UTI and Bacteriuria in Pregnancy

Question 1

Define

Answer 1

· Risk factor à women are at increased risk from week 6 to 24 due to possible blockages

Question 2

Signs and Symptoms

Answer 2

FUND HIPS:

o Pain or burning, frequency, urgency, blood or mucus in urine, lower abdo pain

o Dyspareunia, foul smelling urine

o Signs of infection

Question 3

Investigations

Answer 3

Urinalysis performed at every antenatal visit

o Urine MC&S MSU sent at booking visit as a screening test

1. Protein (renal disease, preeclampsia)
2. Persistent glycosuria (T1/T2DM or GDM)
3. Nitrites (UTIs)

Question 4

Management

Answer 4

Asymptomatic bacteriuria à MC&S (GBS) à ABx:

Immediate antibiotic treatment (7 days):

• Nitrofurantoin (AVOID AT TERM; 100mg, BD, 7 days); OR
• Amoxicillin (500mg, TDS, 7 days); OR
• Cephalexin (500mg, BD, 7 days)

If GBS identified, write in notes as IV benpen will be required intrapartum

UTI in pregnancy, no visible haematuria -> MC&S (GBS) -> ABx:

• Advice and general care -> analgesia, avoid dehydration
• MSU before ABx starts
• Immediate antibiotic treatment (7 days):

· 1st line:

o Nitrofurantoin (AVOID AT TERM; 100mg, BD, 7 days); OR

· 2nd line:

o Amoxicillin (500mg, TDS, 7 days); OR

o Cephalexin (500mg, BD, 7 days)

o Pyelonephritis:

• Cephalexin; OR
• Cefuroxime

Question 5

Complications

Answer 5

Asymptomatic bacteriuria associated with:

Preterm delivery

Pyelonephritis during pregnancy à LBW and early labour

o Good if treated early and well

o Trimethoprim is contraindicated in the first trimester