UTI in pregnancy Flashcards
What is lower urinary tract infection and an upper urinary tract infection?
Lower urinary tract infection involves infection in the bladder, causing cystitis (inflammation of the bladder).
Upper urinary tract infection involves infection up to the kidneys, called pyelonephritis.
What are pregnant women at higher risk of developing?
Pregnant women are at higher risk of developing lower urinary tract infections and pyelonephritis.
What do UTI in pregnant women increase the risk of?
preterm delivery. They may also increase the risk of other adverse pregnancy outcomes, such as low birth weight and pre-eclampsia.
S + S of LUTS?
Dysuria (pain, stinging or burning when passing urine)
Suprapubic pain or discomfort
Increased frequency of urination
Urgency
Incontinence
Haematuria
What does pyelonephritis present with?
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
What shows an UTI on a urine dipstick?
Nitrites are produced by gram-negative bacteria (such as E. coli). These bacteria break down nitrates, a normal waste product in urine, into nitrites. The nitrites in the urine suggest the presence of bacteria.
Leukocytes refer to white blood cells. There are normally a small number of leukocytes in the urine, but a significant rise can be the result of an infection, or alternative cause of inflammation. Urine dipstick tests examine for leukocyte esterase, a product of leukocytes, which gives an indication to the number of leukocytes in the urine.
Nitrites are a more accurate indication of infection than leukocytes.
During pregnancy, midstream urine (MSU) samples are routinely sent to the microbiology lab to be cultured and to have sensitivity testing.
What is the most common cause of UTI?
What are the other causes?
E. coli
Klebsiella pneumoniae (gram-negative anaerobic rod)
Enterococcus
Pseudomonas aeruginosa
Staphylococcus saprophyticus
Candida albicans (fungal)
What is the management for UTI in pregnancy?
7 Days of antibiotics
Nitrofurantoin (avoid in the third trimester)
Amoxicillin (only after sensitivities are known)
Cefalexin
What needs to be avoided in the third trimester and why for UTI?
Nitrofurantoin needs to be avoided in the third trimester as there is a risk of neonatal haemolysis (destruction of the neonatal red blood cells).
What needs to be avoided in the first trimester for UTIs?
Trimethoprim needs to be avoided in the first trimester as it is works as a folate antagonist. Folate is important in early pregnancy for the normal development of the fetus. Trimethoprim in early pregnancy can cause congenital malformations, particularly neural tube defects (i.e. spina bifida). It is not known to be harmful later in pregnancy, but is generally avoided unless necessary.
What can UTI in pregnancy lead to?
increased risk of preterm birth and pyelonephritis affecting maternal and fetal outcome
Epidemiology of UTI in pregnancy?
in about 30% of patients acute pyelonephritis occurs, especially at the time of deliver
has been reported that 20-40% of pregnant women with untreated bacteriuria will develop pyelonephritis
First choice for UTI lower
First choice for treating lower UTI 3
nitrofurantoin (avoid at term) - if eGFR >=45 ml/minute 4, 5
100 mg modified-release twice a day for 7 days
Second choice for treating lower UTI (no improvement in lower UTI symptoms on first choice taken for at least 48 hours or when first choice not suitable)
amoxicillin (only if culture results available and susceptible)
500 mg three times a day for 7 days
OR
cefalexin
500 mg twice a day for 7 days
OR
alternative second choices
Consult local microbiologist, choose antibiotics based on culture and susceptibility results
What are pregnant women withy asymptomatic bacteriuria at higher risk of developing?
- Lower UTI
- Pyelonephritis
- Preterm birth
