Saturday 14 May 2016
Friday 13 May 2016
URINARY TRACT INFECTION AND PREGNANCY
- Urinary tract infections (UTIs) often complicate pregnancy. Precise definitions of UTIs are important.
- A UTI is defined as “the establishment and multiplication of micro-organisms within the urinary tract,” whereas bacteriuria is the detection of bacteria in a voided urine specimen.
- Significant bacteriuria is defined as greater than 1 × 106 of the same organism per milliliter of urine.
- Bacteriuria in pregnancy is often asymptomatic.
- Cystitis is defined as a symptomatic significant bacteriuria with associated bladder mucosal inflammation,
- Whereas pyelonephritis is defined as symptomatic significant bacteriuria with associated inflammation of the renal parenchyma, calices, and pelvis.
- Previous work has established a 5% to 10% prevalence of asymptomatic bacteriuria (ASB) in pregnancy and the association of ASB with the development of symptomatic infections, including pyelonephritis.
- Twenty-five percent to thirty percent of cases of ASB in pregnancy will progress to symptomatic infection.
- This progression from asymptomatic to symptomatic infection with pregnancy is three to fourfold the progression rate in non pregnant females.
- Pyelonephritis has been associated with maternal and fetal morbidity and mortality. Obstetric complications such as preterm labor and low birth weight have been associated with bacteriuria.
- The purpose of this article is to help the physician understand the physiologic changes of the urinary tract associated with pregnancy and the significance of bacteriuria.
- Topics discussed include the screening mechanisms available for bacteriuria in pregnancy and the range of UTIs associated with pregnancy and their treatments
- Urinary tract infection is one of the most frequently seen ‘medical’ complications in pregnancy.
- The pioneering work of Edward Kass discovered that 6% of pregnant women had asymptomatic bacteriuria associated with increased prematurity and perinatal mortality compared to women with sterile urine.
- Screening for bacteriuria in pregnancy has become routine. Other factors such as vaginal colonization have been recognized as important contributors to preterm labour.
- The value of screening for bacteriuria has to be re-addressed considering methods, significance and costs. Treatment of urinary tract infection in pregnancy is critically reviewed.
- Although pregnancy does not increase the prevalence of asymptomatic bacteruria in women, it does enhance the progression rate from asymptomatic to symptomatic disease.
- Symptoms of cystitis include dysuria, hematuria, urinary frequency, urgency or suprapubic discomfort.
- Fever, chills, abdominal pain, flank pain and vomiting are features of pyelonephritis.
- Direct microscopy of the urinary sediment for white cells (pyuria), red cells (haematuria), bacteria (bacteruria) and white cells casts is useful to make a diagnosis.
- The urine culture is a sensitive means of detecting asymptomatic bacteruria and provided antibiotic sensitivity.
- Treatment in the first trimester is complicated by concerns of possible teratogenicity of drugs.
- Amozycillin, Ampicillin, Amoxycillin with clavunate potassium, cephalosporins are drugs that can be used as first-line therapy in pregnancy.
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