UTI in Pregnancy

Question 1

Definition

Answer 1

Lower UTI: Infection in bladder = cystitis
Upper UTI = Infection up to the kidneys = pyelonephritis
Pregnant women are at higher risk of developing LUTI and pyelonephritis = increasing risk of other adverse pregnancy outcomes = low birth weight and pre-eclampsia

Question 2

ASx Bacteriuria

Answer 2

Bacteria present in the urine, without Sx of infection.
Pregnant women with Asx bactieruria are at higher risk of developing UTI’s.

Question 3

How and why are pregnant women tested for Asx Bacteriuria

Answer 3

Tested routinely at booking/check up = Urine MC+S
- Testing for bacteria in urine for ASx patients is not recommended as may lead to unnecessary Abx. Pregnant women are an exception, due to the adverse outcomes assosciated with infection:
= pyelonephritis, preterm birth, low birth weight, and maternal sepsis

Question 4

LUTI Signs and symptoms

Answer 4

Dysuria (pain, stinging, or burning when passing urine)
Supra-pubic pain or discomfort
Increased frequency of urination
Urgency
Incontinence
Haematuria

Question 5

Pyelonephritis signs and symptoms

Answer 5

Fever (MC>LUTI)
Loin, suprapubic or back pain (bilateral or unilateral)
Vomiting
Loss of appetite
Haematuria
Renal angle tenderness on examination

Question 6

Diagnosis

Answer 6

FIRST LINE = Urine dipstick
- Nitrites produced by gram-neg bacteria (such as E.coli) by breaking down nitrates
- Leukocytes = significant rise in infection (+ inflammation)
GOLD STANDARD = Mid stream MC+S

Question 7

Aetiology

Answer 7

Escherichia coli (E.coli) = gram-negative, anaerobic, rod-shaped bacteria (part of normal lower intestinal microbiome)
Klebsiella pneumoniae
Enterococcus
Pseudomonas aeruginosa
Staph saprophyticus
Candida albicans (fungal)

Question 8

Treatment

Answer 8

FIRST LINE = 7 days of Abx
- Nitrofurantoin (avoid in 3rd trimester)
- Amoxicilin (only after sensitivities are known)
- Cefalexin

Question 9

Why is Nitrofurantoin avoided in the 3rd trimester?

Answer 9

There is a risk of neonatal haemolysis (destruction of the neonatal red blood cells).

Question 10

Why is Trimethroprim avoided in 1st trimester?

Answer 10

Folate antagonist. Folate is important in early pregnancy for the normal development of the fetus.
- congenital malformations esp neural tube defects (i.e. spina bifida).
- Not known to be harmful later in pregnancy, but is generally avoided unless necessary.