Monday, 29 August 2016

GUIDANCE FOR UTI'S IN PREGNANCIES


pregnancy does not increase the prevalence of asymptomatic bacteruria in women, it does enhance the progression rate from asymptomatic to symptomatic disease.

Symptoms of cystitis include, dysuria, haematuria, urinary frequency, urgency or suprapubic discomfort. Fever, chills, abdominal pain, flank pain and vomiting are features of pyelonephritis.

Direct microscopy of the urinary sediment for white cells(pyuria), red cells(haematuria), bacteria (bacteruria) and white cells casts is useful to make a diagnosis.
 The urine culture is a sensitive means of detecting asymptomatic bacteruria and provided antibiotic sensitivity.

Treatment in the first trimester is complicated by concerns of possible teratogenicity of drugs. Amozycillin, Ampicillin, Amoxycillin with clavunate potassium, cephalosporins are drugs that can be used as first-line therapy in pregnancy.

                                           



UTI’s more common during pregnancy:

UTI’s are more common during pregnant because of changes in the urinary tract. The uterus sits directly on top of the bladder. As the uterus grow it is increased weight can block the drainage of urine from the bladder causing an infection.

                                  


signs and symptoms of UTI’s :

  • If you have a urinary tract infection you may experience one or more of the following symptoms: 
  • Chills, fever, sweats, leaking of urine (incontinence) 
  • Waking up from sleep to urinate 
  • Change in amount of urine, either more or less 
  • Urine that looks cloudy, smells foul or unusually strong 
  • Pain or burning (discomfort) when urinating 
  • The need to urinate more often than usual 
  • A feeling of urgency when you urinate 
  • Blood or mucus in the urine 
  • Cramps or pain in the lower abdomen 
  • Pain during sexual intercourse.0 
  • Pain, pressure, or tenderness in the area of the bladder 
  • When bacteria spread to the kidneys you may experience: back pain, chills, fever, nausea, and vomiting. 
                                   
Urinary Tract Infection During Pregnancy: Symptoms & Prevention
A urinary tract infection UTI also called bladder infection is a bacterial inflammation in the urinary tract. Pregnant women are at increase the risk for UTI’s starting in week 6 through week 24.

UTI affect:childrens

If the UTI goes untreated it may lead to a kidney infection. Kidney infections may cause early labor and low birth weight. 

If your doctor used to treat a urinary tract infection early and properly, the UTI will not cause harm to your baby.

How do I know if I have a UTI

A urinalysis and a urine culture can detect a UTI throughout pregnancy.




Urinary Tract Infection During Pregnancy :

UTI’s can be safely treated with antibiotics during pregnancy.

 Urinary tract infections are most commonly treat by antibiotic Doctors usually prescribe a minimum amount of days course of antibiotics that is safe for you and the baby. 

Call your doctor if you have fever ,
chills, lower stomach pains, nausea, vomiting, contractions or if after taking medicine for three days you still have a burning feeling when you urinate.

CAN I prevent a UTI:

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

  • Drink 6-8 glasses of water each day and unsweetened cranberry juice regularly. 
  • Eliminating refined foods, fruit juices, caffeine, alcohol, and sugar. 
  • Take Vitamin C is 250 to 500 mg , Beta carotene 25,000 to 50,000 IU per day and Zinc 30-50 mg per day 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 an UTI. 
  • After urinating, blot dry (do not rub), 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. 
  • Don’t soak in the bathtub longer than 30 minutesor more than twice a day. 
                                                   


Pregnancy causes numerous changes in the woman’s body. Hormonal and mechanical changes increase the risk of urinary stasis and vesicoureteral reflux. 

These changes, along with an already short urethra approximately 3-4 cm in females and difficulty with hygiene due to a distended pregnant belly, increase the frequency of urinary tract infections-UTIs in pregnant women.

 Indeed, UTIs are among the most common bacterial infections during pregnancy.

In general, pregnant patients are considered immunocompromised UTI hosts because of the physiologic changes associated with pregnancy (see Pathophysiology). These changes increase the risk of serious infectious complications from symptomatic and asymptomatic urinary infections even in healthy pregnant women.

Oral antibiotics are the treatment of choice for asymptomatic bacteriuria and cystitis. The standard course of treatment for pyelonephritis is hospital admission and intravenous antibiotics. 

Antibiotic prophylaxis is indicated in some cases. See Treatment of UTI in Pregnancy and Urethral Catheterization in Women.Patients treated for symptomatic UTI during pregnancy should be continued on daily prophylactic antibiotics for the duration of their pregnancy.
                                   

Annual health costs for UTI exceed $1 billion. Although the condition-specific cost of asymptomatic bacteriuria or UTI in pregnancy is unknown, screening for these conditions in pregnant women is cost-effective as compared with treating UTI and pyelonephritis without screening. 

Goals for future research include targeting low-income groups and women in developing countries for screening and early treatment, as well as determining whether a causal relation exists between maternal UTI and childhood neurologic consequences.

For patient education information, see the Kidneys and Urinary System Center and Pregnancy and Reproduction Center, as well as Urinary Tract Infections, Pregnancy, Bladder Control Problems, and Blood in the Urine.
Acute pyelonephritis

Pyelonephritis is the most common urinary tract complication in pregnant women, occurring in approximately 2% of all pregnancies. 

Acute pyelonephritis is characterized by fever, flank pain, and tenderness in addition to significant bacteriuria. Other symptoms may include nausea, vomiting, frequency, urgency, and dysuria. 

Furthermore, women with additional risk factors eg, immunosuppression, diabetes, sickle cell anemia, neurogenic bladder, recurrent or persistent UTIs before pregnancy are at an increased risk for a complicated UTI.

Urinary tract infection

UTI is defined as the presence of at least 100,000 organisms per milliliter of urine in an asymptomatic patient, or as more than 100 organisms/mL of urine with accompanying pyuria (>7 white blood cells [WBCs]/mL) in a symptomatic patient. 

A diagnosis of UTI should be supported by a positive culture for a uropathogen, particularly in patients with vague symptoms.

 UTIs are associated with risks to both the fetus and the mother, including pyelonephritis, preterm birth, low birth weight, and increased perinatal mortality.

Asymptomatic bacteriuria

Asymptomatic bacteriuria is commonly defined as the presence of more than 100,000 organisms/mL in 2 consecutive urine samples in the absence of declared symptoms. 

Untreated asymptomatic bacteriuria is a risk factor for acute cystitis (40%) and pyelonephritis (25-30%) in pregnancy.

 These cases account for 70% of all cases of symptomatic UTI among unscreened pregnant women.

Acute cystitis

Acute cystitis involves only the lower urinary tract; it is characterized by inflammation of the bladder as a result of bacterial or nonbacterial causes (eg, radiation or viral infection). 

Acute cystitis develops in approximately 1% of pregnant patients, of whom 60% have a negative result on initial screening.

 Signs and symptoms include hematuria, dysuria, suprapubic discomfort, frequency, urgency, and nocturia. 
These symptoms are often difficult to distinguish from those due to pregnancy itself.

Acute cystitis is complicated by upper urinary tract disease ie, pyelonephritis in 15-50% of cases.