Overview

• Lower UTI → infection of bladder, causing cystitis.
• Upper UTI → infection up to kidneys, called pylonephritis.
  • Pregnant women are at higher risk of developing UTIs.
  • UTIs increase risk of preterm delivery.
• Asymptomatic Bacteriuria ⇒
  • Bacteria present in urine, without symptoms of infection.
  • Pregnant women with asymptomatic bacteriuria are at higher risk of developing lower urinary tract infections and pyelonephritis, and subsequently at risk of preterm birth.
  • Women are tested for asymptomatic bacteriuria at booking and routinely through pregnancy via urine sample sent for MC&S.
  • Treat with oral antibiotics → reduces risk of progression to pyelonephritis and preterm birth.
• Most common UTI cause → E.coli.

Making Diagnosis

Clinical Features

• Lower UTI → dysuria, suprapubic pain, increased frequency, urgency, incontinence, haematuria.
• Pyelonephritis → fever, loin/back pain, vomiting, loss of appetite, haematuria, renal angle tenderness.

Investigations

• Urine Dipstick ⇒
  • Nitrites → produced by gram-negative bacteria (eg. E.coli) suggesting presence of bacteria. More accurate indication of infection than leukocytes.
  • Leukocytes → WBC’s suggesting infection.
• Midstream Urine (MSU) samples routinely sent to microbiology lab to be cultured and for sensitivity testing.
  • MSU sent at booking visit as screening.

Management Plan

• UTI in Pregnancy (or Asymptomatic Bacteriuria) → 7 days of antibiotics.
  • Nitrofurantoin (FIRST-LINE) → avoid close to term due to risk of neonatal haemolysis.
    • If C/I → amoxicillin or cephalexin (SECOND-LINE).
• GBS Bacteriuria → will require intrapartum antibiotics (IV benzylpenicllin).