This document defines urinary tract infections (UTIs) and discusses common types of UTIs during pregnancy such as asymptomatic bacteriuria and acute pyelonephritis. It outlines the causes, symptoms, risk factors, diagnostic testing and treatment for UTIs during pregnancy.

2. Definition
 UTI means infection of any part of urinary tract
(Kidney, Ureter, Bladder or Urethra)
 Infections of the urethra and bladder are often
considered superficial (or mucosal) infections
 While pyelonephritis, and renal suppuration
signify tissue invasion
 Asymptomatic bacteriuria, acute cystitis, and
acute pyelonephritis are common renal disorders
in pregnancy.

3.  Asymptomatic bacteriuria- is defined as the
presence of actively multiplying bacteria in
the urinary tract excluding the distal urethra
in a patient without any obvious symptoms
 Incidence during preg.is 10%.
 The diagnosis is based upon isolation of
microorganisms with a colony count > 105
organisms per milliliter of urine in a clean-
catch specimen.

4.  If asymptomatic bacteriuria is left untreated
in pregnancy, up to 40% of patients will
develop symptoms of UTI.
 Approximately 25–30% of women will develop
acute pyelonephritis. With treatment, the
rate is 10%
 The increased risk is due to:
 decreased ureteral tone,
 decreased ureteral peristalsis,
 temporary incompetence of the
vesicoureteral valves,
 Bladder catheterization

5.  Escherichia coli ( 80% ).
 The Klebsiella-Enterobacter-Serratia group,
 Staphylococcus aureus,
 group B Streptococcus,
 enterococcus
 Proteus are responsible for the remainder
of the case

6.  Dysuria, urgency and frequency-the
symptom.
 Pyuria,bacteriuria and microscopic
hematuria.
 Frequency, urgency, dysuria ,pyuria but
urine culture with no growth may be
urethritis caused by C.trachomatis.
 The bacteria causing acute cystitis are
similar to those in asymptomatic bacteriuria

7.  Acute pyelonephritis is the infection of the
renal pelvis and the kidneys.
 It is one of the most common causes of
hospitalization and serious medical
complication of pregnancy.
 Complicates 1-2% of pregnancies.
 Develops more frequently in second
trimester.
 Isolates from urine or blood are-E.coli(75-
80%),others K .pnuemonia, enterobacter or
proteus

8.  Asymptomatic bacteruria-the single most
important risk factor.
 aprevious history of pyelonephritis,
 Gravidity(primi)
 urinary tract malformation,
 urinary calculi.
 Maternal DM
 Sickle cell trait

9.  Fever(usually > 390C)
 shaking chills,
 bilateral flank pain,
 Nausea, vomiting and possibly diahrrea
 headache,
 increased urinary frequency, and dysuria
 CVA tenderness.

10.  chorio-amnionites,
 appendicites,
 labor,
 placental abruption,
 red degeneration of myoma
 Renal caliculi

11. maternal fetal
 bacterial endotoxemia,
 endotoxic shock
 renal insufficiency(ARF)
 anemia,
 leukocytosis,
 thrombocytopenia,
 Pulmonary dysfunction
(mild cough,rispiratory
infiltrat to sever ARDS)
 low birth weight(small
for GA)
 premature delivery
 neonatal death

12.  CBC(Hct,Hgb,WBC(leukocytosis),pletlet)
 Blood group and RH
 Serum HCG
 Blood sugar level
 U/S,IVP

13. Urine culture:
 Significant bacteriuria= 105 cfu/ml
 symptoms: 1 +ve cuture = infection
 Symptoms: 102 cfu/ml = propable infection
 Asymptomatic: 2 +ve cultures = infection
 False negative : antibiotics, antiseptics, renal
TB, diuresis.

14. Microscopy of urine
 Assessed with Gram-stained uncentrifuged urine
 Microscopic bacteriuria is found in >90% of specimens
with colony counts of at least 105 /mL
 The detection of bacteria by urinary microscopy
constitutes firm evidence of infection, but the
absence of microscopically detectable bacteria does
not exclude the diagnosis
 Pyuria (WBC > 5/HPF) is demonstrated in nearly all
acute bacterial UTIs and its absence calls for the
diagnosis of UTI in question
 Look also for RBCs, WBC casts
 Associated hematuria may indicate urinary calculi.

15. Sterile pyuria
 Pyuria in the absence of bacteriuria
 Indicate infection with unusual agents such as C.
trachomatis, U. urealyticum, or Mycobacterium
tuberculosis or with fungi
 May also occur in noninfectious urologic
conditions such as calculi, anatomic
abnormality, vesicoureteral reflux, interstitial
nephritis, or polycystic disease

16. 1. Hospitalization
2. Urine and blood cultures,RFT,electrolyte
3. Monitor vital signs frequently, including
urinary output; consider indwelling catheter
4. Intravenous crystalloid to establish urinary
output to 30 mL/hr
5. IV antimicrobial therapy(sulfonamides and
cephalosporin are reasonable choices.)

17. 6. Chest radiograph if there is dyspnea or
tachypnea
7. Repeat hematology and chemistry studies in
48 hours
8. Change to oral antimicrobials when afebrile
9. Discharge when afebrile 24 hours; consider
antimicrobial therapy for 7 to 10 days