Bacteriuria during pregnancy: treatment and effect on the fetus

The appearance of bacteria in the urine during pregnancy causes concern among expectant mothers. But this condition is not always dangerous and requires emergency treatment with antibiotics. The woman undergoes additional examination and treatment is prescribed taking into account the indications.

1. Urethritis is a specific or nonspecific inflammation of the urethra. Caused by different types of microbes - staphylococci, streptococci, E. coli, gonococci, chlamydia. Manifested by burning, itching when urinating, discharge of pus or mucus.
2. Cystitis is inflammation of the bladder. Cystitis is characterized by frequent urination, increased temperature, and nagging pain in the lower abdomen.
3. Pyelonephritis is a bacterial inflammation of the kidneys. Accompanied by increased body temperature and pain in the lumbar region.

With true bacteriuria, the color and smell of urine often changes. It can be dark yellow, bloody, with a sour or purulent odor.

Asymptomatic bacteriuria

Asymptomatic bacteriuria occurs when infection penetrates from distant chronic foci. Escherichia coli, staphylococci, and streptococci are detected in small quantities. The pregnant woman feels well and has no complaints.

Types of bacteriuria

In 80% of cases, bacteriuria is provoked by microorganisms that always inhabit the distal (end) section of the urethra. In 2/3 of women, the microbial flora is represented by:

• Proteus;
• enterobacter;
• pyogenic streptococcus;
• saprophytic staphylococcus;
• klebsiella;
• coli;
• Citrobacter.

Most often, bacteriuria occurs in women during pregnancy, which is associated with a natural decrease in immune defense, changes in the chemical composition of urine, or its stagnation in the urinary organs.

There are 2 forms:

• True. Accompanied by changes in the functioning of the urinary system, as indicated by characteristic symptoms - urinary disorders, fever.
• False (asymptomatic). It is detected only in the laboratory during a general urine test.

Asymptomatic bacteriuria during pregnancy occurs 3 times more often. It affects women suffering from nephrolithiasis, bacterial vaginosis, and diabetes mellitus.

Most often, bacteria in urine are detected in the 2nd and 3rd trimesters of pregnancy. As the fetus enlarges, the urinary ducts are compressed or displaced, which leads to impaired urodynamics and stagnation of urine in the bladder and kidneys.

Why is it important to have a urine test during pregnancy?

Pregnancy is accompanied by constant changes in a woman’s body. The fetus grows and this leads not only to an increase in the abdomen, but also to compression of nearby organs. The kidneys are also compressed.

During normal operation of these paired organs, the resulting urine is constantly filtered and discharged into the bladder. When the kidneys are pinched, it begins to stagnate. Under these conditions, bacteria multiply quickly. Their spread leads to inflammation of organ tissues, most often the mucous membranes.

A urine test can detect the disease before it develops and manifests symptoms. Early diagnosis helps to avoid many negative consequences of an infectious disease and prevent the development of gestosis. Read more about gestosis during pregnancy→

Pathways for microorganisms to enter urine

In half of the cases, bacteriuria in pregnant women is the result of an insufficient immune response to the proliferation of opportunistic bacteria. Normally, the kidneys and bladder are sterile. Representatives of normal microflora inhabit only the end section of the urethra. But if the pH of the urine changes or the body’s immunity decreases, they begin to multiply and colonize other parts of the urinary system.

The main ways bacteria enter urine are:

• Rising. Microorganisms enter the bladder and kidneys from the urethra.
• Descending. The infection enters the urethra from the kidneys, ureters and bladder. This route of infection is possible with relapses of urological diseases - ureteritis, cystitis, pyelitis, pyelonephritis.
• Hematogenous. Bacteria enter the urine from distant foci of infection through the bloodstream. Therefore, bacteriuria is more often found in pregnant women who have had acute respiratory viral infections, tonsillitis, or bacterial rhinitis.
• Lymphogenic. The infection enters the urinary system through lymphatic vessels from distant foci of inflammation.

Bacteria usually enter the urinary organs through a relaxed urethral sphincter. Due to decreased immunity during pregnancy, classic inflammation in the end section of the urethra does not occur. Therefore, microorganisms almost freely enter the bladder, ureters and kidneys.

What to do if the analysis is bad?

Mucus, bacteria, protein and white blood cells in the urine are a cause for concern, but not for panic. The results of the study may not be indicative if the rules for collecting urine were violated. One way or another, the doctor will prescribe a repeat test, conduct additional examinations, and prescribe blood donation.

Usually one type of bacteria is found in urine. A mixed culture of microorganisms is a reason to repeat the study.

If leukocytes are found in the analysis of a pregnant woman, then she must be placed in a hospital under the supervision of two specialists: a gynecologist and a nephrologist. What you definitely shouldn’t do if the test results are bad is panic and self-medicate. Drugs prescribed by doctors and taken under their supervision guarantee minimal harm to the child and increase the possibility of a favorable pregnancy outcome.

Svetlana

Causes of bacteriuria in pregnant women

To find out why bacteriuria appeared, you need to undergo a comprehensive examination by a urologist. The presence of bacteria in the urine during pregnancy indicates poor health of the genitourinary system.

Microbial flora provokes complications that negatively affect the body of the expectant mother and fetus.

Cystitis

Very often, bacteriuria during pregnancy occurs against the background of cystitis - inflammation of the bladder. In 86% of women, the pathology is provoked by Escherichia coli. Possible pathogens include Klebsiella, enterococcus, and streptococcus. In some women, bacteria in urine are the result of sexually transmitted infections:

• ureaplasmosis;
• candidiasis;
• gonorrhea;
• chlamydia.

The proliferation of microbial flora in the urine is provoked by hypothermia, dysbacteriosis, metabolic disorders, and hypovitaminosis.

Urethritis

Inflammation of the urethra is a common cause of an increase in the number of bacteria in the urine. In 82% of cases, a pregnant woman is diagnosed with secondary urethritis, provoked by:

• genitourinary infections;
• urinary catheterization;
• vitamin and mineral deficiency;
• urolithiasis;
• unbalanced diet.

With urethritis, opportunistic and pathogenic bacteria are found in the urine - chlamydia, E. coli, gonococci, Proteus.

Pyelonephritis

Gestational pyelonephritis is an infectious inflammation of the kidneys, predominantly of a bacterial nature. Occurs in 7-10% of women in the 2nd and 3rd trimesters of pregnancy. The disease is provoked by opportunistic bacteria that colonize the urethral area.

With bacterial pyelonephritis, the concentration of microbes in the urine exceeds 105 per 1 ml. In half of the cases, kidney inflammation occurs against the background of gynecological diseases - bacterial vaginosis, vulvitis, endocervicitis.

During pregnancy, changes occur in the female body that lead to stagnation of urine. An increase in pressure in the urinary system leads to dilation of the renal pelvis. As a result, conditions are created that are favorable for the growth of bacteria.

Other reasons

Bacteria in urine during pregnancy can be detected as a result of many negative factors. The appearance of microbial flora in the urinary system is facilitated by:

• physical inactivity;
• secondary immunodeficiencies;
• pelvic organ injuries;
• decreased urinary tone;
• gestational diabetes;
• ENT infections;
• lack of personal hygiene;
• wearing tight underwear;
• varicose veins;
• congenital anomalies of the urinary organs.

Women suffering from pyelitis, vesicoureteral reflux, urolithiasis, and diabetes are susceptible to bacteriuria.

Main symptoms of bacteria in urine

Clinical manifestations of bacteriuria depend on the cause of bacterial proliferation and the location of inflammation. The presence of microbes in urine is indicated by:

• frequent urge to go to the toilet;
• cloudy urine;
• burning when urinating;
• discomfort in the suprapubic region;
• lower back pain;
• mucous discharge from the urethra;
• urinating in small amounts.

Bacterial waste products provoke intoxication. Therefore, true bacteriuria during pregnancy is accompanied by:

• muscle weakness;
• drowsiness;
• lack of appetite;
• body aches;
• increased temperature;
• excessive sweating;
• nausea;
• headaches.

Asymptomatic bacteriuria in pregnant women does not manifest itself in any way and is detected only in the laboratory.

To prevent complications during pregnancy, all women should undergo a general urine test once every 2-3 months. The presence of bacteria in the liquid indicates an infectious lesion of the urinary system.

Treatment of bacteriuria: basic methods

The therapeutic direction depends on the underlying diagnosed disease. But in general, the elimination of disorders in which a lot of bacteria are found in the urine is carried out using two methods.

• Non-drug treatment;

If infectious and inflammatory processes are not very pronounced, the pregnant woman may be advised to adjust her diet and increase the amount of fluid she drinks. Sometimes it is enough to simply reduce the acidity of urinary secretions to prevent the risk of proliferation of pathogenic microbes. Also, to speed up the process of removing bacteria from the bladder, urethra and kidneys, you need to drink a lot of water so that it cleanses the body.

• Drug treatment;

This method is used for bacteriuria of various origins. A woman should take a course of antimicrobial agents. Cephalosporins, ampicillin, amoxicillin may be prescribed for 5 days, depending on the severity of the disease. Maintenance therapy is also recommended in the last month of pregnancy and in the first days after birth (nitrofurans at night). These actions will prevent recurrent bacteriuria. If the risk of premature birth increases, then a new generation of Macrolides is used.

But if the patient has an asymptomatic course of the infectious lesion or it is diagnosed for the first time, and is not a recurrent exacerbation, then safer remedies are recommended in the early stages. These include Canephron, Cyston. These drugs are considered phytotherapeutic agents and do not have a toxic effect on the body.

Also, to increase urine output, diuretics or traditional drinks are taken. For example, cranberry juice is an excellent option. At the same time, you should adhere to a dietary diet, excluding fatty, pickled, and spicy foods.

Monural has a powerful effect. But it is prescribed only for one day. Take 3 grams three times a day. If such treatment does not have a positive result, then cephalosporin antibiotics are used. With such therapy, it is important not to delay urination so that there is no stagnation of urine, where microbes will multiply. Diuretic infusions are prescribed without fail.

Treatment of bacteriuria in pregnant patients should be carried out under the strict supervision of a gynecologist. Self-medication is prohibited. As soon as the doctor sees side effects from the prescribed medications or suspects a threat to the development of the fetus, he can change the medications or adjust the dosage.

After treatment, screening tests of the urinary fluid are performed. They do blood tests. Treatment methods differ depending on the duration of pregnancy and the severity of the disease. If after two weeks the bacteriuria has not disappeared, then antibiotics must be used. But expectant mothers should not worry too much or refuse antibacterial agents, considering them dangerous for the developing fetus. Nowadays, pharmaceutical companies produce medications that are safe, but at the same time effective.

Diagnostics

Bacteria in the urine is a nonspecific symptom that accompanies many urological diseases. To determine the cause of the pathological condition, you need to undergo a comprehensive examination with laboratory tests.

Express test

To detect pathogenic bacteria in urine, diagnostic strips are often used - paper or plastic strips with a reagent.

To identify microbes, indicators with Griess reagent are used. When pathogenic bacteria are present in the urine, nitrates are converted to nitrites, causing the strip to change color. If microorganisms are found in the fluid, the woman should consult a doctor for further examination.

Urine culture

Urine culture is a bacteriological study that determines:

• number of microbes per 1 ml of liquid;
• type of bacteria;
• sensitivity of microorganisms to antibiotics.

The study is carried out by inoculating biomaterial on different nutrient media. To test for bacteriuria, urine is collected in a sterile container, which is delivered to the laboratory within 30-60 minutes. If necessary, urine is stored in the refrigerator at temperatures up to 4°C, but not longer than 24 hours.

Additional diagnostic methods

If pathogenic bacteria are found in the urine, additional research will be required:

• General urinalysis (UCA). Based on the results, the density of the liquid and the presence of foreign inclusions in it - protein, ketone bodies, leukocytes - are assessed.
• Blood chemistry. Elevated levels of creatinine and nitrogenous substances indicate kidney dysfunction.
• TTX test. Using a screening method, an increased concentration of bacteria in a portion of urine is detected. The accuracy of the test using triphenyltetrazolium chloride is at least 90%.

Due to decreased immunity during pregnancy, it is undesirable to conduct instrumental examinations of the urinary tract - cystoscopy, urinary catheterization.
If necessary, hardware examination methods are prescribed - ultrasound of the urinary tract, ultrasound examination of the renal vessels, CT scan of the kidneys.

Normal urine levels

After the examination, the doctor compares the test results with normal urine values:

• pH level – 5.0-8.0;
• protein – no more than 0.14 g/l;
• red blood cells - up to 2-3 pieces in the field of view;
• leukocytes – no more than 5 in the field of view;
• urobilinogen – less than 34 mmol/l;
• ketone bodies – no more than 1 mmol/l;
• bilirubin – absent;
• bacteria – up to 104 per 1 ml.

Normal urine is straw-colored. There is no foam, purulent or bloody inclusions. Deviation of laboratory parameters from normal values ​​is a reason for further examination and treatment. The main goal of therapy is to restore the pH of urine plus the destruction of microbial flora in the urinary system.

The importance of taking a urine test during pregnancy

In 2/3 of women, bacteriuria does not manifest itself in any way. But even with a slight increase in the number of bacteria in urine, the course of pregnancy becomes more complicated. Delayed treatment leads to:

• gestational pyelonephritis;
• anemia of pregnant women;
• postpartum endometritis.

Microbial flora in the urinary system during pregnancy provokes the production of inflammatory mediators in the body. They increase the contractile activity of the myometrium (the muscular layer of the uterus), which increases the risk of spontaneous abortion or miscarriage.

Prevention of bacteriuria: what should expectant mothers remember?

Everyone knows that preventive measures, especially during pregnancy, help get rid of various inflammations and prevent the development of serious infections in the body. By taking care of her health, the patient automatically protects the child from pathological changes in the intrauterine space, as well as from diseases that he may develop after birth. Immunity from the mother lasts a long time, so it is important to prevent bacteria from entering.

What can I do to prevent infections and increased protein in the urine from appearing?

• Get examined and tested regularly. Collect the material in a sterile container after hygiene of the external genitalia. Before going to the laboratory, avoid drinking alcoholic beverages, spicy foods, pickled foods, etc. All these types of food can distort test results.
• A pregnant woman should remove synthetic underwear from her wardrobe and regularly carefully observe intimate hygiene. Synthetics provoke the proliferation of infections and ascending infection by pathogenic microbes.
• It is necessary to follow all doctor’s recommendations and not self-medicate. If you suddenly feel pain when urinating, you should immediately see a gynecologist or urologist. The doctor will prescribe effective and safe treatment for the current stage of pregnancy.
• It is important to strengthen your immune system and exercise. These actions will speed up metabolism and prevent stagnation in the body, which can lead to infection.

It is worth recalling that bacteriuria, according to statistics, occurs in every fifth patient. This is not enough. Therefore, it is important to undergo regular examinations so that the asymptomatic course does not cause complications.

How to treat bacteriuria during pregnancy

The presence of pathogenic bacteria in the urine is a serious reason for complex treatment. In uncomplicated pregnancy, therapy is carried out on an outpatient basis under the supervision of a urologist and obstetrician-gynecologist.

Medicinal treatments

Treatment of asymptomatic bacteriuria is carried out with low-toxic antibiotics:

• Cefuroxime;
• Ampicillin;
• Ospamox;
• Cefaclor;
• V-mox;
• Ceftriaxone.

At the beginning of pregnancy, 2-3 generation cephalosporins and beta-lactam penicillins are prescribed.

In the 2nd trimester of pregnancy, synthetic nitrofurans are indicated - Solafur, Furagin, Furadonin. To disinfect the urinary tract, uroseptics are used - Urolesan, Canephron, Uroprofit.

Folk remedies

Self-treatment of bacteriuria during pregnancy is dangerous due to complications. Some herbs are strictly prohibited for pregnant women. Therefore, folk remedies are used only on the recommendation of a urologist.

To destroy pathogenic bacteria in urine, decoctions are used based on:

• bearberry;
• peppermint;
• pharmaceutical chamomile;
• juniper;
• birch buds.

The course of treatment is from 2 to 4 weeks.

Diet and drinking regime

During pregnancy, foods that alkalize urine and irritate the urinary tract mucosa are excluded from the diet:

• strong coffee;
• carbonated drinks;
• spices;
• marinades;
• semi-finished products;
• greenery;
• onion.

To create unfavorable conditions for the growth of bacteria, they consume more products that shift the pH of urine to the acidic side - fruit drinks, fermented milk products, chicken eggs.

How bacteria in urine affects pregnancy

Bacteriuria has a negative effect on the fetus and the body of the expectant mother. Pathogenic bacteria increase the content of toxins in the blood, which leads to poisoning and metabolic disorders. Untimely destruction of microbes is dangerous:

• fetoplacental insufficiency;
• oxygen starvation of the fetus;
• late toxicosis;
• increased maternal blood pressure;
• infection of the birth canal.

In 10% of cases, uroinfections provoke chorioamnionitis - an infectious lesion of the fetal fluid and membranes. Mortality rates in newborns with bacteriuria during pregnancy increase by 2.5 times.

Prevention

Primary prevention is aimed at eliminating factors that provoke the growth of bacteria in the urine. To prevent bacteriuria during pregnancy, you should:

• treat kidney and ureter diseases in a timely manner;
• be examined by a urologist once every 3 months;
• eat a balanced diet;
• take vitamins;
• Take OAM once a quarter.

Women with chronic pyelonephritis should regularly undergo ultrasound of the kidneys and have their urine tested. To reduce the risk of bacterial growth in the urinary organs, consumption of berry fruit drinks is recommended. Preventive treatment with herbal uroseptics is carried out as prescribed by a doctor. Compliance with preventive measures prevents complicated pregnancy and congenital diseases in the child.

The impact of asymptomatic bacteriuria on the child and pregnant woman

Since the organs of the urinary system are located directly near the uterus, pathogenic microorganisms can spread to its area, as well as the fetal membranes. Pyelonephritis and cystitis can seriously complicate the normal course of pregnancy.

Lack of proper therapy for bacteriuria is fraught with:

• intrauterine infection of the child;
• delayed intrauterine development of the baby;
• the birth of low birth weight babies (body weight less than 2500 g);
• premature rupture of membranes.

Timely detection and initiation of treatment will allow the pathogenic flora to be completely eliminated, pregnancy to proceed normally and the birth of a healthy baby.