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  • Definitions
  • Prevalence
  • Etiology
  • Pathogenesis
  • Clinical Features
  • Complications Urinary t track infection in Pregnancy
  • Diagnosis
  • Treatment of Urinary t track infectionin Pregnancy
  • Prevention of Urinary t track infection

  • Urinary t track infection – is infection of any part of the urinary tract/system by a pathogenic microbial agents.
  • Asymptomatic bacteriuria (ASB) – presence of ≥ 100000 microorganisms/ml of urine of the same species in cultured mid-stream urine culture
  • Cystitis – inflammation of the urinary bladder mucosa as a result of UTI
  • Pyelonephritis – inflammation of the kidney Pelvis & parenchyma


  • The prevalence of ASB in pregnant women is 5-11% (as opposed to 3-8% in nonpregnant women) – USA statistics
  • 8% of pregnant women have asymptomatic bacteriuria if untreated; 25% of these may progress to symptomatic UTI.


  • The organisms that cause UTIs during pregnancy are the same as those found in nonpregnant patients.
  • Organisms that cause urinary infections are those from the normal perineal flora.
  • Commonest is Escherichia coli, less commonly implicated are Streptococci, Proteus, Pseudomonas and Klebsiella

Predisposing Factors for UTI in Pregnancy

  • Physiological and anatomical changes during pregnancy i.e. dilatation of ureter and kidneys leading to increased stasis
  • Sexual activity
  • Low social economic activity
  • History of recurrent cystitis
  • Renal tract abnormalities (duplex system, scarred kidneys, ureteric damage and stones)
  • Immunosupression e.g. HIV and AIDS, Diabetes
  • Bladder emptying problems
  • Haemoglobinopathies (i.e., sickle cell anaemia or trait)

Pathogenesis of UTI in Pregnancy

  • Pregnant women are at increased risk for UTIs.
  • From week 6 and to weeks 22 – 24, approximately 90% of pregnant women develop ureteral dilatation, which will remain until delivery (hydronephrosis of pregnancy).
  • There is Increased bladder volume and decreased bladder tone, along with decreased ureteral tone(hormonal)
  • These à increased urinary stasis and ureterovesical reflux à UTI

Pathogenesis contd

  • Additionally, the physiologic increase in plasma volume during pregnancy decreases urine concentration.
  • Up to 70% of pregnant women develop glycosuria, which encourages bacterial growth in the urine.
  • Increases in urinary progestins and estrogens may lead to a decreased ability of the lower urinary tract to resist invading bacteria
  • This allows some strains of bacteria to selectively grow
  • These factors altogether contribute to the development of UTIs during pregnancy
  • Additionally, shifts in the position of the urinary tract during pregnancy & compression of bladder make it easier for bacteria to travel up the ureters to the kidneys

Clinical Presentation of Urinary t track infection in Pregnancy

Similar to overall, and may include:

  • Dysuria , hematuria
  • Increased urinary frequency
  • A feeling of urgency after urinating
  • Cramps or pain in the lower abdomen
  • Lower back pain
  • General malaise

Clinical features contd

  • Chills, fever, sweats, +incontinence
  • Change in amount of urine, either more or less
  • Urine that looks cloudy, smells foul or unusually concentrated
  • Tenderness in the lower abdomen
  • When bacteria spreads to the kidneys one may experience: flank pain, chills, fever, nausea, and vomiting.



  • febrile
  • Dehydration
  • Flank/loin tenderness
  • Tenderness on the lower abdomen

Complications Of UTI in Pregnancy

  • Premature labor
  • Premature rupture of membrane
  • Perinatal mortality and morbidity
  • Amnionitis
  • Low birth weight
  • Hypertensive disorders of pregnancy (such as Pregnancy Induced Hypertension and preeclampsia)
  • Anemia



  • Means – Presence of at least 100,000 colony-forming units (CFU)/mL of urine in a voided midstream clean-catch specimen in absence of clinical features of UTI
  • ASB develops in 10-15% of pregnant women
  • However, it is more likely to lead to acute pyelonephritis in pregnant women
  • 25-30% of pregnant women with untreated bacteriuria develop pyelonephritis Vs 1-4% of non-pregnant women


  • Not more common in pregnant women than in non pregnant women.
  • Symptoms of cystitis are often confused with symptoms noted in normal pregnancy
  • Include urgency, frequency, suprapubic discomfort, etc.


  • Acute pyelonephritis is more common in pregnant women than in nonpregnant women
  • Reason – stasis of urine and bacteria in the urinary tract caused by relative obstruction.
  • How?

– Dilatatioprogesterone in early pregnancy

– Mechanical obstruction from the gravid uterus later in pregnancy

– n of the ureters secondary to

Acute Pyelonephritis contd

  • Second only to obstetric complications, acute pyelonephritis is the most common indication for hospitalization in pregnant patients
  • Features typical for A.P. include fever, costovertebral angle tenderness(flanks), urinalysis findings with WBC and bacteria, and significant bacteriuria


  1. Clinical
  2. Laboratory
  • Urinalysis – midstream, clean-catch urine specimen for urine microscopy;
  • Nitrites, leukocyte esterase, WBCs, RBCs, and protein suggest UTI.
  • Urine Culture – criterion standard for evaluation of UTI during pregnancy
  • ≥ 100,000 CFUs/ml – positive culture
  • Added advantage of testing 4 antimicrobial sensitivity
  • Urine dipstick

– Finding nitrites and leukocyte esterase is suggestive of ASB.

– Sensitivities range 50-92%, and specificity is 86-97% when compared with culture in the diagnosis of ASB.

– Useful test In the evaluation of symptomatic patients

– Cheap

– The addition of protein and blood cells increases the sensitivity and specificity of test for UTI.

  • Full blood count
  • Renal ultrasound scan.

Uncomplicated cystitis

  • Oral fluids, Nitrofurantoin – is a safe and effective drug; however, be avoided in the 3rd trimester à haemolytic anaemia in a newborn infant.
  • amoxicillin or cephalosporins( cephalexin, ceftriaxone)
  • Bactrim can be used in 2nd trimester only.
  • Avoid quinolones due to risk of cartilage abnormalities to fetus
  • Pyelonephritis
  • Hospitalize ,IV fluids
  • Pyelonephritis – treated with cephalosporins (cephalexin, ceftriaxone etc), nitrofurantoin or ampicillin( if culture negative 4 coli)
  • may need to add gentamycin.

NB: Avoid penicillins if E.coli is the offending microbe (resistance ~40%)

Simple analgesics and antipyretics to keep temp <101°F/38°C. e.g., Paracetamol, acetaminophen

  • Avoid NSAD
  • ASB – should be treated with similar drugs

Drugs 2 b avoided 4 Rx of UTI in Pregnancy:

  • Tetracyclines – (adverse effects on fetal teeth and bones, congenital defects),
  • Quinolones – (various congenital defects),
  • Trimethoprim – in the first trimester (facial defects, cardiac abnormalities),
  • Sulfonamides – (last trimester) – hemolytic anemia in mothers ċ G-6-PD deficiency, jaundice and kernicterus
  • Chloramphenicol – Gray syndrome
  • Nitrofurantoin – 3rd trimester only

Prevention of UTI (General)
  • Drink 6-8 glasses of water each day
  • Eliminate refined foods, fruit juices, caffeine, alcohol, and sugar.
  • Take Vitamin C (250 to 500 mg), β-carotene 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 sexual intercourse (both partners).
  • Avoid intercourse while you are being treated for an UTI
  • After urinating, blot dry (do not rub), and keep your genital area clean.
  • 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

systemic hypertension( htn)