Do you have a urine infection?

Urinary Tract infection (UTI) during pregnancy

Most common type of bacterial infection during pregnancy.

Caused by bacteria that normally lives in the colon (intestines) or the skin around the anus or vagina, where they do not cause any harm.

Infection occurs when the bacteria is present in feces and travels to the opening of the urinary tract and into the bladder (usually during intercourse, pregnant or not) attaching to the wall and growing. Once there, the bladder becomes irritated, causing pain. In a lapse of about 48hrs the symptoms become more evident, in pregnant woman UTI is usually is asymptomatic, but might become symptomatic without treatment.

Physiologic changes during pregnancy

Hydronephrosis, dilation renal calyces, pelvis, and parenchyma, resulting from an obstruction.

– Relaxation of the smooth muscles of the genitourinary tract by the increased progesterone

– Decreased ureteral peristalsis

– Physical pressure on bladder and uretersC

UTI most common during pregnancy

Pregnant women are more prone for developing urinary tract infections because as hormones relax the urethra, makes it easy for bacteria to enter and sometimes some urine is left in the bladder after urinating as they are not able to empty their bladder completely.

Causative agents (germs)

1. 90% Escherichia coli, leading cause of UTI.

2. Staphylococcus saprophyticus, 2nd leading cause of UTI in sexually active women “Honeymoon cystitis”.

3. Klebsiella pneumoniae, 3rd leading cause of UTI.

4. Enterococcus

5. Proteus

6. Pseudomonas aeruginosa

Escherichia coli

Named after Theodor Escherich a German bacteriologist and coli derived from colon

Normally live in the intestines.

Has a bad reputation!But not always harmful. Some actually are essential to good health, produces vitamin K and vitamin B12, also keeps a guardian space for other beneficial bacteria. Yes, there are some that can make you sick, either urinary tract infections, diarrhea or illness outside of the intestinal tract (e.g. pneumonia)

  • Gram-negative bacteria
  • Facultative anaerobe
  • Bacillus bacterium (rod-shaped)

Predisposing factors

  1. Pregnancy
  2. Urinary stasis
  3. Vesicoureteral reflux
  4. Diabetes
  5. History of UTI
  6. Sickle cell trait (Black race)
  7. Obstruction
  8. Kidney surgery
  9. Catheterization
  10. Genitourinary malformation

Urinary tract infections types:

  1. Asymptomatic bacteriuria (most common)

Symptomatic

  • Cystitis
  • Pyelonephritis

Asymptomatic (“without symptoms”) bacteriuria

Most common: in an African-American woman who has had multiple pregnancies with sickle-cell trait.

Diagnostic: Urine clean catch specimen > 100,000 bacteria of the same species per milliliter.

Recommendation: treat with even as low as 20,000 to 50,000 bacteria, because risk of developing symptomatic cystitis and pyelonephritis.

Important: Have urine test at the first prenatal visit (urine culture preferably or leukocyte esterase-nitrite Dipstick – fast test), it’s usually a routine test on every prenatal visit.  

Associated: low birth weight, preterm delivery, pregnancy associated hypertension, and anemia.

Treatment

Symptomatic + positive urine dipstick

  • Initiate empiric antibiotics until urine culture results
  • Change antibiotics if necessary when culture results are available, making sure that the bacteria present is sensitive for that antibiotics.

Asymptomatic bacteriuria

Empirical:

  • 3 to 5 course of Fosfomycin, cephalexin or ceftriaxone can successfully treat most UTI
  • 10 days with nitrofurantoin, 21 days for recurrent bacteriuria
  • Change antibiotics if necessary when culture results are available, making sure that the bacteria present is sensitive for that antibiotics.

Note: Ampicillin, amoxicillin, and Sulfa-containing drugs due to antibiotic resistance are no longer go-tos for combatting UTIs.

Contraindicated during pregnancy:

For women with glucose-6-phosphate dehydrogenase (G6PD) deficiency, since drug-induced hemolysis may occur and cause hemolytic anemia.

– Nitrofurantoin

After 36 weeks, may be a factor in kernicterus of the newborn

– Sulfamethoxazole and trimethoprim (Sulfa-containing drugs)

Suppressive therapy

Doesn’t cure the infection but will suppress the bacteria causing the infection as long the drug is taken. Recommended when two courses of treatment have been completed without success of curing the infection.

Prevention

  • If you know you are susceptible of getting UTI, start drinking unsweetened cranberry juice or take cranberry supplements

There are some studies that shows that proanthocyanidins (PAC), prevents bacteria from adhering to uroepithelial cells.

  • Vitamin C

It enhances the immune system and makes urine more acidic and reduces the chances of the growth of E. coli infection.

  • Probiotics (lactobacilli)

Are good bacteria, that helps maintain a natural bacterial environment in the vagina, lowers pH, produce hydrogen peroxide in urine, prevents bacteria from attaching to urinary tract cells. Found in yogurts, kefir (a fermented milk drink with a sour taste, made using a culture of yeasts and bacteria) and sauerkraut (chopped cabbage that has been pickled in brine)

  • Stay hydrated, drink lots of water! Remember water so important.

Helps flush away bacteria from bladder.

  • Urinate after having sex

Helps flush bacteria away that may have moved up to the urethra.

  • Wipe from front to back and wash hands.

Help to prevent bacteria from your anus from spreading to your urethra

Leave a Reply

Your email address will not be published. Required fields are marked *