Asymptomatic bacteriuria is detected in pregnant women during preventive examinations quite often, which is associated with physiological changes in the pelvic area, increased pressure on the urinary tract, which weakens local immunity and increases the risk of infection.
Learn in the article on estet-portal.com about the features of the course, diagnosis and treatment of inflammatory diseases of the urinary tract during pregnancy
Treatment of bacteriuria during pregnancy
After detecting bacteriuria, leukocyturia of a pregnant woman, it is imperative to repeat laboratory tests of urine after careful hygiene of the external genital organs, since the test results may be erroneous due to the presence of additional secretions.
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If pathological changes in the general urine test are detected again, it is necessary to perform a bacteriological examination of the urine in order to determine the degree of bacteriuria and the sensitivity of microorganisms to antibiotics.
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Asymptomatic bacteriuria found in pregnant women should be treated with antibiotic therapy, according to the European Association of Urology (EAU, 2011) (Evidence A, Evidence Level 1a). The EAU currently recommends the following antibacterial agents for the treatment of asymptomatic bacteriuria in pregnancy (Evidence A):
1) nitrofurans (100 mg every 12 hours for 3-5 days),
2) amoxicillin (500 mg every 8 hours for 3-5 days),
3) amoxicillin/clavulanic acid (500 mg every 12 hours for 3-5 days),
4) cephalexin (500 mg every 8 hours for 3-5 days),
5) fosfomycin (3 g single dose),
6) sulfamethoxazole / trimethoprim (except I and III trimester of pregnancy).
These drugs should be used to treat acute cystitis during pregnancy. In the treatment of asymptomatic bacteriuria and acute cystitis of pregnancy, short courses (3 days) of antibiotic therapy should be preferred (EAU, 2011) (Evidence A, Evidence Level 1a). Upon completion of therapy, it is necessary to conduct repeated bacteriological studies of urine and prescribe a course of prophylaxis.
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Acute pyelonephritis during pregnancy
Acute pyelonephritis of pregnancy − a vivid example of secondary obstructive pyelonephritis. Acute pyelonephritis is noted less frequently than a chronic inflammatory process in the active phase. Due to the high frequency of pyelonephritis (≈ 10% of pregnant women), as well as the peculiarities of its occurrence, clinical course, diagnosis, treatment, consequences and prevention opportunities, this disease deserves a separate description.
Acute pyelonephritis of pregnancy − one of the most frequent and serious complications of the middle and second half of pregnancy. It occurs more often in women who have not given birth than in repeated pregnancies. In the first, the tone of the anterior abdominal wall is better preserved and counteracts the deviation of the enlarged uterus forward, which leads to its greater pressure on the placed ureters.
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Pathogenesis of pyelonephritis during pregnancy
During pregnancy, the uterus is generally tilted to the right. Some adverse effects on the urinary tract are carried out by changes in the hormonal background of pregnant women, but as a result of an increase in the uterus, mechanical factors that disrupt the outflow of urine from the kidneys play a certain role.
Since acute pyelonephritis of pregnant women usually develops in the middle or second half of pregnancy, the mechanical factor and the resulting obstruction of the upper urinary tract are considered to be decisive in the development of the disease. The dilatation of the upper ureters is also associated with the obstruction.
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The peculiarities of the pathogenesis of the disease suggest that the main role in the occurrence of hypotension of the urinary tract and impaired urodynamics belongs to neurohumoral factors against the background of mechanical pressure of the enlarged uterus on the ureters. Hypotension of the ureters, combined with their obstruction by an enlarged uterus, leads to urostasis, stagnation of urine in the ureters and kidney bowls and contributes to infection.
Favorable factors for the development of pyelonephritis are anatomical features (wide short urethra, prolapse of the vaginal walls, nephroptosis).
Symptomatology and diagnosis of acute pyelonephritis during pregnancy
Symptoms of acute pyelonephritis of pregnant women are the same as in secondary acute pyelonephritis of another origin. The disease begins acutely, it is often characterized by a severe course with intoxication. The clinical picture consists of pain in the area of the affected kidney, hectic fever, headache, general weakness, a significant deterioration in the general condition, chills are often noted. Sometimes there are symptoms of renal colic. Possible development of urosepsis.
The earliest sign of acute pyelonephritis of pregnancy, and the one that precedes it, is asymptomatic bacteriuria – the appearance of bacteria in the urine without any other signs of the disease. In this early period of the disease, using antimicrobial treatment, it is possible to eliminate bacteriuria and interrupt the development of the disease. For this, women, especially from the middle of pregnancy, should regularly do a urine test, including bacteriological culture.
The diagnosis of acute pyelonephritis during pregnancy has to be established mainly on the basis of clinical, laboratory signs, chromocystoscopy data, bypassing radiation diagnostic methods.
In recent years, ultrasound, which is harmless for both the pregnant woman and the unborn child, has become of great importance in the diagnosis of acute pyelonephritis in pregnant women, as well as other urological diseases. Ultrasound determines the degree of expansion of the renal pelvis, and also allows you to identify / exclude focal purulent-destructive changes in the kidney parenchyma. Ultrasound and, if necessary, magnetic resonance imaging are recommended by the EAU (2011) (Evidence B) for the examination of pregnant women due to the minimal impact of these techniques on fetal development.
X-ray and radioisotope studies are contraindicated for pregnant women due to the possibility of harmful effects on the fetus.
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