🔹Urinary tract infections (UTIs) are 14 times more frequent in women than in men because:
● The urethra is shorter (4cm)
● The lower third of the urethra is continually contaminated with pathogens from the vagina and the rectum 🔹
Contribute factors in pregnancy:
Pregnancy hormones {e.g. progesterone} may cause hypotonic of
● Women tend not to empty their bladders as completely as men
● Exposure of the urogenital system to bacteria during intercourse
🔹
ureteral smooth muscle.
Enlargement of ovarian vein in the infundibulo-pelvic ligament may
NON PREGNANT WOMAN: -UTI in pregnancy………………...why worry? 🔹
compress the ureters at the pelvic brim.
Hyperplasia of smooth muscle in the distal third of the ureter may
🔹
-Untreated UTI in antenatal patients was associated with:
🔹
cause reduction in luminal size leading to dilatation in the upper two-
🔹
42% pyelonephritis rate in the antenatal period third.
🔹
🔹
27% premature delivery rate (<2500g)
14% prenatal mortality rate
6% of antenatal patients had UTI without any symptoms
The sigmoid colon and dextrorotation of the uterus likely reduce
compression {and dilatation } of the left ureter relative to the right.
🔹Prevalence:
⦿ Urinary tract infection occur frequently during pregnancy .
⦿ Approximately 2-7% of all pregnant women have asymptomatic bacteruria, and if untreated, 25% of them will
develop acute pyelonephritis.
🔹 Etiology:
UTI”S results :
Hormonal and/ or Anatomical [obstructive] factors
Prevalence & Etiology:
🔹Aggravating fact:
⦿ High parity
⦿ Older age.
⦿ Low socio-economic state.
⦿ Sexual intercourse. { A new sex partner or multiple partners. & More frequent intercourse }.
⦿ History of UTI. {A history of UTI's, especially if the infections were less than six months apart }.
⦿ Increase urinary glucose .
⦿ Medical diseases such as : Diabetes & sickle cell trait. {Decrease host defenses}
🔹 Pregnant women are at increased risk for UTI's starting in week 6 through 24 of pregnancy
🔹ThePredisposing factors:
normal physiological changes during pregnancy:
⦿ Dilatation of ureters and renal pelves. 🔹
Causative Organisms:
🔹Normal vaginal flora .
Most common organisms:
⦿ Stasis of the urine in the bladder and ureters
⦿ Escherichia coli is isolated in 70% of the cases.
Pathogenesis: Routes of infections:
⦿ Klebsiella (3% of cases)⦿ Proteus (2% of cases).
⦿ The infection of the renal parenchyma occurs by the following methods:
⦿ Gram positive cocci such as group B streptococcus (10% of cases),
▪ Stasis of urine in the bladder ---->favours multiplication of the bacteria either pre-existing or which enters
staphylococcus aureus and Enterococcus are responsible for the
through the short urethra ---->influx of the infected urine into the ureters and renal pelves due to laxity of the
remainder cases
vesico-ureteric sphincters dueto odema.
▪ Blood borne infection from the intestine or septic tonsillitis or other septic foci
🔷4. Upper tract UTI (Pyelonephritis)
🔹 Acute pyelonephritis during pregnancy is a serious systemic illness that can
progress to:
maternal sepsis,
⦿ preterm labor and
⦿ premature delivery.
⦿ Renal parenchymal infection occurs in approximately 1-3% of all pregnancies.
⦿ Is one of the most causes of hospitalization during pregnancy
Causes :
❑ Escherichia coli (most common, in as many as 70%of cases)
❑ Group B Streptococcus (10%)
❑ Klebsiella or Enterobacter species (3%)
🔷2. Lower UTI (Cystitis )Results from an ❑ Proteus species (2%)
Urinary tract infection(UTI) have three principle presentations: irritation of the lower urinary tract mucosa:
● Asymptomatic bacteruria ❑ Acute cystitis is uncommon in pregnancy (approximately 1% The diagnosis is made when:
● Lower UTI (Cystitis ) and urethritis of pregnant women). ❑ the presence of bacteriuria accompanied by systemic symptoms or signs such
● Upper tract UTI (Pyelonephritis)
🔻
❑ The bacteria causing acute cystitis are similar to those in as
🔷1.Asymptomatic bacteriuria:
The diagnosis and treatment of UTI depends on the presentation: asymptomatic bacteruria Symptoms:
➢ High grade Fever > 38.5 degree C.
● defined as the presence of actively multiplying bacteria within the urinary tract ,excluding the distal Symptoms: ➢ Chills
urethra without symptoms of infection ❑ Dysuria ➢ Nausea and vomiting
● Is a positive urine culture without specific symptoms. ❑ Urgency (the need to urinate without delay)
🔻
➢ Cost vertebral angle (CVA) or flank pain
● Asymptomatic bacteriuria occurs in 2-7% of pregnancies 40% progress to symptomatic UTIs
❑ Frequency of urination Signs:
● Asymptomatic bacteriuria usually are diagnosed incidentally on routine urine analysis and urine culture. ➢ CVA tenderness may be present.
❑ Suprapubic tenderness, pelvic discomfort
🔻
● Asymptomatic bacteriuria Risk factors: previous history of Diabetes & sickle cell anemia. ➢ Suprapubic tenderness may be present.
Complications: ❑ Pain during sexual intercourse,
➢ The fetal heart rate should be noted.
Urinary Tract Asymptomatic bacteriuria has been associated with an increased risk of: ❑ Hematuria ➢ Pelvic examination is strongly recommended in all patients (with the exception of the third-
⦿preterm birth ❑ Change in amount of urine, either more or less
Infections during ⦿ low birth weight Complication of UTI (Cystitis ):
trimester patient with bleeding) to rule out vaginitis or Cervicitis.
Differential Diagnoses :
⦿↑perinatal mortality and morbidity
Pregnancy ⦿ Risks Maternal Pyelonephritis, ➢ Cervicitis
Diagnosis and treatment of Urinary ⦿ Hypertension, ➢ Renal calculi
tract infection(UTI) : 🔹
Diagnosis of asymptomatic bacteriuria:
Is based upon isolation of microorganism with a colony count > 100000 organism per milliliter of urine in ⦿ Maternal anemia ➢ Sexually transmitted infections.
➢ Urethritis
clean catch specimen. ⦿ Fetal Preterm birth, low birth weight,
➢ vaginitis
⦿ Increased perinatal mortality Diagnosis
🔹
Screening:
UTI (Cystitis ) Diagnosis by: ⦿ Urinalysis and culturing
Urine culture should be used as a routine screening procedure at the first prenatal visit or between 12 to
by fatema okoff Urinalysis and urine culture (mid stream)or catheterization (100,000 CFU/mL= Colony Forming Units/ml) (contamination rather
🔹
16 weeks of gestation.
A repeat urine culture should be obtained during the third trimester, because the urine of treated
patients may not remain sterile for the entire pregnancy.
Treatment of Cystitis:
Similar to the treatment of asymptomatic bacteriuria.
than an infection)
⦿ Imaging Studies not necessary
⦿ Renal ultrasonography may be helpful.
TREATMENT
● It is recommended that all pregnant women who have confirmed {Asymptomatic Bacteriuria} are treated
🔷 3. Urethritis:
Is usually caused by Chlamydia trachomatis. It should be
Complication of acute Pyelonephritis
with antibiotics. Maternal:
suspected in the clinical setting of : ⦿ Preterm labour.
● The choice of antibiotics can be guided by the known sensitivities , in the following order of preference:
❑ Urinary frequency. ⦿ PROMs.
- Amoxicillin : 250-500 mg three times a day.
- Nitrofurantoin :50 mg four times a day.( Avoid at 36+ weeks). ❑ Urgency and dysuria. ⦿ Bacteremia.
- Trimethoprim : 300 mg once a day ( Avoid at first trimester). ❑ Pyuria with negative urine culture ⦿ Septic shock.
- Cephalexin : 500 mg twice a day . ❑ Mucopurulent Cervicitis may coexist ⦿ Adult respiratory distress syndrome.
Notes: all antibiotics should given for 7 days to ensure cure. ⦿ Anemia
Treatment:
A repeat culture one to two weeks after completing therapy is required to ensure eradication of bacteriuria.
⦿ Azithromycine 1 gram orally single dose is the treatment ⦿ renal insufficiency.
⦿ Recurrent infection.
of choice.
⦿ Perinephric abscess
Fetal
⦿ Fetal death.
⦿ Prematurity.
⦿ Small for gestational age {LBW}.
Treatment of acute Pyelonephritis
Early, aggressive treatment is important in preventing complications from pyelonephritis.
1. hospitalization is indicated for patients
● who are exhibiting signs of sepsis,
● who are vomiting and unable to stay hydrated,
● and who are having contractions.
2. Intravenous fluids.
🔹
🔹Administration
{May be initiated before obtaining the results of urine culture and sensitivity}.
of broad spectrum antibiotics {combined IV and oral for 10-14 days after clinical improvement
❑ Cephalosporin such as:
- Cefazolin sodium 1-2 grams parentally every 8 hrs OR
-Ceftriaxone 1-2 gm parentally every 24 hrs. OR,
❑ Ampicillin sulbactum 3 gm 8hrs IV .
⦿ The most common used the combination therapy :
⦿ Penicillin 2gm or Ampicillin 2gm 6 hrs plus gentamycine 2mg /kg then 1.7 mg/kg, OR
🔹
⦿ Clindamycin plus gentamycine for penicilline allergic patient
The parental treatment should continued until the fever subside for at least 48 hrs
Antibiotic therapy ⦿ Vital signs monitoring.
🔹
⦿ Blood culture , urine culture CBC , serum creatinine , electrolyte
After resolution of acute Pyelonephritis,the treatment should continue for 2weeks, followed by suppressive
therapy for the remainder of pregnancy.
Treatment failure:
🔹
⦿ If the symptoms do not respond to appropriate antibiotics : you should performed:
Renal ultrasonography:To evaluate for the presence of:
❑ Anatomical anomalies.
❑ Nephrolithiasis.
❑ Intra-renal or perinephric abscess.
You may do everything right and still experience a urinary tract infection, but you can reduce the likelihood by
doing the following:
⦿ Drink 6-8 glasses of water each day and unsweetened cranberry juice() البري التوتregularly.
⦿ Eliminate refined foods, fruit juices, caffeine, alcohol, and sugar. SUMMARY:
⦿ Take Vitamin C (250 to 500 mg), Beta-carotene (25,000 to 50,000 IU per day) and Zinc (30-50 mg per day) to ▪ UTI’S are one of the most common medical conditions encountered in
help fight infection. pregnancy.
⦿ Develop a habit of urinating as soon as the need is felt and empty your bladder completely when you urinate. ▪ UTI’S can occur anywhere along the urinary tract – from theurethra to
⦿ Urinate before and after intercourse. the kidneys.
How can I prevent a UTI? ▪ E. Coli or gastrointestinal bacteria causes 70- 90% of these infections
⦿ Avoid intercourse while you are being treated for an UTI.
▪ Pregnant women are more prone to UTI”S because of physiological
⦿ After urinating, blot dry (do not rub), and keep your genital area clean. Make sure you wipe from the front toward
changes to UT in pregnancy.
the back.
▪ A number of antibiotics such as Nitrofurantion , Sulfonamides ,
⦿ Avoid using strong soaps, douches, antiseptic creams, feminine hygiene sprays, and powders.
Amoxicillin & Cephalosporin can used for treatment of UTI”S in
⦿ Change underwear and pantyhose every day. pregnancy
⦿ Avoid wearing tight-fitting pants.
⦿ Wear all cotton or cotton-crotchunderwear and pantyhose.
⦿ Don't soak in the bathtub longer than 30 minutes or more than twice a day
● The urethra is shorter (4cm)
● The lower third of the urethra is continually contaminated with pathogens from the vagina and the rectum 🔹
Contribute factors in pregnancy:
Pregnancy hormones {e.g. progesterone} may cause hypotonic of
● Women tend not to empty their bladders as completely as men
● Exposure of the urogenital system to bacteria during intercourse
🔹
ureteral smooth muscle.
Enlargement of ovarian vein in the infundibulo-pelvic ligament may
NON PREGNANT WOMAN: -UTI in pregnancy………………...why worry? 🔹
compress the ureters at the pelvic brim.
Hyperplasia of smooth muscle in the distal third of the ureter may
🔹
-Untreated UTI in antenatal patients was associated with:
🔹
cause reduction in luminal size leading to dilatation in the upper two-
🔹
42% pyelonephritis rate in the antenatal period third.
🔹
🔹
27% premature delivery rate (<2500g)
14% prenatal mortality rate
6% of antenatal patients had UTI without any symptoms
The sigmoid colon and dextrorotation of the uterus likely reduce
compression {and dilatation } of the left ureter relative to the right.
🔹Prevalence:
⦿ Urinary tract infection occur frequently during pregnancy .
⦿ Approximately 2-7% of all pregnant women have asymptomatic bacteruria, and if untreated, 25% of them will
develop acute pyelonephritis.
🔹 Etiology:
UTI”S results :
Hormonal and/ or Anatomical [obstructive] factors
Prevalence & Etiology:
🔹Aggravating fact:
⦿ High parity
⦿ Older age.
⦿ Low socio-economic state.
⦿ Sexual intercourse. { A new sex partner or multiple partners. & More frequent intercourse }.
⦿ History of UTI. {A history of UTI's, especially if the infections were less than six months apart }.
⦿ Increase urinary glucose .
⦿ Medical diseases such as : Diabetes & sickle cell trait. {Decrease host defenses}
🔹 Pregnant women are at increased risk for UTI's starting in week 6 through 24 of pregnancy
🔹ThePredisposing factors:
normal physiological changes during pregnancy:
⦿ Dilatation of ureters and renal pelves. 🔹
Causative Organisms:
🔹Normal vaginal flora .
Most common organisms:
⦿ Stasis of the urine in the bladder and ureters
⦿ Escherichia coli is isolated in 70% of the cases.
Pathogenesis: Routes of infections:
⦿ Klebsiella (3% of cases)⦿ Proteus (2% of cases).
⦿ The infection of the renal parenchyma occurs by the following methods:
⦿ Gram positive cocci such as group B streptococcus (10% of cases),
▪ Stasis of urine in the bladder ---->favours multiplication of the bacteria either pre-existing or which enters
staphylococcus aureus and Enterococcus are responsible for the
through the short urethra ---->influx of the infected urine into the ureters and renal pelves due to laxity of the
remainder cases
vesico-ureteric sphincters dueto odema.
▪ Blood borne infection from the intestine or septic tonsillitis or other septic foci
🔷4. Upper tract UTI (Pyelonephritis)
🔹 Acute pyelonephritis during pregnancy is a serious systemic illness that can
progress to:
maternal sepsis,
⦿ preterm labor and
⦿ premature delivery.
⦿ Renal parenchymal infection occurs in approximately 1-3% of all pregnancies.
⦿ Is one of the most causes of hospitalization during pregnancy
Causes :
❑ Escherichia coli (most common, in as many as 70%of cases)
❑ Group B Streptococcus (10%)
❑ Klebsiella or Enterobacter species (3%)
🔷2. Lower UTI (Cystitis )Results from an ❑ Proteus species (2%)
Urinary tract infection(UTI) have three principle presentations: irritation of the lower urinary tract mucosa:
● Asymptomatic bacteruria ❑ Acute cystitis is uncommon in pregnancy (approximately 1% The diagnosis is made when:
● Lower UTI (Cystitis ) and urethritis of pregnant women). ❑ the presence of bacteriuria accompanied by systemic symptoms or signs such
● Upper tract UTI (Pyelonephritis)
🔻
❑ The bacteria causing acute cystitis are similar to those in as
🔷1.Asymptomatic bacteriuria:
The diagnosis and treatment of UTI depends on the presentation: asymptomatic bacteruria Symptoms:
➢ High grade Fever > 38.5 degree C.
● defined as the presence of actively multiplying bacteria within the urinary tract ,excluding the distal Symptoms: ➢ Chills
urethra without symptoms of infection ❑ Dysuria ➢ Nausea and vomiting
● Is a positive urine culture without specific symptoms. ❑ Urgency (the need to urinate without delay)
🔻
➢ Cost vertebral angle (CVA) or flank pain
● Asymptomatic bacteriuria occurs in 2-7% of pregnancies 40% progress to symptomatic UTIs
❑ Frequency of urination Signs:
● Asymptomatic bacteriuria usually are diagnosed incidentally on routine urine analysis and urine culture. ➢ CVA tenderness may be present.
❑ Suprapubic tenderness, pelvic discomfort
🔻
● Asymptomatic bacteriuria Risk factors: previous history of Diabetes & sickle cell anemia. ➢ Suprapubic tenderness may be present.
Complications: ❑ Pain during sexual intercourse,
➢ The fetal heart rate should be noted.
Urinary Tract Asymptomatic bacteriuria has been associated with an increased risk of: ❑ Hematuria ➢ Pelvic examination is strongly recommended in all patients (with the exception of the third-
⦿preterm birth ❑ Change in amount of urine, either more or less
Infections during ⦿ low birth weight Complication of UTI (Cystitis ):
trimester patient with bleeding) to rule out vaginitis or Cervicitis.
Differential Diagnoses :
⦿↑perinatal mortality and morbidity
Pregnancy ⦿ Risks Maternal Pyelonephritis, ➢ Cervicitis
Diagnosis and treatment of Urinary ⦿ Hypertension, ➢ Renal calculi
tract infection(UTI) : 🔹
Diagnosis of asymptomatic bacteriuria:
Is based upon isolation of microorganism with a colony count > 100000 organism per milliliter of urine in ⦿ Maternal anemia ➢ Sexually transmitted infections.
➢ Urethritis
clean catch specimen. ⦿ Fetal Preterm birth, low birth weight,
➢ vaginitis
⦿ Increased perinatal mortality Diagnosis
🔹
Screening:
UTI (Cystitis ) Diagnosis by: ⦿ Urinalysis and culturing
Urine culture should be used as a routine screening procedure at the first prenatal visit or between 12 to
by fatema okoff Urinalysis and urine culture (mid stream)or catheterization (100,000 CFU/mL= Colony Forming Units/ml) (contamination rather
🔹
16 weeks of gestation.
A repeat urine culture should be obtained during the third trimester, because the urine of treated
patients may not remain sterile for the entire pregnancy.
Treatment of Cystitis:
Similar to the treatment of asymptomatic bacteriuria.
than an infection)
⦿ Imaging Studies not necessary
⦿ Renal ultrasonography may be helpful.
TREATMENT
● It is recommended that all pregnant women who have confirmed {Asymptomatic Bacteriuria} are treated
🔷 3. Urethritis:
Is usually caused by Chlamydia trachomatis. It should be
Complication of acute Pyelonephritis
with antibiotics. Maternal:
suspected in the clinical setting of : ⦿ Preterm labour.
● The choice of antibiotics can be guided by the known sensitivities , in the following order of preference:
❑ Urinary frequency. ⦿ PROMs.
- Amoxicillin : 250-500 mg three times a day.
- Nitrofurantoin :50 mg four times a day.( Avoid at 36+ weeks). ❑ Urgency and dysuria. ⦿ Bacteremia.
- Trimethoprim : 300 mg once a day ( Avoid at first trimester). ❑ Pyuria with negative urine culture ⦿ Septic shock.
- Cephalexin : 500 mg twice a day . ❑ Mucopurulent Cervicitis may coexist ⦿ Adult respiratory distress syndrome.
Notes: all antibiotics should given for 7 days to ensure cure. ⦿ Anemia
Treatment:
A repeat culture one to two weeks after completing therapy is required to ensure eradication of bacteriuria.
⦿ Azithromycine 1 gram orally single dose is the treatment ⦿ renal insufficiency.
⦿ Recurrent infection.
of choice.
⦿ Perinephric abscess
Fetal
⦿ Fetal death.
⦿ Prematurity.
⦿ Small for gestational age {LBW}.
Treatment of acute Pyelonephritis
Early, aggressive treatment is important in preventing complications from pyelonephritis.
1. hospitalization is indicated for patients
● who are exhibiting signs of sepsis,
● who are vomiting and unable to stay hydrated,
● and who are having contractions.
2. Intravenous fluids.
🔹
🔹Administration
{May be initiated before obtaining the results of urine culture and sensitivity}.
of broad spectrum antibiotics {combined IV and oral for 10-14 days after clinical improvement
❑ Cephalosporin such as:
- Cefazolin sodium 1-2 grams parentally every 8 hrs OR
-Ceftriaxone 1-2 gm parentally every 24 hrs. OR,
❑ Ampicillin sulbactum 3 gm 8hrs IV .
⦿ The most common used the combination therapy :
⦿ Penicillin 2gm or Ampicillin 2gm 6 hrs plus gentamycine 2mg /kg then 1.7 mg/kg, OR
🔹
⦿ Clindamycin plus gentamycine for penicilline allergic patient
The parental treatment should continued until the fever subside for at least 48 hrs
Antibiotic therapy ⦿ Vital signs monitoring.
🔹
⦿ Blood culture , urine culture CBC , serum creatinine , electrolyte
After resolution of acute Pyelonephritis,the treatment should continue for 2weeks, followed by suppressive
therapy for the remainder of pregnancy.
Treatment failure:
🔹
⦿ If the symptoms do not respond to appropriate antibiotics : you should performed:
Renal ultrasonography:To evaluate for the presence of:
❑ Anatomical anomalies.
❑ Nephrolithiasis.
❑ Intra-renal or perinephric abscess.
You may do everything right and still experience a urinary tract infection, but you can reduce the likelihood by
doing the following:
⦿ Drink 6-8 glasses of water each day and unsweetened cranberry juice() البري التوتregularly.
⦿ Eliminate refined foods, fruit juices, caffeine, alcohol, and sugar. SUMMARY:
⦿ Take Vitamin C (250 to 500 mg), Beta-carotene (25,000 to 50,000 IU per day) and Zinc (30-50 mg per day) to ▪ UTI’S are one of the most common medical conditions encountered in
help fight infection. pregnancy.
⦿ Develop a habit of urinating as soon as the need is felt and empty your bladder completely when you urinate. ▪ UTI’S can occur anywhere along the urinary tract – from theurethra to
⦿ Urinate before and after intercourse. the kidneys.
How can I prevent a UTI? ▪ E. Coli or gastrointestinal bacteria causes 70- 90% of these infections
⦿ Avoid intercourse while you are being treated for an UTI.
▪ Pregnant women are more prone to UTI”S because of physiological
⦿ After urinating, blot dry (do not rub), and keep your genital area clean. Make sure you wipe from the front toward
changes to UT in pregnancy.
the back.
▪ A number of antibiotics such as Nitrofurantion , Sulfonamides ,
⦿ Avoid using strong soaps, douches, antiseptic creams, feminine hygiene sprays, and powders.
Amoxicillin & Cephalosporin can used for treatment of UTI”S in
⦿ Change underwear and pantyhose every day. pregnancy
⦿ Avoid wearing tight-fitting pants.
⦿ Wear all cotton or cotton-crotchunderwear and pantyhose.
⦿ Don't soak in the bathtub longer than 30 minutes or more than twice a day
