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Urinary tract infections complicating pregnancy
1Parkland Memorial Hospital, Department of Obstetrics and Gynaecology and Medicine, University of Texas South Western, Medical Center Dallas 75235-9032.
Bailliere'S Clinical Obstetrics and Gynaecology
|June 1, 1994
Summary
Screening pregnant women for covert bacteriuria is recommended, especially in high-risk groups, to prevent serious infections like pyelonephritis. Early detection and treatment are crucial for better maternal and infant outcomes.
Area of Science:
- Obstetrics and Gynecology
- Infectious Diseases
- Urology
Background:
- Urinary tract infections (UTIs) are common in pregnancy, ranging from asymptomatic bacteriuria to severe pyelonephritis.
- Untreated asymptomatic bacteriuria can lead to serious infections in a significant proportion of cases.
- Screening for bacteriuria is particularly important in high-risk pregnant populations, including those from lower socioeconomic backgrounds.
Purpose of the Study:
- To highlight the spectrum of urinary infections during pregnancy.
- To emphasize the importance of screening for covert bacteriuria in pregnant women.
- To discuss the management and complications of UTIs in pregnancy, including cystitis and pyelonephritis.
Main Methods:
- Review of existing literature on urinary infections in pregnancy.
- Analysis of clinical outcomes associated with untreated and treated bacteriuria.
- Evaluation of treatment regimens and complications of acute cystitis and pyelonephritis.
Main Results:
- Untreated asymptomatic bacteriuria leads to serious infections in 25% of cases.
- Covert bacteriuria recurs in one-third of treated women, with a 25% risk of recurrent pyelonephritis.
- Pyelonephritis is the most common severe bacterial infection in pregnancy, with 85-90% responding to IV fluids and antimicrobials within 72 hours.
- Severe pyelonephritis can lead to complications such as septic shock, renal dysfunction, and pulmonary injury in up to 20% of cases.
Conclusions:
- Routine screening for asymptomatic bacteriuria in high-risk pregnant women is clinically justified.
- Single-dose therapy for acute cystitis is not recommended due to the risk of misdiagnosing early pyelonephritis.
- Prompt recognition and management of pyelonephritis, including search for obstruction in non-responders, are essential to minimize maternal morbidity.