UTI

URINARY TRACT DISORDER IN PREGNANCY

2015-2016

Classifications of UTIs in pregnancy

1-Asymptomatic bacteriuria
2-Cystitis
3-Pyelonephritis

Risk factors for UTI in pregnancy

-previous history of UTI
-multiparity
-lower socioeconomic status
-DM-anatomical abnormalities
-advanced maternal age
-presence of hemoglobin S

Causative organisms

Escherichia coli (E.coli) in 90% of cases.
Klebsiella,
streptococcus ,
staphylococcus,
proteus,
pseudomonus & others.


Asymptomatic bacteriuria
It's the presence of 100 000 organisms/ ml of the same species in two cultured fresh midstream specimens of urine in a woman without symptoms.

Complications

1-symptomatic infections as cystitis & pyelonephritis.
2-anaemia
3-hypertension
4-lUGR.
5-preterm delivery.

Treatment

Amoxicillin 500 mg/8hr
Cephalosporin as cefixime 500 mg/6hr for 10 days
Nitrofurantoin 100 mg/6 hr.

Cystitis

Bacteria are confined to the lowet urinary tract in these patients.
Clinical features
frequency, urgency, dysuria, hematuria or suprapubic pain in the absence of fever & flank pain.
Diagnosis
GUE (presence of pyuria) & urine culture .


Treatment
1-hydration to wash the bacteria.
2-antibiotics, obtain a urine culture in patient with signs & symptoms suggestive of cystitis & start antibiotic therapy, then adjust the treatment depend on final culture results & the patient's response to therapy. Types of antibiotics given; Ampicillin, Amoxicillin, Augmentin, Nitrofurantoin.

Pyelonephritis

It's infammation of the renal pelvis & parenchyma.
It's most serious complication in pregnancy, it may cause renal dysfunction & even renal failure.

Predisposing factors during pregnancy

-urine stasis during pregnancy due to ; compression of the ureter by the gravid uterus against the pelvic brim particularly on the right side.

-relaxation of the ureter by progesterone effect.

-increase urinary excretion of glucose & amino acid favours the growth of bacteria.

Clinical features

-asymptomatic
-malaise
-anorexia
-nausea & vomiting
-rigor
-dysuria, urgency, frequency of micturition.
-flank pain commonly on the right side.
Signs
-fever reaching 40 C°
-rapid pulse
-tenderness in one or both renal angles.


Investigations

1-urine analysis(midstream)

2-urine culture & sensitivity to isolate m.o.
3-blood picture
4-RFT
Note. Routine imaging studies are not indicated in the evaluation of pregnancy related UTI. Renal US or IV pyelography may be helpful in patients with recurrent UTI or symptoms suggestive nephrolithiasis.

Complications

1-chronicity due to recurrent infections. In these cases, plain X-ray & IV pyelography should be done after delivery to exclude urinary stones.
2-hypertension & renal failure
3-pulmonary oedema & adult RDS due to dehydration.
4-effect on fetus; abortion, preterm labour, prenatal mortality & morbidity.

Treatment

1-admition to hospital "some patient can be managed as outpatients" & bed rest.
2-light diet & rehydration. IV fluid may be needed if there is vomiting.
3-analgesics & antipyretics.
4-alkalies as K citrate to inhibit the growth of E.coli.
5-antibiotics as ampicillin 500 mg/ 6hr or nitrofurantoin 100 mg/ 6hr or cephalosporins 500 mg/6hr untill the result of culture & sensitivity. The treatment is continued for 7-10 days.
6-repeat culture after 2 wk.s


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