UTI IN PREGNANCY

INVESTIGATIONS
AND MANAGEMENT
 PHYSICAL EXAMINATION
 Pelvic examination- done in all symptomatic patients
except 3rd trimester patients with bleeding
To rule out vaginitis or cervicitis
 In Asymptomatic Bacteriuria- no physical findings are
typically present
 In cystitis- tenderness is present
 In pyelonephritis- Fever (usually > 38 Celsius)
Flank tenderness
FHR elevated to more than 160 bpm
INVESTIGATIONS
• BLOOD STUDIES
Complete blood count
Serum electrolytes
Blood urea nitrogen (BUN)
Serum creatinine
URINE STUDIES
URINE SPECIMEN COLLECTION
 Midstream clean catch
 In all pregnant women Screening has to be done in the first pre natal
visit or at 12-16 weeks:
it is done to identify asymptomatic bacteriuria and also other findings
such as glucosuria
URINE ANALYSIS
 Positive findings of NITRATES, LEUKOCYTE
ESTERASE, WBCs,RBCs and PROTEIN :
suggest UTI
 Bacteria found in the specimen can help with the
diagnosis
 1-2 bacteria in an unspun catheterized specimen or
>20bacteria/HPF in spun urine correlate closely with
bacterial colony counts >100,00 CFU/ml on a urine
culture.
URINE CULTURE
 Standard method for evaluating for UTI during
pregnancy
 Indications: Recurrent UTI, Pyelonephritis, History
of recent instrumentation, Hospital admission
 Positive culture: two consecutive voided specimens
with isolation of same bacterial strain at a colony
count of 100,000 CFU/ml or higher OR a single
catheterized specimen yielding a colony count of
atleast 100 CFU/ml
DIPSTICK TESTING
 For Nitrites and leukocytes esterase
 Nitrite dipstick testing: maybe a reasonable and cost
effective screening strategy for women who
otherwise may not undergo screening for bacteriuria ,
as is often seen in case in developing countries.
 Leukocyte esterase test may be unreliable in patients
with low level pyuria.
 URINE CYTOLOGY: Clumping WBCs and
WBC casts seen in Pyelonephritis
 ASO titer
 Sulfosalicylic acid (SSA) test
 Renal USG and Limited intravenous
Pyelography (IVP)
TREATMENT
BACTERIURIA AND CYSTITIS
 Administration of fluid if the patient is dehydrated
 Administration of appropriate antibiotics
Oral Antibiotics are treatments of choice for asymptomatic
bacteriuria and cystitis
 Admission if any indication of complicated UTI exists
SINGLE DOSE TREATMENT
 Amoxicillin 3g
 Ampicillin 2g
 Cephalosporin 2g
 Nitrofurantoin 200mg
 Trimethoprim-sulfamthoxazole 320/1600mg
3 DAY COURSE
 Amoxicillin 500mg tid
 Ampicillin 250mg qid
 Cephalosporin 250mg qid
 Nitrofurantoin 50 to 100mg qid
 Trimethoprim-sulfamethoxazole 160/800 mg bd
 To prevent recurrence and in case of recurrent
infections : ANTIMICROBIAL SUPPRESSION
THERAPY is continued till the end of pregnancy –
NITROFURANTOIN 100 mg daily at bedtime
 10-14 days of treatment is usually recommended to eradicate the
offending bacteria
 Treatment for 3 days is sufficient for Asymptomatic bacteriuria
 5-7 days antibiotics in Cystitis
 A test for cure urine culture should show negative findings 1-2 weeks
after therapy
 A non negative culture is an indication for 10-14 day course of a
different antibiotic followed by suppression therapy until 6 weeks
postpartum.