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UTIs during pregnancy are common and treatable | Your Pregnancy Matters

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Your Pregnancy Matters

September 20, 2021

Your Pregnancy Matters

Robyn Horsager-Boehrer, M. D. Obstetrics and Gynecology

A UTI during pregnancy is no cause for alarm – unless it’s left untreated. If you experience symptoms, tell your doctor right away. Drinking plenty of water during pregnancy can help prevent UTIs.

As you adjust to new changes in your body during pregnancy, it can be easy to overlook symptoms of everyday health conditions, such as urinary tract infections (UTIs). UTIs are equally common in pregnant and non-pregnant patients and usually require medication to clear the infection.

But if left untreated during pregnancy, a UTI can progress to s serious infection that can lead to preterm labor, premature delivery, or even fetal loss.

UTIs occur when bacteria enter and grow in the urinary tract. During pregnancy, your bladder – which is in the lower part of your urinary tract – is less likely to empty entirely when you urinate, thanks to pressure from your expanding uterus and an increase in hormones that relax the muscles in your uterus. The longer urine stays in your body, the higher the chances that you’ll grow too much bacteria.

We watch for three types of UTIs during pregnancy:

Asymptomatic: Approximately 7% of pregnant women may have a UTI that doesn’t cause symptoms. An untreated asymptomatic infection has a 25% chance of advancing to the next level of UTI – your bladder and then your kidney.
Cystitis: Localized to the bladder, this infection will cause symptoms typically associated with UTIs, such as frequent but small amounts of urine, painful urination, and strong urges to urinate immediately.
Pyelonephritis: This kidney infection can lead to serious issues such as septic shock, anemia, excess lung fluid, and pre-term labor. It typically includes the symptoms of cystitis, plus nausea, fever, chills, and pain in your lower back and sides.

Because UTIs are prevalent during pregnancy, we request a urine sample to conduct a culture test as part of your prenatal care. The test looks for specific types of bacteria in your urine that can cause an infection.

We will likely test your urine multiple times throughout your pregnancy. But don’t assume we’re looking for a UTI every time; this is a common misconception. It’s important to talk with your doctor if you experience UTI symptoms to make sure you get the right test. The earlier we diagnose a UTI, the sooner we can treat you and prevent a more dangerous condition.

UTI treatment: What to expect

UTI treatments during pregnancy are safe and easy, usually involving a short course (3-7 days) of oral antibiotics. There are two exceptions:

If you continue to have UTIs after we treat the first one, we may recommend suppressive therapy. You will take a lower dose of antibiotics every day of your pregnancy instead of larger doses for just a few days.
If you have pyelonephritis (kidney infection), you will need to receive antibiotics through an IV at a hospital.

For most patients, receiving antibiotic treatment is much safer than risking a kidney infection. We will discuss all your health conditions and pregnancy symptoms to determine the best type of antibiotic for you, depending on what will work effectively against the bacteria in your urine.

Not all urine tests are the same

In the third trimester, we’ll likely test your urine for the presence of protein or glucose, which can indicate high blood pressure or gestational diabetes. Around this time, we also test urine for sexually transmittable diseases such as chlamydia and gonorrhea, which can be transferred to your baby.

Neither of these tests will tell us whether you have a UTI. If you’re experiencing UTI symptoms, please tell us so we can perform the appropriate test and begin treatment.

What increases or reduces risk of UTIs during pregnancy?

Women who have or carry the trait for sickle cell disease are at increased risk for UTIs. We test these patients monthly to ensure we detect an infection as soon as possible.

If you have diabetes, you’re also at a higher risk. We might not test you as frequently, but we will consistently look for symptoms. Both conditions make it harder for the body to fight infections.

Just as when you’re not pregnant, you can take specific actions to lower your chances of getting a UTI, such as:

Wiping front to back in the bathroom
Urinating before and after sex
Wearing cotton underwear
Avoiding tight and wet clothing
Drinking more water

Prepare for possible postpartum UTIs

In some cases, the risks of developing a UTI increase after you give birth.

Patients who have a C-section or receive an epidural during labor have a catheter inserted into their bladder. This ensures a safer delivery by keeping your bladder empty. But a catheter increases your risk of infection the longer it stays in your body, and its placement provides the perfect track for bacteria to enter your bladder.

To decrease your UTI risk, our goal is to remove your catheter no more than six to eight hours after surgery and even sooner after an epidural. An infection can take days to appear, so watch for symptoms after you leave the hospital and tell your doctor right away if you experience them. We don’t perform routine UTI tests after delivery, so it’s important to alert us to abnormal pain or discomfort.

Related reading: Tips to prevent involuntary urine leakage (incontinence) during and after pregnancy

With so many new tasks to complete and emotions to experience after bringing your newborn home, it can feel overwhelming to keep track of one more thing – but your health remains a priority after the birth of your baby. The more you tell us about how you feel, the more we can do to help you stay healthy.

To visit with an Ob/Gyn, call 214-645-8300 or request an appointment online.

Urinary Tract Infections (UTI) During Pregnancy

Written by WebMD Editorial Contributors

Medically Reviewed by Nivin Todd, MD on September 04, 2022

UTI Symptoms

If you have a UTI, you may have:

An urgent need to pee, or peeing more often
Trouble with peeing
A burning sensation or cramps in your lower back or lower belly
A burning feeling when you pee
Urine that looks cloudy or has an odor
Blood in your pee, which can turn it red, bright pink, or cola-colored

If you have a kidney infection, you may have:

Fever
Nausea
Vomiting
Upper back pain, often on just one side

If you have symptoms of a kidney infection, see your doctor right away. Without treatment, the infection can spread into your bloodstream and cause life-threatening conditions.

Why Are UTIs More Common During Pregnancy?

Hormones are one reason. In pregnancy, they cause changes in the urinary tract, and that makes women more likely to get infections. Changes in hormones can also lead to vesicoureteral reflux, a condition in which your pee flows back up from your bladder to your kidneys. This can cause UTIs.

When you’re pregnant, your pee has more sugar, protein, and hormones in it. These changes also put you at higher risk for a UTI.

Because you’re pregnant, your growing uterus presses on your bladder. That makes it hard for you to let out all the urine in your bladder. Leftover urine can be a source of infection.

Other causes of UTIs include:

Escherichia coli and other bacteria from your poop. E. Coli is the most common cause of UTIs and can move from your rectum to your urethra if you don’t wipe from front to back.

Sexual activity. Fingers, your partner’s penis, or devices can move bacteria near your vagina into your urethra.

Group B streptococcus. Many women have this bacteria in their colon and vagina. It can cause UTIs and women can pass it to their newborns. Your doctor will test you for this bacteria around weeks 36 to 37 of pregnancy. If you’re positive for group B strep, your doctor will give you IV antibiotics during labor.

UTI Diagnosis

You’ll take a urine test. Your doctor will test it for bacteria and red and white blood cells. A urine culture may also be checked. It shows what kind of bacteria are in the urine.

UTI Treatment During Pregnancy

You’ll take antibiotics for 3 to 7 days or as your doctor recommends. If your infection makes you feel uncomfortable, your doctor will probably start your treatment before you get your urine test results.

Your symptoms should go away in 3 days. Take all of your medication on schedule anyway. Don’t stop it early, even if your symptoms fade.

Many common antibiotics -- amoxicillin, erythromycin, and penicillin, for example -- are considered safe for pregnant women. Your doctor wouldn’t prescribe others, such as ciprofloxacin (Cipro), sulfamethoxazole, tetracycline, or trimethoprim (Primsol, Proloprim, Trimpex), that can affect your baby’s development.

UTI Complications During Pregnancy

Pyelonephritis is a UTI that affects the kidneys. If you’re pregnant it can cause:

Preterm labor
Severe infection
Adult respiratory distress syndrome
Anemia
Long-term infection

UTI Prevention

To try to avoid getting a UTI:

Drink at least eight glasses of water a day.
Wipe yourself from front to back when you go to the bathroom.
Empty your bladder shortly before and after sex.
If you need a lubricant when you have sex, choose a water-based one.
Don't douche.
Avoid strong feminine deodorants or soaps that cause irritation.
Wash your genital area with warm water before sex.
Wear cotton underwear.
Take showers instead of baths.
Don’t wear pants that are too tight.
Pee often.
Avoid alcohol, citrus juices, spicy food, and caffeinated drinks, which can irritate your bladder.

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Urinary tract infections vs pregnancy: treatment and prevention

Resume. 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 speech0276 Olga Grishchenko , Head of the Department of Perinatology, Obstetrics and Gynecology of the Kharkov Medical Academy of Postgraduate Education during a 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. nine0075

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. nine0075

In the presence of UTI in pregnant women, the risk of preterm labor and rupture of amniotic fluid, chorioamnionitis, preterm 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. nine0075

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. nine0075

Infectious agents can enter the bladder by ascending (with inflammatory diseases of the urethra), descending (most often with tuberculous kidney disease), 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). nine0075

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. nine0075

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, medication, 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. nine0075

Asymptomatic bacteriuria during pregnancy

Asymptomatic bacteriuria during pregnancy is dangerous for both the mother and the 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. nine0075

The diagnosis of asymptomatic bacteriuria can be established by detecting 10 ⁵ CFU/ml of one bacterial strain or 10 ² CFU/ml of the uropathogen Escherichia coli in 2 urine samples taken from leukocytes containing > 4 h 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. nine0075

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%. nine0075

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. nine0075

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. nine0075

Choice of drugs for the treatment of pregnant women with UTIs

There are specific 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. nine0075

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). nine0075

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; nine0010
II degree - chronic uncomplicated pyelonephritis, noted before pregnancy;

III degree - pyelonephritis with hypertension, azotemia, pyelonephritis of a single kidney.
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