UTI's in pregnancy

Question 1

What is the complication of UTIs in pregnancy?

Answer 1

Higher risk of preterm delivery, low birth weight & pre-eclampsia

Question 2

What is asymptomatic bacteria?

Answer 2

Refers to bacteria present in the urine, without symptoms of infection but these women are at higher risk of developing lower UTIs and pyelonephritis so are at risk of preterm birth

Question 3

How routinely are they tested?

Answer 3

They are tested for asymptomatic bacteriuria at booking and then throughout pregnancy

Question 4

How do lower UTIs present?

Answer 4

Dysuria (pain, stinging or burning), suprapubic pain or discomfort, increased frequency of urination, urgency, incontinence, haematuria

Question 5

How does pyelonephritis present?

Answer 5

Fever, loin, suprapubic or back pain, looking or feeling generally unwell, vomiting, loss of appetite, haematuria, renal angle tenderness on examination

Question 6

What is the most common cause of UTIs?

Answer 6

E. coli which is gram negative, anaerobic, rod shaped bacteria

Question 7

What is the management for UTIs in pregnancy?

Answer 7

7 days of nitrofurantoin (but avoid in third trimester), amoxicillin, cefalexin

Question 8

Why does nitrofurantoin need to be avoided in the third trimester?

Answer 8

Risk of neonatal haemolysis

Question 9

Why does trimethoprim need to be avoided in the first trimester?

Answer 9

Works as a folate antagonist so trimethoprim in early pregnancy can cause congenital malformations esp neural tube defects