8.12 Urinary Tract Infection in Pregnancy Flashcards
What does Urinary Tract Infection in Pregnancy increase the risk of?
Increased risk of preterm delivery
and other adverse outcomes: low birth weight and pre-eclampsia
When do pregnant women get and MC&S done?
Routinely –> in pregnant women you check for asymptomatic bacteriuria.
At booking and routinely throughout you send MSU for MC&S
What is the presentation of a lower urinary tract infection?
- dysuria (burning, stinging)
- suprapubic pain
- increased frequency
- urgency
- incontinence
- haematuria
What is the presentation of a upper urinary tract infection?
ie pyelonephritis:
- FEVER
- LOIN, suprapubic or back pain
- looking unwell
- vomiting
- loss of appetite
- haematuria
- renal angle tenderness on examination
Where do nitrites come from on a urine dip?
Gram negative bacteria eg E coli
they break down nitrates into nitrites
(fairly accurate indicator of infection)
What is being tested when you look for immune cells on urine dip?
looking for leukocyte esterase (by product of leukocytes in the urine)
(less accurate than nitrites)
What is the most common pathogen in UTI?
E. coli (normal in intestine)
How does E coli appear on microscopy?
- gram negative
- rod shaped
- anaerobic
Other than E Coli, what are 5 other pathogens causing UTI?
- KLEBSIELLA pneumoniae (gram-ve anaerobic rod)
- Enterococcus
- Pseudomonas aeruginosa
- Staphylococcus saprophyticus
- Candida albicans (fungal)
How do you manage UTI in pregnancy?
7 days Abx
What are you Abx choices for UTI in pregnancy?
- nitrofurantoin (avoid in 3rd trimester)
- amoxicillin (only once sensitivities are known)
- cefalexin
What antibiotic needs to be avoided in third trimester? Why?
Nitrofurantoin - risk of neonatal haemolysis
When and why must you avoid trimethoprim in pregnancy?
avoid in the first trimester as it is a folate antagonist (NTDs and spina bifida)
(not known to be harmful later on but it is generally avoided in pregnancy)
