A urinary tract infection (UTI), also called bladder infection, is a bacterial inflammation in the urinary tract. Pregnant women are at increased risk for UTIs starting in week 6 through week 24 because of changes in the urinary tract. The uterus sits directly on top of the bladder. As the uterus grows, its increased weight can block the drainage of urine from the bladder, causing a urinary tract infection during pregnancy.
UTIs can be safely treated with antibiotics during pregnancy. Urinary tract infections are most commonly treated by antibiotics. Doctors usually prescribe a 3-7 day course of antibiotics that is safe for you and the baby. Call your doctor if you have fever, chills, lower stomach pains, nausea, vomiting, contractions, or if after taking medicine for three days, you still have a burning feeling when you urinate.
utis during early pregnancy
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Urinary tract infections are common during pregnancy, and the most common causative organism is Escherichia coli. Asymptomatic bacteriuria can lead to the development of cystitis or pyelonephritis. All pregnant women should be screened for bacteriuria and subsequently treated with antibiotics such as nitrofurantoin, sulfisoxazole or cephalexin. Ampicillin should no longer be used in the treatment of asymptomatic bacteriuria because of high rates of resistance. Pyelonephritis can be a life-threatening illness, with increased risk of perinatal and neonatal morbidity. Recurrent infections are common during pregnancy and require prophylactic treatment. Pregnant women with urinary group B streptococcal infection should be treated and should receive intrapartum prophylactic therapy.
Urinary tract infections (UTIs) are frequently encountered in the family physician's office. UTIs account for approximately 10 percent of office visits by women, and 15 percent of women will have a UTI at some time during their life. In pregnant women, the incidence of UTI can be as high as 8 percent.1,2 This article briefly examines the pathogenesis and bacteriology of UTIs during pregnancy, as well as patient-oriented outcomes. We review the diagnosis and treatment of asymptomatic bacteriuria, acute cystitis and pyelonephritis, plus the unique issues of group B streptococcus and recurrent infections.
Pregnant women are at increased risk for UTIs. Beginning in week 6 and peaking during weeks 22 to 24, approximately 90 percent of pregnant women develop ureteral dilatation, which will remain until delivery (hydronephrosis of pregnancy). Increased bladder volume and decreased bladder tone, along with decreased ureteral tone, contribute to increased urinary stasis and ureterovesical reflux.1 Additionally, the physiologic increase in plasma volume during pregnancy decreases urine concentration. Up to 70 percent of pregnant women develop glycosuria, which encourages bacterial growth in the urine. Increases in urinary progestins and estrogens may lead to a decreased ability of the lower urinary tract to resist invading bacteria. This decreased ability may be caused by decreased ureteral tone or possibly by allowing some strains of bacteria to selectively grow.1,3 These factors may all contribute to the development of UTIs during pregnancy.
The organisms that cause UTIs during pregnancy are the same as those found in nonpregnant patients. Escherichia coli accounts for 80 to 90 percent of infections. Other gram-negative rods such as Proteus mirabilis and Klebsiella pneumoniae are also common. Gram-positive organisms such as group B streptococcus and Staphylococcus saprophyticus are less common causes of UTI. Group B streptococcus has important implications in the management of pregnancy and will be discussed further. Less common organisms that may cause UTI include enterococci, Gardnerella vaginalis and Ureaplasma ureolyticum.1,4,5
[ corrected] Significant bacteriuria may exist in asymptomatic patients. In the 1960s, Kass6 noted the subsequent increased risk of developing pyelonephritis in patients with asymptomatic bacteriuria. Significant bacteriuria has been historically defined as finding more than 105 colony-forming units per mL of urine.7 Recent studies of women with acute dysuria have shown the presence of significant bacteriuria with lower colony counts. This has not been studied in pregnant women, and finding more than 105 colony-forming units per mL of urine remains the commonly accepted standard. Asymptomatic bacteriuria is common, with a prevalence of 10 percent during pregnancy.6,8 Thus, routine screening for bacteriuria is advocated.
Untreated asymptomatic bacteriuria leads to the development of symptomatic cystitis in approximately 30 percent of patients and can lead to the development of pyelonephritis in up to 50 percent.6 Asymptomatic bacteriuria is associated with an increased risk of intra-uterine growth retardation and low-birth-weight infants.9 The relatively high prevalence of asymptomatic bacteriuria during pregnancy, the significant consequences for women and for the pregnancy, plus the ability to avoid sequelae with treatment, justify screening pregnant women for bacteriuria.
By screening for and aggressively treating pregnant women with asymptomatic bacteriuria, it is possible to significantly decrease the annual incidence of pyelonephritis during pregnancy.8,12 In randomized controlled trials, treatment of pregnant women with asymptomatic bacteriuria has been shown to decrease the incidence of preterm birth and low-birth-weight infants.13
Pregnant women should be treated when bacteriuria is identified (Table 217,18). The choice of antibiotic should address the most common infecting organisms (i.e., gram-negative gastrointestinal organisms). The antibiotic should also be safe for the mother and fetus. Historically, ampicillin has been the drug of choice, but in recent years E. coli has become increasingly resistant to ampicillin.19 Ampicillin resistance is found in 20 to 30 percent of E. coli cultured from urine in the out-patient setting.20 Nitrofurantoin (Macrodantin) is a good choice because of its high urinary concentration. Alternatively, cephalosporins are well tolerated and adequately treat the important organisms. Fosfomycin (Monurol) is a new antibiotic that is taken as a single dose. Sulfonamides can be taken during the first and second trimesters but, during the third trimester, the use of sulfonamides carries a risk that the infant will develop kernicterus, especially preterm infants. Other common antibiotics (e.g., fluoroquinolones and tetracyclines) should not be prescribed during pregnancy because of possible toxic effects on the fetus.
Acute pyelonephritis during pregnancy is a serious systemic illness that can progress to maternal sepsis, preterm labor and premature delivery. The diagnosis is made when the presence of bacteriuria is accompanied by systemic symptoms or signs such as fever, chills, nausea, vomiting and flank pain. Symptoms of lower tract infection (i.e., frequency and dysuria) may or may not be present. Pyelonephritis occurs in 2 percent of pregnant women; up to 23 percent of these women have a recurrence during the same pregnancy.26
The maternal and neonatal complications of a UTI during pregnancy can be devastating. Thirty percent of patients with untreated asymptomatic bacteriuria develop symptomatic cystitis and up to 50 percent develop pyelonephritis.6 Asymptomatic bacteriuria is also associated with intrauterine growth retardation and low-birth-weight infants.9 Schieve and associates39 conducted a study involving 25,746 pregnant women and found that the presence of UTI was associated with premature labor (labor onset before 37 weeks of gestation), hypertensive disorders of pregnancy (such as pregnancy-induced hypertension and preeclampsia), anemia (hematocrit level less than 30 percent) and amnionitis (Table 337). While this does not prove a cause and effect relationship, randomized trials have demonstrated that antibiotic treatment decreases the incidence of preterm birth and low-birth-weight infants.13 A risk of urosepsis and chronic pyelonephritis was also found.40 In addition, acute pyelonephritis has been associated with anemia.41
UTIs during pregnancy are a common cause of serious maternal and perinatal morbidity; with appropriate screening and treatment, this morbidity can be limited. A UTI may manifest as asymptomatic bacteriuria, acute cystitis or pyelonephritis. All pregnant women should be screened for bacteriuria and subsequently treated with appropriate antibiotic therapy. Acute cystitis and pyelonephritis should be aggressively treated during pregnancy. Oral nitrofurantoin and cephalexin are good antibiotic choices for treatment in pregnant women with asymptomatic bacteriuria and acute cystitis, but parenteral antibiotic therapy may be required in women with pyelonephritis.
A urinary tract infection (UTI) is an infection of the urinary system. UTIs are the most common bacterial infection that women develop during pregnancy. They can occur in different parts of the urinary tract, including the bladder (cystitis), urethra (urethritis) or kidneys (pyelonephritis). Sometimes when a UTI develops and bacteria are detected in the urinary tract, you may not have any symptoms of an infection. This is known as asymptomatic bacteriuria.
Urinary tract infections are not associated with preterm labor, according to research published in the Journal of the Chinese Medical Association. However, if a urinary tract infection is left untreated, it can progress to a kidney infection. And a kidney infection (pyelonephritis) during pregnancy can modestly increase your chances of early contractions and delivery. Research published in the American Journal of Obstetrics & Gynecology notes that women diagnosed with acute pyelonephritis in pregnancy have a 10.3 percent chance of preterm delivery compared with the 7.9 percent chance among women without a kidney infection during pregnancy. 2ff7e9595c
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