UTI IN PREGNANCY Flashcards
Is an infection in any part of the urinary system.
Urinary Tract Infection
Infection of the kidneys
Pyelonephritis
Infection of the ureters
Ureteritis
Infection of the bladder
Cystitis
Infection of the urethra
Urethritis
Reasons why females & pregnant women are more at risk for developing UTI
1) Anatomical Differences (Female)
2) Hormonal Changes (Pregnancy)
3) Increased Frequency of Urinary Tract Manipulation (Females and Pregnant Women)
4) Immune System Changes (Pregnancy)
5) Increased blood glucose levels
What are the anatomical differences of the female anatomy that makes them more prone to UTI
1) Shorter Urethra
2) Proximity to the Anus
3) Wider urethra
The female urethra is located closer to the anus, making it easier…
For fecal bacteria to reach the urethra + more difficult to maintain hygiene with a gravid/pregnant uterus
Because females have shorter urethra they are more prone to UTIs. Why so?
Shorter urethra means short distance for the bacteria to travel up into the urinary tract.
Hormonal Changes during Pregnancy that makes them have a higher risk of UTI
1) Increased Progesterone
2) Increased Uterine Pressure
How does increased progesterone become a factor causing UTI?
Higher levels of progesterone relax the smooth muscles of the urinary tract, including the bladder, leading to urinary stasis, which creates an environment for bacterial growth
What does urinary statis mean?
Retention of urine in the bladder or inability of the bladder to completely empty urine
How does increased uterine pressure become a factor causing UTI
As uterus expand, it can exert pressure on the bladder, hindering complete emptying. Allowing urine to remain in the bladder, increasing the risk of infection.
Urinary Tract Manipulations that can cause UTI
1) Sexual Activity
2) Use of catheters
How does changes in the immune system during pregnancy causes pregnant women more vulnerable to infections?
Mother’s immune system is slightly suppressed to allow for the fetal cells to grow & develop.
How do high glucose levels in the urine become a factor causing UTI?
Provide food source for bacteria, increasing the likelihood of infection.
Most common microorganism causing UTI
Escherichia Coli
Projections that enable the bacteria to stick & climb up the urinary tract
Pili
Where can GBS be found in an healthy individual as part of the normal flora?
- Intestines
- Rectum
- Vaginal area
GBS in individuals with weakened immune system can cause infections like:
1) UTIs
2) Skin & soft tissue infections
3) Sepsis
4) Pneumonia
Urine is refluxing or backing-up in the ureters instead of emptying into the urethra
VesicoUreteral Reflex
What causes vesicoureteral reflex?
Obstruction or nerve damage
Signs & Symptoms of Lower UTIs (Bladder & Urethra)
- Frequent Urge to Urinate
- Pain or Burning Sensation during urination (Dysuria)
- Cloudy or Foul-Smelling Urine
- Blood in Urine (Hematuria)
- Pelvic or lower abdominal pain
- Incontinence
- Pressure or Fullness in the Lower Abdomen
Signs & Symptoms of Upper UTIs
- High Fever
- Flank Pain
- Nausea & Vomiting
- General Malaise or Fatigue
- Painful urination
How is ASB detected / diagnosed?
Urine culture
Why is urinalysis not the best for detecting ASB?
Urinalysis may show the presence of bacteria in the urine, but the amount of bacteria may not be enough
WHY IS ASB potentially dangerous in pregnancy?
Bacteria can travel up to the kidneys & develop into Pyelonephritis which is associated with preterm labor & preterm rupture of membranes, sepsis & fetal death.
How does prostaglandin help during inflammation associated to infection?
Prostaglandins + Nitric oxide are released as part of the body’s natural response to infection:
- promoting vasodilation
-enhancing blood flow
- regulating immune responses
Overproduction of the prostaglandin can be dangerous. Why?
Promote uterine contractions contributing to embryonic & fetal expulsion
Signs & Symptoms of Pyelonephritis
- Fever
- Flank pain
- Painful urination (Dysuria)
- Urgency & Frequency
- Cloudy or foul-smelling urine
- Nausea & vomiting
- Malaise
- Shaking Chills
- Hematuria
How is UTI tested or diagnosed
1) Medical History
2) Physical Examination
3) Urinalysis
4) Urine culture & Sensitivity
How to assess tenderness during physical examination?
Palpation & percussion of the lower abdomen & costovertebral angle (CVA)
Most common diagnostic test for a UTI
Urinalysis
A urine sample is collected & tested for presence of:
- Leukocyte esterase
- Nitrites
- Red blood cells
- White blood cells
- Bacteria
An enzyme produced by WBCs, indicating infection
Leukocyte esterase
Helps identify the specific bacteria causing the infection & determines which antibiotics are most effective in treating it (Sensitivity Test)
Urine Culture & Sensitivity
How should urine sample be collected?
Mid-stream clean catch
What is the treatment of UTIs
Antibiotics - eliminate bacteria causing the infection
First line of antibiotics for non-pregnant women
- Nitrofurantoin
- Trimethoprim-Sulfamethoxazole (interferes with folate metabolism, neonatal jaundice)
-Fosfomycin
First Line of Antibiotics for Pregnant women
- Nitrofurantoin (during the 2nd trimester)
- Amoxicillin -Clavulanate
- Cephalexin
- Fosfomycin
Prenatal education on UTI:
1) Educate on UTI risks during pregnancy
2) Educate on symptom recognition
Prevention strategies for UTI
1) Hydration - to help flush urinary tract
2) Personal Hygiene - wipe front to back
3) Proper clothing - breathable cotton underwear
4) Urinary frequency - avoid holding urine for long periods
5) Voiding immediately after sex
Medication & Treatment for UTI
1) Antibiotic Safety
2) Completion of antibiotic course
3) Seek medical attention if they experience UTI symptoms
4) use of cranberry juice - anti- adhesion properties
Advise on using cranberry products, especially for those with underlying conditions or those on medications
Can interfere with blood-thinning medications like warfarin, increasing risk of bleeding.
