20% false positive results. Bacteriuria appears and can be detected 2 days earlier than pyuria.
Choice of drugs for the treatment of pregnant women with UTIs
There are certain requirements for antibiotics for the treatment of UTIs in pregnant women. In particular, they must be effective against most pathogenic pathogens, have the ability to create a high concentration in organs - foci of infection, have a long half-life sufficient to maintain a high concentration of the antibiotic in the blood, not have toxic and allergic effects, be well tolerated by patients, be harmless to mother and fetus.
It has been shown that for the treatment of pregnant women with acute cystitis, asymptomatic bacteriuria, acute pyelonephritis, it is advisable to use antibacterial uroseptics. In particular, fosfomycin trometamol has a bactericidal effect associated with blocking the bacterial enzyme involved in the synthesis of the cell wall, as well as an anti-adhesive effect (destroys the fimbria of Escherichia coli, preventing it from fixing on the wall of the urothelium and promoting leaching from the urinary tract).
After a single dose of the drug, the therapeutic concentration is observed for 48 hours (this is enough to sterilize urine and recover).
An alternative to antibiotics are phytoneering preparations with anti-adhesive and antibacterial activity, as well as anti-inflammatory, antispasmodic, nephroprotective properties.
Organization of care for pregnant women with UTI and prevention
Delivery of pregnant women with UTI (without obstetric pathology) is carried out through the natural birth canal, taking into account the obstetric situation.
There are degrees of risk of pyelonephritis:
- I degree - uncomplicated pyelonephritis that occurred during pregnancy;
- II degree - chronic uncomplicated pyelonephritis, noted before pregnancy;
- III degree - pyelonephritis with hypertension, azotemia, pyelonephritis of a single kidney.
They must be taken into account when managing pregnant women. So, at I-II degree of risk, pregnancy can be prolonged, but at III degree (creatinine> 265 μmol / l, glomerular filtration rate < 30 ml / min), pregnancy should be terminated.
Prevention of UTIs in pregnant women should include sanitation of the vagina in case of violation of its microflora and other sources of infection (teeth, pharynx, etc.), normalization of bowel function, optimal water regime. are not rare. Women turn to urologists both for the first time faced with this situation, and with an exacerbation of a chronic, pre-existing disease.
Pregnant women are more vulnerable to urinary tract infections, as the woman's body experiences a state of physiological immunodeficiency, which makes it more susceptible to various infectious factors. And the urinary system is not least exposed to inflammatory processes, especially if all chronic diseases have not been treated before pregnancy.
The second moment that affects UTI is the growing "pregnant" uterus, which, as it grows, begins to compress the ureter (more right), thereby causing a violation of the outflow of urine. According to ultrasound in this case, you can see calicopyeloectasia - the expansion of the calyces and pelvis of the kidneys.
This is a physiological condition, but it can contribute to the development of infection.
Because your risk of developing a urinary tract infection is higher during pregnancy, you will have periodic urinalysis and cultures to help diagnose possible UTIs early. With what frequency, the gynecologist who observes the pregnancy will tell. If there are changes in urine tests, you will be referred to a urologist, do not be surprised, urologists treat not only men, who will deal with UTIs in the future.
There are several conditions that characterize UTI during pregnancy:
First: if there are complaints of dysuria (increased painful urination, blood in the urine) or pain in the lumbar region + increased body temperature, and in urine tests - an increased number of leukocytes and/or RBCs is a clear UTI that should be treated with antibiotics.
But there is also a second option: does not bother anything, general urinalysis is normal, but there are bacteria in the urine culture (bacteria concentration should be more than 10 * 5 CFU / ml in two crops with an interval of 7-10 days, and both cultures must have the same bacterium) - this condition is called asymptomatic bacteriuria, which also requires antibiotic therapy.
A very common question: "Why should I take antibiotics if I feel good?"
- Yes, of course, there may be no symptoms of UTI, but the presence of a large titer of bacteria in the urine can further complicate the course of labor and the postpartum period, up to preterm labor and intrauterine infection of the fetus, and also develop into an "obvious" form of UTI already with symptoms!
I would also like to note that one should not be afraid of antibiotics (often women start to worry after the mention of them) and their possible impact on the child. There is a certain list of acceptable antibacterial drugs in different trimesters of pregnancy!
In the first trimester, use of: protected penicillins (Ampicillin, Amoxicillin/clavulonate, Amoxicillin/sulbactam), Fosfomycin trometalol (Monural) (can be used in all trimesters), macrolides (Josamycin, Azithromycin). In the second and third trimester: third-generation cephalosporins (Cefixime, Ceftriaxone, Cefotaxime, Ceftazidime) are added to the first list.
But remember that taking certain drugs, and especially during pregnancy, should only be prescribed by a doctor.
In addition to antibiotics during pregnancy, herbal uroantiseptics (Phytolysin, Kanefron, Cyston, etc.) are often prescribed as maintenance therapy along with antibacterial drugs. Quite often, gynecologists prescribe them as a prophylactic, sometimes for the entire duration of pregnancy. But they should not be abused, and even more so taken on their own without a doctor's recommendation, since they can contribute to the formation of oxalate stones with long-term continuous use, especially if there are already violations of mineral metabolism, as they sometimes say, "sand" in the kidneys by ultrasound. They should be taken in courses with interruptions, the duration of the course is determined only by the doctor!
Unfortunately, sometimes conventional antibiotic therapy is not effective (especially in chronic processes) and one has to resort to invasive techniques, such as cystoscopy followed by instillations into the bladder.
Cystoscopy, as well as instillations into the bladder, are carried out only according to strict indications, only in cases where they really cannot be dispensed with! But sometimes you have to resort to these methods during pregnancy, so you should not be surprised if the doctor prescribes the above studies and procedures for you.
Finally, I would like to tell you about such a condition as Calicopyeloectasia during pregnancy . As mentioned earlier, calicopyeloectasia is a physiological condition during pregnancy, but it happens that against the background of an expanded pyelocaliceal system (PCS) of the kidney, a bacterial infection joins (especially with chronic pyelonephritis and cystitis poorly treated before pregnancy).
In such conditions as: the presence of chronic pyelonephritis in the active phase + expansion of the PCS, as well as pain syndrome (for example, caused by an acute infectious process or renal colic (migration of a stone along the urinary tract) - kidney stenting is performed.
A stent is a specially designed tube made of a flexible plastic material that fits into the ureter, allowing what is known as "closed drainage" of the urinary tract. Stents are designed specifically for placement in the urinary system. A stent is placed using a special instrument, a cystoscope or ureteroscope, which is passed into the bladder through the urethra (urethra).0007
The stent can be in the body for a long time (up to 3 months or more) until delivery. Depending on the quality of the stent, it may need to be replaced after 2-3 months. The stent is also removed using a cysto- or ureteroscope. It is worth saying that the presence of a stent in the body can cause some side effects: more frequent than usual, the urge to urinate, the admixture of blood in the urine, a feeling of incomplete emptying of the bladder, pain in the kidney area during urination and beyond.
As a prevention of problems in the functioning of the urinary system and to help the kidneys during pregnancy, it is very useful to do the exercise "drainage position" - this is standing in a knee-elbow position for 5-10 minutes several times a day (preferably more than 5 times, but less than more often the better).
