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Treatment Of Urinary Tract Infection In Pregnancy

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Symptomatic Urinary Tract Infection

UTIs During Pregnancy, Prevention and Treatment

About 1520% of women with pyelonephritis have bacteremia . They may develop various complications, such as acute kidney injury, anemia, hypertension, preeclampsia, sepsis and septic shock, hemolysis, thrombocytopenia, and acute respiratory distress syndrome, particularly if treatment is initiated too late . Although these associations have not always been proved to be causal, most of the complications seem to be due to renal or other tissue damage caused by bacterial endotoxins and a systemic inflammatory response with endothelial injury .

A number of observational studies have demonstrated the relationship between maternal symptomatic UTI and the risk of premature delivery and lower birth weight . The frequency of preterm deliveries in women with acute pyelonephritis is significantly higher than in women free of this complication, and pyelonephritis seems to be an important independent risk factor for delivery before 37 weeks gestation . However, again, a substantial heterogeneity between these studies, together with many possible biases, makes it difficult to establish the overall contribution of UTI to preterm birth . A rare but severe complication is the transmission of the infection onto the newborn baby . Very often the transmitted infection originates from a heavily colonized birth canal, usually with GBS .

What Causes A Uti During Pregnancy

Several factors can lead to a UTI during pregnancy, including:

  • Changes in your body. All women are at risk for UTIs . But pregnant women may be more prone: Changes in hormones may give bacteria an easier opportunity to travel up the urinary tract and cause an infection. Your growing uterus also puts added pressure on your bladder, making it more difficult to completely empty it of urine .
  • Bacteria from the bowel. UTI-causing bacteria can come from several places. By far the most common bacterial invader, E. coli, comes from the bowel. Because the urethra is located close to the rectum, these bacteria can be transported up the urethra. Wiping from front to back every time you use the bathroom can help keep bacteria away from this area.
  • Intercourse. Sex during pregnancy is perfectly healthy but there is a downside: It also has the potential to lead to a UTI, as bacteria near the vagina may be pushed into the urethra during intercourse. It may not be romantic, but its important to urinate before and after sex to move that bacteria along.
  • Group B streptococcus. This type of bacteria, commonly carried in the intestinal tract, can also cause UTIs during pregnancy. Late in your pregnancy, your doctor will test you for this infection and treat you with antibiotics if necessary.

There are also some less avoidable risk factors. If any of these apply to you, be sure to discuss them with your doctor so you can be closely monitored for signs of an infection:

Is A Uti Dangerous During Pregnancy

Any infection during pregnancy can be extremely dangerous for you and your baby. Thats because infections increase the risk of premature labor.

I found out the hard way that an untreated UTI during pregnancy can also wreak havoc after you deliver. After I had my first daughter, I woke up a mere 24 hours after coming home with a fever approaching 105F .

I landed back in the hospital with a raging infection from an undiagnosed UTI, a condition called pyelonephritis. Pyelonephritis can be a life-threatening illness for both mother and baby. It had spread to my kidneys, and they suffered permanent damage as a result.

Moral of the story? Let your doctor know if you have any symptoms of a UTI during pregnancy. If youre prescribed antibiotics, be sure to take every last pill to knock out that infection.

You can help prevent UTIs during your pregnancy by:

  • emptying your bladder frequently, especially before and after sex
  • wearing only cotton underwear
  • avoiding douches, perfumes, or sprays
  • drinking plenty of water to stay hydrated
  • avoiding any harsh soaps or body wash in the genital area

Most UTIs during pregnancy are treated with a course of antibiotics. Your doctor will prescribe an antibiotic that is pregnancy-safe but still effective in killing off bacteria in your body.

If your UTI has progressed to a kidney infection, you may need to take a stronger antibiotic or have an intravenous version administered.

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Why Are Utis Common In Pregnant Women

When youre pregnant, the anatomy of your urinary tract actually changes. For instance, your kidneys become larger and your growing uterus can compress your ureters and bladder. Because of this compression, fully emptying your bladder during pregnancy becomes more difficult. In addition, your progesterone and estrogen levels increase during pregnancy, which can weaken your bladder and ureters. Pregnancy also alters the makeup of your urine, reducing the acidity and increasing the amount of protein, hormones, and sugar in your urine. That excess sugar, for one, can encourage bacterial growth. All of the above contribute to a heightened chance of developing a UTI in pregnancy. And that is why its recommended that all pregnant women receive a urinalysis and urine culture at 12 to 16 weeks or during the first prenatal visit.

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Urinary Tract Infection In Pregnancy

How to Treat a Urinary Tract Infection During Pregnancy ...

, MD, PhD, University of Texas Health Medical School at Houston, McGovern Medical School

Urinary tract infection Introduction to Urinary Tract Infections Urinary tract infections can be divided into upper tract infections, which involve the kidneys , and lower tract infections, which involve the bladder , urethra… read more is common during pregnancy, apparently because of urinary stasis, which results from hormonal ureteral dilation, hormonal ureteral hypoperistalsis, and pressure of the expanding uterus against the ureters. Asymptomatic bacteriuria occurs in about 15% of pregnancies and sometimes progresses to symptomatic cystitis Cystitis Bacterial urinary tract infections can involve the urethra, prostate, bladder, or kidneys. Symptoms may be absent or include urinary frequency, urgency, dysuria, lower abdominal pain… read more or pyelonephritis Acute pyelonephritis Bacterial urinary tract infections can involve the urethra, prostate, bladder, or kidneys. Symptoms may be absent or include urinary frequency, urgency, dysuria, lower abdominal pain… read more . Frank UTI is not always preceded by asymptomatic bacteriuria.

Asymptomatic bacteriuria, UTI, and pyelonephritis increase risk of

  • Nitrofurantoin

  • Trimethoprim/sulfamethoxazole

After treatment, proof-of-cure cultures are required.

Women who have pyelonephritis or have had more than one UTI may require suppressive therapy, usually with TMP/SMX or nitrofurantoin, for the rest of the pregnancy.

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What Are The Symptoms Of Utis During Pregnancy

Common symptoms of a UTI during pregnancy are similar to those that you might experience at any other time, and include:

  • a burning sensation when you pass urine
  • feeling the urge to urinate more often than usual
  • urinating before you reach the toilet
  • feeling like your bladder is full, even after you have urinated
  • urine that looks cloudy, bloody or is very smelly
  • pain above the pubic bone
  • fever

Sometimes the first sign of an infection is a faint prickly sensation when you pass urine. If the infection is more advanced and has moved up to the kidneys, you may also experience fever with a particularly high temperature, back pain and vomiting.

Are Utis Dangerous During Pregnancy

UTIs can rapidly progress to a kidney infection in pregnancy, which can be much more dangerous than a kidney infection in nonpregnant women, says Bartos. Severe infections can lead to respiratory problems and , which can then lead to preterm labor or even the need to urgently deliver the baby. Beyond a kidney infection, simply having a UTI during pregnancy appears to possibly be a contributing factor to low birth weight. Women who have a UTI in pregnancy also have a 1.31-fold higher risk of developing preeclampsia, a pregnancy complication characterized by high blood pressure, according to a meta-analysis published in September 2018 in the journal Medicine. Its thought that a UTI may alter a pregnant womans inflammatory response, which can spur preeclampsia.

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What Is A Uti

A UTI occurs when bacteria from somewhere outside of a womans body gets inside her urethra and causes an infection.

Women are more likely to get UTIs than men. The female anatomy makes it easy for bacteria from the vagina or rectal areas to get in the urinary tract because they are all close together.

Can A Uti Cause Contractions During Pregnancy

Urinary Tract Infection in Pregnancy | Signs, Symptoms, Complications & Treatment- Dr. H S Chandrika

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 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.

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Recurrent Urinary Tract Infection

For women who suffer from frequent, chronic, and recurrent UTIs, low-dose antibiotic prophylaxis including nitrofurantoin , cephalexin , or trimethoprimâsulfamethoxazole can provide symptomatic relief.

However, as discussed earlier in the section âUTIs in Pregnancy,â the increasing prevalence of antibiotic-resistant bacteria limits the effectiveness of our current antibiotic arsenal. For example, individuals who suffer from serious recurrent or chronic UTIs may benefit greatly from carbapenems such as ertapenem, but these antibiotics are considered one of our last lines of defense and so should be used cautiously. The ongoing emergence of antibiotic-resistant strains, with the high frequency of rUTIs, highlights the need for a better understanding of these infections and the development of new therapeutic strategies.

Recurrent UTIs are thought to arise from the ability of bacteria to attach to and invade the bladder epithelium, where they can form intracellular reservoirs protected from antibiotics and host defenses. Thus, many emerging treatments for UTIs are aimed at blocking adhesion of bacteria to the urothelium.

Jack D. Sobel, Donald Kaye, in, 2015

Urine Infection In Pregnancy

In this series

Urine infection is common in pregnancy. If left untreated some urine infections may progress to cause serious kidney infection. Treatment is with a medicine called an antibiotic. The aim is to cure the infection and also to prevent possible complications.

In this article

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Safety Of Antimicrobial Treatment

Nearly all antimicrobials cross the placenta, and some of them may exert teratogenic effects. Commonly accepted antibiotics used in treating UTIs during pregnancy, regardless of its period, include derivatives of penicillin and cephalosporins, particularly those with low protein-binding ability , all of FDA pregnancy category B .

Why Are Utis More Common During Pregnancy

Urinary Tract Infection (UTI) In Pregnancy: Symptoms ...

Hormones are one reason. In pregnancy, they cause changes in the urinary tract, and that makes women more likely to get infections. Changes in hormones can also lead to vesicoureteral reflux, a condition in which your pee flows back up from your bladder to your kidneys. This can cause UTIs.

When youâre pregnant, your pee has more sugar, protein, and hormones in it. These changes also put you at higher risk for a UTI.

Because youâre pregnant, your growing uterus presses on your bladder. That makes it hard for you to let out all the urine in your bladder. Leftover urine can be a source of infection.

Other causes of UTIs include:

Escherichia coli and other bacteria from your poop. E. Coli is the most common cause of UTIs and can move from your rectum to your urethra if you donât wipe from front to back.

Sexual activity. Fingers, your partnerâs penis, or devices can move bacteria near your vagina into your urethra.

Group B streptococcus. Many women have this bacteria in their colon and vagina. It can cause UTIs and women can pass it to their newborns. Your doctor will test you for this bacteria around weeks 36 to 37 of pregnancy. If youâre positive for group B strep, your doctor will give you IV antibiotics during labor.

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Group B Streptococcal Infection

Group B streptococcal vaginal colonization is known to be a cause of neonatal sepsis and is associated with preterm rupture of membranes, and preterm labor and delivery. GBS is found to be the causative organism in UTIs in approximately 5 percent of patients.31,32 Evidence that GBS bacteriuria increases patient risk of preterm rupture of membranes and premature delivery is mixed.33,34 A randomized, controlled trial35 compared the treatment of GBS bacteriuria with penicillin to treatment with placebo. Results indicated a significant reduction in rates of premature rupture of membranes and preterm delivery in the women who received antibiotics. It is unclear if GBS bacteriuria is equivalent to GBS vaginal colonization, but pregnant women with GBS bacteriuria should be treated as GBS carriers and should receive a prophylactic antibiotic during labor.36

How Can I Prevent A Bladder Infection

You may do everything right and still experience a urinary tract infection during pregnancy, but you can reduce the likelihood by doing the following:

  • Drink 6-8 glasses of water each day and unsweetened cranberry juice regularly.
  • Eliminate refined foods, fruit juices, caffeine, alcohol, and sugar.
  • Take Vitamin C , Beta-carotene and Zinc to help fight infection.
  • Develop a habit of urinating as soon as the need is felt and empty your bladder completely when you urinate.
  • Urinate before and after intercourse.
  • Avoid intercourse while you are being treated for a UTI.
  • After urinating, blot dry , and keep your genital area clean. Make sure you wipe from the front toward the back.
  • Avoid using strong soaps, douches, antiseptic creams, feminine hygiene sprays, and powders.
  • Change underwear and pantyhose every day.
  • Avoid wearing tight-fitting pants.
  • Wear all-cotton or cotton-crotch underwear and pantyhose.
  • Dont soak in the bathtub longer than 30 minutes or more than twice a day.

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Uti Symptoms And Prevention

A urinary tract infection , 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.

Categories Of Urinary Tract Infections And Clinical Manifestations In Adult Women

How to Treat Urinary Tract Infection During Pregnancy | 11 Home Remedies for Urinary Tract Infection

A broad spectrum of anatomic levels and clinical manifestations of UTI that can be categorized separately are useful in choosing appropriate antibiotic therapy. Tables 2 and 3 present a guide for differentiating acute pyelonephritis, acute uncomplicated UTI, urethritis, and vulvovaginitis.

Acute uncomplicated UTI refers to a bacterial infection of the bladder that causes the abrupt onset of severe symptoms in a non-pregnant woman with a normal urinary tract and no underlying medical complications. Typical symptoms include internal dysuria, urgency, frequency, and suprapubic pain. Hematuria can occur. The spectrum of pathogens is quite narrow and predictable in acute uncomplicated UTI.

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Urinary Tract Infections During Pregnancy

JOHN E. DELZELL, JR., M.D., and MICHAEL L. LEFEVRE, M.D., M.S.P.H., University of Missouri-Columbia School of Medicine, Columbia, Missouri

Am Fam Physician. 2000 Feb 1 61:713-720.

See related patient information handout on urinary tract infections during pregnancy, written by the authors of this article.

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.

Management Of Urinary Tract Infections In Pregnancy

A critically important aspect of urologic management of the pregnant patient includes understanding of the pathophysiology and potential complications of ASB recommendations with detailed analysis available elsewhere in this volume .

ASB is generally discovered in 2% to 7% of women during pregnancy . Historical data and contemporary systematic review confirm with moderate quality evidence that antibiotic treatment of ASB during pregnancy likely reduces the risk for progression of infection to pyelonephritis . As described earlier , a myriad number of anatomic and physiologic alterations progress during pregnancy that may affect the natural history of bacteriuria and subsequent progression to pyelonephritis .

Indeed, in pregnant patients with untreated ASB, pyelonephritis may occur at an incidence of 15% to 45% . Most women experience episodes of pyelonephritis when hydronephrosis and urinary stasis are most prominent in the third trimester . Approximately one-third of pregnant women who develop pyelonephritis have a documented prior history of pyelonephritis .

The increased likelihood that ASB may progress to acute pyelonephritis during pregnancy alters the morbidity of bacteriuria for this group. Treatment of ASB in pregnancy likely decreases the incidence of acute pyelonephritis during pregnancy to 1% to 4% and reduces the potential for preterm birth and low birth weight .

Michael J. Field MD, BS, BSc, FRACP, … Carol A. Pollock MB, BS, PhD, FRACP, in, 2010

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Are Utis A Risk During Pregnancy

During pregnancy, many changes occur in your body that increase your risk of developing a UTI, including changes to the make-up of your urine and immune system. As your baby grows, there is also an increase in the pressure on your bladder, which can reduce the flow of your urine and lead to an infection.

UTIs can affect women whether they are pregnant or not. However, pregnant women are more likely to develop repeated or more severe infections. Up to 1 in 10 pregnant women will have a UTI but not have any symptoms at all.

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