Antenatal - UTI in pregnancy

Question 1

what are the risks of urinary tract infections in pregnant women?

Answer 1

increase risk of preterm delivery

may also increase risk of other adverse pregnancy outcomes, such as low birth weight and pre-eclampsia

pyelonephritis - sepsis, growth restriction, IUD

Question 2

what is asymptomatic bacteriuria? and what are the risks for pregnant women?

Answer 2

bacteria present in the urine without symptoms of infection - pregnant women with asymptomatic bacteriuria are at higher risk of developing UTI (upper and lower) and therefore increased risk of preterm labour

Question 3

how are pregnant women tested for asymptomatic bacteriuria?

Answer 3

tested at booking and routinely throughout pregnancy

urine sample sent to the lab for microscopy, culture and sensitivities

Question 4

how might a lower urinary tract infection present?

Answer 4

• Dysuria (pain, stinging or burning when passing urine)
• Suprapubic pain or discomfort
• Increased frequency of urination
• Urgency
• Incontinence
• Haematuria

Question 5

how might pyelonephritis present?

Answer 5

• Fever (more prominent than in lower urinary tract infections)
• Loin, suprapubic or back pain (this may be bilateral or unilateral)
• Looking and feeling generally unwell
• Vomiting
• Loss of appetite
• Haematuria
• Renal angle tenderness on examination

Question 6

what might show up on urine dipstick to indicate infection?

Answer 6

nitrites (bacterial such as e.coli breakdown nitrates to nitrites)

leukocytes (dipstick tests for leukocyte esterase a product of leukocytes gives an indication of number of leukocytes)

nitrites more accurate than leukocytes

Question 7

what microbes commonly cause UTI?

Answer 7

most common: Escherichia coli

also:

• Klebsiella pneumoniae (gram-negative anaerobic rod)
• Enterococcus
• Pseudomonas aeruginosa
• Staphylococcus saprophyticus
• Candida albicans (fungal)

Question 8

how are UTIs managed in pregnancy?

Answer 8

7 days of abx - 5 days if asymptomatic

• nitrofurantoin (AVOID in 3rd trimester)
• amoxicillin (only after sensitivities are known)
• cefalexin

Question 9

when does nitrofurantoin need to be avoided and why?

Answer 9

third trimester

rick of neonatal haemolysis

Question 10

when does trimethoprim need to be avoided and why?

Answer 10

first trimester

folate antagonist - folate is important in early pregnancy for normal development of fetus

can cause congenital malformations particularly neural tube defects

Question 11

why are pregnant woman at increased risk of UTI?

Answer 11

less ureteric peristalsis so easier to ascend

glucosuria

more stasis

Question 12

recurrent UTI in pregnancy

Answer 12

prophylactic cefelexin