Urinary system disorders & epilepsy Flashcards
What are the classifications of urinary tract infections inn pregnancy?
1- asymptomatic bacteriuria
2- acute cystitis
3- acute pyelonephritis
How is asymptomatic bacteriuria diagnosed?
Urine culture from midstream urine -> significant if colony count is 100 000/ml
What are the causes of asymptomatic bacteria?
75-90% infection by E. coli
- Streptococci
- Proteus
- Pseudomonas
- Klebsiella
40% will develop symptomatic UTI & 30% acute pyelonephritis if untreated
How is asymptomatic bacteriuria treated?
Penicillin’s & cephalosporins for 3 days
What are the symptoms of acute cystitis?
- urinary frequency
- urgency
- dysuria
- hematuria
- proteinuria
- suprapubic pain
What causes acute cystitis & how is it diagnosed?
caused by E. coli infection
- significant bacteriuria in MSU
- hematuria: microscopic or gross in case of hemorrhagic cystitis
What are the risk factors for acute cystitis?
- recurrent cystitis
- renal tract abnormalities
- bladder emptying problems
- diabetes
How is acute cystitis managed?
- antipyretic
- antibiotics: Beta lactam, cephalosporin, nitrofurantoin, trimethoprim
for 5 - 7 days
What is the cause of acute pyelonephritis?
- infection of renal parenchyma
- physiological dilatation of upper urinary tract
- consequence of untreated symptomatic bacteriuria
What are the risk factors for acute pyelonephritis?
- polycystic kidneys
- urinary tract calculi
- neurogenic bladder
- congenital abnormalities of the renal tract
What is the clinical picture of acute pyelonephritis?
- leading cause of septic shock in pregnancy
- occurs in the second half of pregnancy
- unilateral, right sided in 50% of cases
- may predispose to preterm labor
costovertebral angle tenderness
What are the symptoms of acute pyelonephritis?
- abrupt onset
- loin pain & abdominal pain
- gross or microscopic hematuria
- temperature > 38.5 & rigors
- vomiting
How is acute pyelonephritis diagnosed?
- significant bacteriuria
- FBC = increased TWBCs
- blood culture if patient is suspected of having sepsis
How is acute pyelonephritis managed?
1- admission
2- rehydration with IV fluids (esp if the mother is volume depleted)
3- antibiotics IV: Penicillin’s or cephalosporin for the first 24hrs then orally for 2 weeks
4- Renal function tests to check for acute kidney injury
5- Ultrasound -> look for hydronephrosis, congenital abnormalities, or calculi
6- repeat urine culture after 2 weeks
How are recurrent UTIs prevented?
- MSU specimens each antenatal visit
- low dose prophylactic oral antibiotics -> 100mg nitrofurantoin daily (in case of recurrent disease)
- investigations should take place after delivery (unless frank hematuria)
- oral intake of plenty of water
- empty bladder after sexual intercourse
- renal ultrasound scan
What is the effect of epilepsy on pregnancy?
- 10 fold increase in maternal mortality
- fetal malformations & seizures
- increased risk of miscarriage, FGR, preterm labour, placental abruption, hypertensive disorders, hemorrhage, postpartum depression
- children have 10% risk of having seizure disorders
What should be done before an epileptic woman gets pregnant?
- review medications -> aim for monotherapy with lamotrigine (least teratogenic) & lowest effective dose
- folic acid supplement -> 0.4mg tab per day for 1 month before pregnancy will be changed to 4mg tab per day when she gets pregnant
- give medication to stop nausea & vomiting
- Anomaly scan mid pregnancy
- counsel about complications
What is the cause of the 20-30% increase in rates of seizures among pregnant ladies?
- sub therapeutic levels of medication due to nausea & vomiting
- sleep deprivation
- pain during labour
What are fetal malformations caused by epilepsy medications?
- valproate -> NTDs, cleft palate, cardiac anomalies, developmental delay
- Phenytoin -> Fetal hydantoin syndrome: craniofacial abnormalities, fingernails hypoplasia, growth deficiency
- Carbamazepine -> Fetal hydantoin syndrome, spina bifida
- Phenobarbital -> clefts, urinary tract anomalies
How should an epileptic mother give birth?
- ensure good analgesia during labour
- continue epileptic during labour
- delivery mode & timings are not changed
- breast feeding is encouraged but delayed a few hours after taking medications
