UTIs in Pregnancy Flashcards
What is the difference between an upper and lower UTI?
lower UTI:
- infection of the bladder that causes cystitis
- cystitis = inflammation of the bladder
upper UTI:
- involves infection up to the kidneys
- pyelonephritis = inflammation of the kidneys due to bacterial infection
Why are urinary tract infections so significant in pregnancy?
- pregnant women are at a higher risk of developing UTIs
- UTIs increase the risk of preterm birth
- they also increase the risk of other adverse outcomes, such as pre-eclampsia & low birth weight
What is asymptomatic bacteriuria?
bacteria present in the urine WITHOUT symptoms of infection
What does asymptomatic bacteriuria increase the risk of in pregnancy?
asymptomatic bacteriuria increases the risk of developing lower UTI** or **pyelonephritis
this then increases the risk of preterm birth
How is asymptomatic bacteriuria monitored in pregnancy?
- pregnant women are tested at booking and routinely throughout pregnancy
- a urine sample** is sent to the lab for **MC&S
(MC&S = microscopy, culture & sensitivities)
How is asymptomatic bacteriuria tested for in people who are not pregnant?
- testing for bacteria in the urine of asymptomatic patients is NOT recommended
- it results in unnecessary antibiotic use
- pregnant women are the exception to this rule due to the potential risks
How do lower urinary tract infections present?
- dysuria (pain / stinging when passing urine)
- increased frequency
- urgency
- suprapubic pain / discomfort
- incontinence
- haematuria
How does pyelonephritis tend to present?
- fever
- loin, suprapubic or back pain (bilateral or unilateral)
- looking / feeling generally unwell
- N&V
- loss of appetite
- haematuria
- renal angle tenderness on examination
What are the 2 markers of infection on urine dipstick?
nitrites and leukocytes
(nitrites are a more accurate marker of infection than leukocytes)
Why are nitrites in the urine suggestive of infection?
- nitrites are produced by gram-negative bacteria (e.g. E. coli)
- the bacteria break down nitrates, which are a normal waste product of urine
- the presence of nitrites suggests bacteria in the urine
What are leukocytes in the urine suggestive of?
- urine dipstick tests measure leukocyte esterase
- leukocyte esterase is produced by leukocytes (WBCs)
- the level of leukocyte esterase gives an indication of the number of WBCs in the urine
- it is normal to have some WBCs in the urine, but a significant rise suggests infection / inflammation
What samples are sent for MC&S during pregnancy?
midstream urine (MSU)
What is the most common cause of UTI during pregnancy?
Escherichia coli
- a gram-negative, anaerobic, rod-shaped bateria
- part of the normal lower intestinal microbiome
- can easily spread to the bladder as it is found in faeces
What are other causes of UTI in pregnancy?
- Klebsiella pneumoniae (gram-negative anaerobic rod)
- Enterococcus
- Pseudomonas aeruginosa
- Staphylococcus saprophyticus
- Candida albicans (fungus)
How many days of antibiotics are required for a UTI in pregnancy?
7 days
