UTI in Pregnancy Flashcards

1
Q

Definition

A

Lower UTI: Infection in bladder = cystitis
Upper UTI = Infection up to the kidneys = pyelonephritis
Pregnant women are at higher risk of developing LUTI and pyelonephritis = increasing risk of other adverse pregnancy outcomes = low birth weight and pre-eclampsia

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2
Q

ASx Bacteriuria

A

Bacteria present in the urine, without Sx of infection.
Pregnant women with Asx bactieruria are at higher risk of developing UTI’s.

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3
Q

How and why are pregnant women tested for Asx Bacteriuria

A

Tested routinely at booking/check up = Urine MC+S
- Testing for bacteria in urine for ASx patients is not recommended as may lead to unnecessary Abx. Pregnant women are an exception, due to the adverse outcomes assosciated with infection.

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4
Q

LUTI Signs and symptoms

A

Dysuria (pain, stinging, or burning when passing urine)
Supra-pubic pain or discomfort
Increased frequency of urination
Urgency
Incontinence
Haematuria

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5
Q

Pyelonephritis signs and symptoms

A

Fever (MC>LUTI)
Loin, suprapubic or back pain (bilateral or unilateral)
Vomiting
Loss of appetite
Haematuria
Renal angle tenderness on examination

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6
Q

Diagnosis

A

FIRST LINE = Urine dipstick
- Nitrites produced by gram-neg bacteria (such as E.coli) by breaking down nitrates
- Leukocytes = significant rise in infection (+ inflammation)
GOLD STANDARD = Mid stream MC+S

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7
Q

Aetiology

A

Escherichia coli (E.coli) = gram-negative, anaerobic, rod-shaped bacteria (part of normal lower intestinal microbiome)
Klebsiella pneumoniae
Enterococcus
Pseudomonas aeruginosa
Staph saprophyticus
Candida albicans (fungal)

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8
Q

Treatment

A

FIRST LINE = 7 days of Abx
- Nitrofurantoin (avoid in 3rd trimester)
- Amoxicilin (only after sensitivities are known)
- Cefalexin

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9
Q

Why is Nitrofurantoin avoided in the 3rd trimester?

A

There is a risk of neonatal haemolysis (destruction of the neonatal red blood cells).

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10
Q

Why is Trimethroprim avoided in 1st trimester?

A

Folate antagonist. Folate is important in early pregnancy for the normal development of the fetus.
- congenital malformations esp neural tube defects (i.e. spina bifida).
- Not known to be harmful later in pregnancy, but is generally avoided unless necessary.

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