URINARY TRACT INFECTION IN PREGNANCY A urinary tract

URINARY TRACT INFECTION IN PREGNANCY

• A urinary tract infection (UTI) is an infection that begins in the urinary system. • UTIs limited to the bladder can be painful and annoying.

Parts of the urinary tract • two kidneys - a pair of purplish-brown organs located below the ribs toward the middle of the back. • two ureters - narrow tubes that carry urine from the kidneys to the bladder. • bladder - a triangle-shaped, hollow organ located in the lower abdomen. • two sphincter muscles - circular muscles that help keep urine from leaking by closing tightly like a rubber band around the opening of the bladder. • urethra -the tube that allows urine to pass outside the body.

Pregnancy and urinary tract infections: CHANGES IN THE URINARY SYSTEM DURING PREGNANCY Ø Kidney enlargement Ø Compression of the ureters and bladder Ø Incomplete emptying of the bladder Ø The urine is not as acidic Ø It contains more sugars, protein, and hormones.

Types of UTI in pregnancy q ASYMPTOMATIC BACTERIURIA • silent (without symptoms) infection • caused by bacteria present in the woman's system before pregnancy • may lead to pyelonephritis if left untreated. q ACUTE URETHRITIS OR CYSTITIS • symptoms including pain or burning with urination, frequent urination, feeling of needing to urinate, and fever. q PYELONEPHRITIS • a kidney infection • symptoms of acute cystitis plus flank (back) pain • may lead to preterm labor, severe infection, and adult respiratory distress syndrome.

The most common causative organism of UTI • Escherichia coli (E. coli) Other organisms may also cause UTI • group B streptococcus, and sexually transmitted gonorrhea and chlamydia.

Signs and symptoms • A strong, persistent urge to urinate • A burning sensation when urinating • Passing frequent, small amounts of urine • Blood in the urine (hematuria) or cloudy, strong-smelling urine

Diagnosis: Dip slide technique Treatment: For 7 to 10 days 1. Ampillicin 500 mg qid 2. Nitrofurantoin 100 mg qid 3. Cephalexin 500 mg tid 4. Amoxicillin – Clavulanic acid 375 mg tid In case of recurrent infection, Nitrofurantoin 50 mg or Amoxycillin 250 mg at night to continue till delivery

Cystitis ù Results from bacterial infections of the bladder ù Often in the 16 th week of pregnancy with marked retroversion of the gravid uterus ù Urine examination reveals: RBC, pus cells and bacteria ù Treatment: antimicrobial therapy and correction of retoversion.

Pyelonephrititis ³Condition characterized by an inflammation of the renal parenchyma and collecting tubules ³Predisposing factors: ØProgesterone ØPressure by the gravid uterus

³Clinical features üSymptomatic manifestations like fever, malaise, nausea, vomiting and urgency of micturition and tenderness at renal angle of the affected side. ³Investigations üHb, TC and DC, C – reactive protein üBlood culture üUrine: smear, culture and antibiotic sensitivity üRenal function test

³Management • Admission to hospital • Complete bed rest • Intravenous fliuds • Intravenous antibiotics • Antipyretics • Continuation of treatment with oral antibiotics for at least 2 weeks

³Complications • Septicemia • ARDS • Renal abscess and scarring • Preterm labour and delivery • Increased perinatal morbidity and mortality • DIC

Prevention of UTI • Drink plenty of liquids • Urinate promptly • Wipe from front to back • Empty your bladder as soon as possible after intercourse. Also, drink a full glass of water to help flush bacteria. • Avoid potentially irritating feminine products