UTI during Pregnancy

Urinary tract infections are common during pregnancy, and the most common causative organism is Escherichia coli. Escherichia coli accounts for 80 to 90 percent of infections. Other gram-negative rods such as Proteus mirabilis and Klebsiella pneumoniae are also common.

It's possible to have UTI during pregnancy without any symptoms. UTI affects up to 10% of pregnant women. Hormonal changes, particularly the rise of progesterone levels, physiological changes during pregnancy such as ureteral dilation, decreased urine concentration, increased bladder volume, and decreased ureteral and bladder tone increase the risk of developing a UTI.

Asymptomatic bacteriuria can lead to the development of cystitis or pyelonephritis, and associated with an increased risk of intra-uterine growth retardation and low-birth-weight infants.

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Symptoms of UTIs in Pregnancy

Patients experience one or a combination of these symptoms during pregnancy:

Dysuria,
Urinary urgency, the immediate need to pee frequently
Turbid, or foamy urine
Haematuria,
Suprapubic pain,

Frequent urination is common, but that may be normal with pregnancy as it progresses.

When to screen Pregnant women for UTI?

Urine culture is the best way to identify ASB. The American College of Obstetrics and Gynecology recommends screening not only on the first prenatal visit, but during the second and third trimesters as well.

Asymptomatic bacteriuria is common. Thus, routine screening for bacteriuria is advocated. All pregnant women should be screened for bacteriuria and subsequently treated with antibiotics.

Antibiotic Choices for Treatment of UTIs during Pregnancy

Pregnant women should be treated when bacteriuria is identified. Oral antibiotics are the treatment of choice for asymptomatic bacteriuria.

The antibiotic that is safe for use during pregnancy, including:

· Nitrofurantoin (Treatment limited to the 2^nd trimester)

· Cephalexin

· Cefuroxime

· Fosfomycin

· Amoxicillin-clavulanic acid

10-14 days of treatment is usually recommended to eradicate the offending bacteria. The treatment always depends on symptoms, medical history, allergy to medications, and presence of pathogens from the urine culture.

Antibiotic selection should be based on urine culture sensitivities, if known. Often, therapy must be initiated on an empirical basis, before culture results are available.

Severe or complicated UTIs may need intravenous antibiotics in a hospital.