UTIs in Pregnancy

Definition

• Urinary tract infection: infection that affects

part (or all of) the urinary tract.
– Urethritis
– Cystitis
– Pyelonephritis
• UTI can be considered as lower urinary tract
(acute cystitis) or upper tract (acute
pyelonephritis).
 Epidemiology and Risk Factors
• Incidence is roughly the same as non-pregnancy women.
• Recurrent bacteriuria is more common in pregnancy.
Pyelonephritis is also more common than in the general
population.
• Asymptomatic bacteriuria occurs in 7% of pregnancies, and
without treatment, 40% will progress to UTI.
• Most UTIs occur in 2nd and 3rd trimesters
--------------------------------
RF
• Prior UTI
• Pre-existing diabetes
• Increased parity
• Low SES
Aetiology and Pathophysiology (+ anatomy if relevant)
 Patho for pregnancy

• However, the smooth muscle relaxation and subsequent ureteral

dilatation that accompany pregnancy are thought to facilitate the ascent
of bacteria from the bladder to the kidney, resulting in the greater
propensity for bacteriuria to progress to pyelonephritis during pregnancy.

• Pressure on the bladder from the enlarging uterus may also increase the
risk of progression to pyelonephritis. In addition, the immunosuppression
of pregnancy may contribute. As an example, mucosal interleukin-6 levels
and serum antibody responses to Escherichia coli antigens appear to be
lower in pregnant women.
 Microbiology
• E.coli 70%
• Klebsiella 3%
• Enterobacter 3%
• Proteus 2%
• Group B streptococcus 10%
 Symptoms / Signs

• Asymptomatic bacteriuria is asymptomatic

• UTI symptoms
– Frequency
– Urgency
– Dysuria
– Lower abdominal pain
 Physical Examination

• Screening MSU collected for MC&S and

dipstick performed at EACH antenatal visit
 Investigation (labs + imaging + special)

• Screening MSU – culture and sensitivity

• Follow-up in 1-2 weeks

Management: UTI and Asymptomatic Bacteriuria
 Prognosis with and without treatment

• Untreated bacteriuria is associated with increased

risk of:
– Preterm birth
– Low birth weight
– Perinatal mortality
• No such research can show lower tract UTIs have the
same complications, because they tend to be
treated.
• Pyelonephritis has the same poor outcomes as
untreated bacteriuria.