Urinary tract infections in pregnancy

Urinary tract infections in pregnancy

Classification

Urinary tract infections are divided into two groups:

Lower urinary tract: These involve bladder and urethra, include acute cystitis and asymptomatic bacteriuria.

Upper urinary tract: These involve the kidneys, acute pyelonephritis.

Pathophysiology

Urinary tract infections (UTIs) usually originate from organisms in the vagina/rectum. These ascend from the urethra and ultimately reach the kidneys. Gram-negative enteric bacteria predominate. Escherichia coli (E. coil) are implicated in 80% of infections. In the rest of the 20% other organisms like Klebsiella, Pseudomonas, Enterococci and Proteus occur.

Risk factors

Mechanical obstruction: Ureteropelvic junction, ureteric/urethral stenosis, presence of calculi.

Functional obstruction: Pregnancy, vesicoureteral reflux.

Systemic illnesses: Diabetes, gout, sickle cell disease, renal cysts.

Clinical manifestations

Infections of the urinary tract during pregnancy present in various forms: Asymptomatic bacteriuria (ASB)

Incidence in pregnancy-8% approximate.

Predisposes to preterm delivery, PIH, DIC, increased obstetric morbidity.

Diagnosed on urine culture showing >100,000 colonies/ml.

7-10 day administration of appropriate antibiotic like cefotaxime. Acute cystitis

The clinician must be aware of the following:

Incidence: About 1.0%.

It may progress to pyelonephritis, if not treated promptly and completely.

Symptoms: Frequency, dysuria, urgency, suprapubic pain.

Often unremarkable, pain in palpation of the bladder base vaginally.

Urine analysis: Turbid, proteins present. Microscopy: RBCs and pus cells.

Order a urine culture and sensitivity test: Treat accordingly.

Acute pyelonephritis

Incidence: 1-2%.

Symptoms: Onset sudden, fever with chills, headache, malaise, anorexia, vomiting, backache. On examination—pain in the flanks, costovertebral angle tenderness, evidence of dehydration, rise in temperature, mild tachycardia. The tongue appears furred.

Investigations: Urine shows presence of proteins, microscopy—pus cells present, significant bacteriuria present.

Management: Hospitalize, intravenous fluids, to correct dehydration and fluid loss. Antipyretic analgesics, parenteral antibiotics like ampicillin/ cephalosporins every 6 hours for 2 days followed by oral antibiotics for a week.

Follow up urine examination, culture and sensitivity S.O.S.

Watch out for relapse, reinfection, and superinfection.

All pregnant women should be tested for ASB and treated promptly.