Urinary tract infection pregnancy treatment

Urinary Tract Infections During Pregnancy

JOHN E. DELZELL, JR., M.D., AND MICHAEL L. LEFEVRE, M.D., M.S.P.H.

This is a corrected version of the article that appeared in print.

Am Fam Physician. 2000;61(3):713-720

See related patient information handout on urinary tract infections during pregnancy, written by the authors of this article.

Urinary tract infections are common during pregnancy, and the most common causative organism is Escherichia coli. Asymptomatic bacteriuria can lead to the development of cystitis or pyelonephritis. All pregnant women should be screened for bacteriuria and subsequently treated with antibiotics such as nitrofurantoin, sulfisoxazole or cephalexin. Ampicillin should no longer be used in the treatment of asymptomatic bacteriuria because of high rates of resistance. Pyelonephritis can be a life-threatening illness, with increased risk of perinatal and neonatal morbidity. Recurrent infections are common during pregnancy and require prophylactic treatment. Pregnant women with urinary group B streptococcal infection should be treated and should receive intrapartum prophylactic therapy.

Urinary tract infections (UTIs) are frequently encountered in the family physician's office. UTIs account for approximately 10 percent of office visits by women, and 15 percent of women will have a UTI at some time during their life. In pregnant women, the incidence of UTI can be as high as 8 percent. ^1,2 This article briefly examines the pathogenesis and bacteriology of UTIs during pregnancy, as well as patient-oriented outcomes. We review the diagnosis and treatment of asymptomatic bacteriuria, acute cystitis and pyelonephritis, plus the unique issues of group B streptococcus and recurrent infections.

Pathogenesis

Pregnant women are at increased risk for UTIs. Beginning in week 6 and peaking during weeks 22 to 24, approximately 90 percent of pregnant women develop ureteral dilatation, which will remain until delivery (hydronephrosis of pregnancy). Increased bladder volume and decreased bladder tone, along with decreased ureteral tone, contribute to increased urinary stasis and ureterovesical reflux.¹ Additionally, the physiologic increase in plasma volume during pregnancy decreases urine concentration. Up to 70 percent of pregnant women develop glycosuria, which encourages bacterial growth in the urine. Increases in urinary progestins and estrogens may lead to a decreased ability of the lower urinary tract to resist invading bacteria. This decreased ability may be caused by decreased ureteral tone or possibly by allowing some strains of bacteria to selectively grow.^1,3 These factors may all contribute to the development of UTIs during pregnancy.

Bacteriology

The organisms that cause UTIs during pregnancy are the same as those found in nonpregnant patients. Escherichia coli accounts for 80 to 90 percent of infections. Other gram-negative rods such as Proteus mirabilis and Klebsiella pneumoniae are also common. Gram-positive organisms such as group B streptococcus and Staphylococcus saprophyticus are less common causes of UTI. Group B streptococcus has important implications in the management of pregnancy and will be discussed further. Less common organisms that may cause UTI include enterococci, Gardnerella vaginalis and Ureaplasma ureolyticum.^1,4,5

Diagnosis and Treatment of UTIs

UTIs have three principle presentations: asymptomatic bacteriuria, acute cystitis and pyelonephritis. The diagnosis and treatment of UTI depends on the presentation.

ASYMPTOMATIC BACTERIURIA

[ corrected] Significant bacteriuria may exist in asymptomatic patients. In the 1960s, Kass⁶ noted the subsequent increased risk of developing pyelonephritis in patients with asymptomatic bacteriuria. Significant bacteriuria has been historically defined as finding more than 10⁵ colony-forming units per mL of urine.⁷ Recent studies of women with acute dysuria have shown the presence of significant bacteriuria with lower colony counts. This has not been studied in pregnant women, and finding more than 10⁵ colony-forming units per mL of urine remains the commonly accepted standard. Asymptomatic bacteriuria is common, with a prevalence of 10 percent during pregnancy.^6,8 Thus, routine screening for bacteriuria is advocated.

Untreated asymptomatic bacteriuria leads to the development of symptomatic cystitis in approximately 30 percent of patients and can lead to the development of pyelonephritis in up to 50 percent. ⁶ Asymptomatic bacteriuria is associated with an increased risk of intra-uterine growth retardation and low-birth-weight infants.⁹ The relatively high prevalence of asymptomatic bacteriuria during pregnancy, the significant consequences for women and for the pregnancy, plus the ability to avoid sequelae with treatment, justify screening pregnant women for bacteriuria.

SCREENING

The American College of Obstetrics and Gynecology recommends that a urine culture be obtained at the first prenatal visit.¹⁰ A repeat urine culture should be obtained during the third trimester, because the urine of treated patients may not remain sterile for the entire pregnancy.¹⁰ The recommendation of the U.S. Preventative Services Task Force is to obtain a urine culture between 12 and 16 weeks of gestation (an “A” recommendation).¹¹

By screening for and aggressively treating pregnant women with asymptomatic bacteriuria, it is possible to significantly decrease the annual incidence of pyelonephritis during pregnancy. ^8,12 In randomized controlled trials, treatment of pregnant women with asymptomatic bacteriuria has been shown to decrease the incidence of preterm birth and low-birth-weight infants.¹³

Rouse and colleagues¹⁴ performed a cost-benefit analysis of screening for bacteriuria in pregnant women versus inpatient treatment of pyelonephritis and found a substantial decrease in overall cost with screening. The cost of screening for bacteriuria to prevent the development of pyelonephritis in one patient was $1,605, while the cost of treating one patient with pyelonephritis was $2,485. Wadland and Plante¹⁵ performed a similar analysis in a family practice obstetric population and found screening for asymptomatic bacteriuria to be cost-effective.

The decision about how to screen asymptomatic women for bacteriuria is a balance between the cost of screening versus the sensitivity and specificity of each test. The gold standard for detection of bacteriuria is urine culture, but this test is costly and takes 24 to 48 hours to obtain results. The accuracy of faster screening methods (e.g., leukocyte esterase dipstick, nitrite dipstick, urinalysis and urine Gram staining) has been evaluated (Table 1¹⁶). Bachman and associates¹⁶ compared these screening methods with urine culture and found that while it was more cost effective to screen for bacteriuria with the esterase dipstick for leukocytes, only one half of the patients with bacteriuria were identified compared with screening by urine culture. The increased number of false negatives and the relatively poor predictive value of a positive test make the faster methods less useful; therefore, a urine culture should be routinely obtained in pregnant women to screen for bacteriuria at the first prenatal visit and during the third trimester.^10,11

The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.

TREATMENT

Pregnant women should be treated when bacteriuria is identified (Table 2^17,18). The choice of antibiotic should address the most common infecting organisms (i.e., gram-negative gastrointestinal organisms). The antibiotic should also be safe for the mother and fetus. Historically, ampicillin has been the drug of choice, but in recent years E. coli has become increasingly resistant to ampicillin.¹⁹ Ampicillin resistance is found in 20 to 30 percent of E. coli cultured from urine in the out-patient setting.²⁰ Nitrofurantoin (Macrodantin) is a good choice because of its high urinary concentration. Alternatively, cephalosporins are well tolerated and adequately treat the important organisms. Fosfomycin (Monurol) is a new antibiotic that is taken as a single dose. Sulfonamides can be taken during the first and second trimesters but, during the third trimester, the use of sulfonamides carries a risk that the infant will develop kernicterus, especially preterm infants. Other common antibiotics (e.g., fluoroquinolones and tetracyclines) should not be prescribed during pregnancy because of possible toxic effects on the fetus.

Antibiotic	Pregnancy category	Dosage
Cephalexin (Keflex)	B	250 mg two or four times daily
Erythromycin	B	250 to 500 mg four times daily
Nitrofurantoin (Macrodantin)	B	50 to 100 mg four times daily
Sulfisoxazole (Gantrisin)	C*	1 g four times daily
Amoxicillin-clavulanic acid (Augmentin)	B	250 mg four times daily
Fosfomycin (Monurol)	B	One 3-g sachet
Trimethoprim-sulfamethoxazole (Bactrim)	C†	160/180 mg twice daily

A seven- to 10-day course of antibiotic treatment is usually sufficient to eradicate the infecting organism(s). Some authorities have advocated shorter courses of treatment—even single-day therapy. Conflicting evidence remains as to whether pregnant patients should be treated with shorter courses of antibiotics. Masterton²¹ demonstrated a cure rate of 88 percent with a single 3-g dose of ampicillin in ampicillin-sensitive isolates. Several other studies have found that a single dose of amoxicillin, cephalexin (Keflex) or nitrofurantoin was less successful in eradicating bacteriuria, with cure rates from 50 to 78 percent.^1,22–24 Fosfomycin is effective when taken as a single, 3-g sachet.

Other antibiotics have not been extensively researched for use in UTIs, and further studies are necessary to determine whether a shorter course of other antibiotics would be as effective as the traditional treatment length.¹ After patients have completed the treatment regimen, a repeat culture should be obtained to document successful eradication of bacteriuria.¹⁰

Acute Cystitis

Acute cystitis is distinguished from asymptomatic bacteriuria by the presence of symptoms such as dysuria, urgency and frequency in afebrile patients with no evidence of systemic illness. Up to 30 percent of patients with untreated asymptomatic bacteriuria later develop symptomatic cystitis.⁶ Over a six-year period, Harris and Gilstrap²⁵ found that 1.3 percent of obstetric patients who delivered at a single hospital developed acute cystitis with no symptoms of pyelonephritis.

TREATMENT

In general, treatment of pregnant patients with acute cystitis is initiated before the results of the culture are available. Antibiotic choice, as in asymptomatic bacteriuria, should focus on coverage of the common pathogens and can be changed after the organism is identified and sensitivities are determined. A three-day treatment course in nonpregnant patients with acute cystitis has a cure rate similar to a treatment course of seven to 10 days, but this finding has not been studied in the obstetric population.¹ Patients treated for a shorter time frame are more likely to have a recurrence of the infection. In the pregnant patient, this higher rate of recurrence with shorter treatment periods may have serious consequences. Table 2^17,18 lists oral antibiotics that are acceptable treatment choices. Group B streptococcus is generally susceptible to penicillin, but E. coli and other gram-negative rods typically have a high rate of resistance to this agent.

Pyelonephritis

Acute pyelonephritis during pregnancy is a serious systemic illness that can progress to maternal sepsis, preterm labor and premature delivery. The diagnosis is made when the presence of bacteriuria is accompanied by systemic symptoms or signs such as fever, chills, nausea, vomiting and flank pain. Symptoms of lower tract infection (i.e., frequency and dysuria) may or may not be present. Pyelonephritis occurs in 2 percent of pregnant women; up to 23 percent of these women have a recurrence during the same pregnancy.²⁶

Early, aggressive treatment is important in preventing complications from pyelonephritis. Hospitalization, although often indicated, is not always necessary. However, hospitalization is indicated for patients who are exhibiting signs of sepsis, who are vomiting and unable to stay hydrated, and who are having contractions. A randomized study of 90 obstetric inpatients with pyelonephritis compared treatment with oral cephalexin to treatment with intravenous cephalothin (Keflin) and found no difference between the two groups in the success of therapy, infant birth weight or preterm deliveries.²⁷

Further support for outpatient therapy is provided in a randomized clinical trial that compared standard inpatient, intravenous treatment to outpatient treatment with intramuscular ceftriaxone (Rocephin) plus oral cephalexin.²⁸ Response to antibiotic therapy in each group was similar, with no evident differences in the number of recurrent infections or preterm deliveries.

Antibiotic therapy (and intravenous fluids, if hospitalization is required) may be initiated before obtaining the results of urine culture and sensitivity. Several antibiotic regimens may be used. A clinical trial comparing three parenteral regimens found no differences in length of hospitalization, recurrence of pyelonephritis or preterm delivery. ²⁹ Patients in this trial were randomized to receive treatment with intravenous cefazolin (Ancef), intravenous gentamycin plus ampicillin, or intramuscular ceftriaxone.

Parenteral treatment of pyelonephritis should be continued until the patient becomes afebrile. Most patients respond to hydration and prompt antibiotic treatment within 24 to 48 hours. The most common reason for initial treatment failure is resistance of the infecting organism to the antibiotic. If fever continues or other signs of systemic illness remain after appropriate antibiotic therapy, the possibility of a structural or anatomic abnormality should be investigated. Persistent infection may be caused by urolithiasis, which occurs in one of 1,500 pregnancies,³⁰ or less commonly, congenital renal abnormalities or a perinephric abscess.

Diagnostic tests may include renal ultrasonography or an abbreviated intravenous pyelogram. The indication to perform an intravenous pyelogram is persistent infection after appropriate antibiotic therapy when there is the suggestion of a structural abnormality not evident on ultrasonography. ³⁰ Even the low-dose radiation involved in an intravenous pyelogram, however, may be dangerous to the fetus and should be avoided if possible.

Group B Streptococcal Infection

Group B streptococcal (GBS) vaginal colonization is known to be a cause of neonatal sepsis and is associated with preterm rupture of membranes, and preterm labor and delivery. GBS is found to be the causative organism in UTIs in approximately 5 percent of patients.^31,32 Evidence that GBS bacteriuria increases patient risk of preterm rupture of membranes and premature delivery is mixed.^33,34 A randomized, controlled trial³⁵ compared the treatment of GBS bacteriuria with penicillin to treatment with placebo. Results indicated a significant reduction in rates of premature rupture of membranes and preterm delivery in the women who received antibiotics. It is unclear if GBS bacteriuria is equivalent to GBS vaginal colonization, but pregnant women with GBS bacteriuria should be treated as GBS carriers and should receive a prophylactic antibiotic during labor. ³⁶

Recurrence and Prophylaxis

The majority of UTIs are caused by gastrointestinal organisms. Even with appropriate treatment, the patient may experience a reinfection of the urinary tract from the rectal reservoir. UTIs recur in approximately 4 to 5 percent of pregnancies, and the risk of developing pyelonephritis is the same as the risk with primary UTIs. A single, postcoital dose or daily suppression with cephalexin or nitrofurantoin in patients with recurrent UTIs is effective preventive therapy.³⁷ A postpartum urologic evaluation may be necessary in patients with recurrent infections because they are more likely to have structural abnormalities of the renal system.^26,30,38 Patients who are found to have urinary stones, who have more than one recurrent UTI or who have a recurrent UTI while on suppressive antibiotic therapy should undergo a postpartum evaluation.^30,38

Outcomes

The maternal and neonatal complications of a UTI during pregnancy can be devastating. Thirty percent of patients with untreated asymptomatic bacteriuria develop symptomatic cystitis and up to 50 percent develop pyelonephritis.⁶ Asymptomatic bacteriuria is also associated with intrauterine growth retardation and low-birth-weight infants.⁹ Schieve and associates³⁹ conducted a study involving 25,746 pregnant women and found that the presence of UTI was associated with premature labor (labor onset before 37 weeks of gestation), hypertensive disorders of pregnancy (such as pregnancy-induced hypertension and preeclampsia), anemia (hematocrit level less than 30 percent) and amnionitis (Table 3³⁷). While this does not prove a cause and effect relationship, randomized trials have demonstrated that antibiotic treatment decreases the incidence of preterm birth and low-birth-weight infants.¹³ A risk of urosepsis and chronic pyelonephritis was also found.⁴⁰ In addition, acute pyelonephritis has been associated with anemia. ⁴¹

Outcome	Odds ratio	95% confidence interval
Perinatal
Low birth weight (weight less than 2,500 g [5 lb, 8 oz])	1.4	1.2 to 1.6
Prematurity (less than 37 weeks of gestation at delivery)	1.3	1.1 to 1.4
Preterm low birth weight (weight less than 2,500 g and less than 37 weeks of gestation at delivery)	1.5	1.2 to 1.7
Maternal
Premature labor (less than 37 weeks of gestation at delivery)	1.6	1.4 to 1. 8
Hypertension/preeclampsia	1.4	1.2 to 1.7
Anemia (hematocrit level less than 30%)	1.6	1.3 to 2.0
Amnionitis (chorioamnionitis, amnionitis)	1.4	1.1 to 1.9

Neonatal outcomes that are associated with UTI include sepsis and pneumonia (specifically, group B streptococcus infection).^31,42 UTI increases the risk of low-birth-weight infants (weight less than 2,500 g [5 lb, 8 oz]), prematurity (less than 37 weeks of gestation at delivery) and preterm, low-birth-weight infants (weight less than 2,500 g and less than 37 weeks of gestation at delivery)³⁹(Table 3³⁷).

Final Comment

UTIs during pregnancy are a common cause of serious maternal and perinatal morbidity; with appropriate screening and treatment, this morbidity can be limited. A UTI may manifest as asymptomatic bacteriuria, acute cystitis or pyelonephritis. All pregnant women should be screened for bacteriuria and subsequently treated with appropriate antibiotic therapy. Acute cystitis and pyelonephritis should be aggressively treated during pregnancy. Oral nitrofurantoin and cephalexin are good antibiotic choices for treatment in pregnant women with asymptomatic bacteriuria and acute cystitis, but parenteral antibiotic therapy may be required in women with pyelonephritis.

UTIs during pregnancy are common and treatable | Your Pregnancy Matters

What can we help you find?

Refine your search: Find a Doctor Search Conditions & Treatments Find a Location

Appointment New Patient Appointment
or Call214-645-8300

MedBlog

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 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.

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, 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.

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 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).

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, 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.

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.

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.

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 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.

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.
Learn more

When should my baby be talking

How to intubate a child

What do you pass during a miscarriage

Pregnancy in pcos complication

Going out with newborn

How to become a foster child

Cures for heartburn in pregnancy

Beta in pregnancy

Red rash on kids face

Recommended caffeine intake for pregnancy

How to help swelling in feet during pregnancy