UTI and Bacteriuria in Pregnancy

Question 1

At what point in pregnancy are UTI and bacteriuria the most likely to develop?

Answer 1

6 to 24 weeks due to possible blockages

Question 2

What are the signs and symptoms of a UTI in pregnancy?

Answer 2

• Pain or burning
• Frequency
• Urgency
• Haematuria or mucus in urine
• Lower abdominal pain
• Dyspareunia
• Foul smelling urine
• Signs of infection

Question 3

What are the appropriate investigations for a suspected UTI in pregnancy?

Answer 3

• Urinalysis - performed at every antenatal visit
• Urine MC&S - booking as a screen
  
  • Protein → renal disease, pre-eclampsia
  • Persistent glycosuria → T1/T2DM or GDM
  • Nitrites → UTIs

Question 4

What is the management of asymptomatic bacteriuria in pregnancy?

Answer 4

• Immediate antibiotic treatment (7 days):
  
  • Nitrofurantoin (100mg, BD, 7 days)
  • Amoxicillin (500mg, TDS, 7 days)
  • Cephalexin (500mg, BD, 7 days)
• If GBS identified = IV benpen intrapartum

Question 5

What is the management of UTI in pregnancy?

Answer 5

• Advice and general care - analgesia, avoid dehydration
• MSU before Abx starts
• Immediate antibiotic treatment (7 days):
  
  • 1st line:
    
    • Nitrofurantoin (100mg, BD, 7 days)
  • 2nd line:
    
    • Amoxicillin (500mg, TDS, 7 days)
    • Cephalexin (500mg, BD, 7 days)

Question 6

What is the management of pyelonephritis in pregnancy?

Answer 6

• Cephalexin
• Cefuroxime

Question 7

What are the complications of UTI or bacteriuria in pregnancy?

Answer 7

• Asymptomatic bacteriuria associated with:
  
  • Preterm delivery
  • Pyelonephritis during pregnancy à LBW and early labour
• Good if treated early and well
• Trimethoprim is contraindicated in the first trimester