Urinary tract infections are a common infectious disease in women, and due to changes in anatomy and hormone levels, women are more likely to develop urinary tract infections during pregnancy. Pregnancy is a sensitive time when many diseases can unknowingly stalk the mother-to-be. Women experience urinary tract infections more frequently during pregnancy, as high as 7% to 10%. This is due to the following reasons.
1, increased secretions: vaginal secretions will increase accordingly during pregnancy, the female urethra is located in the vulva, adjacent to the vaginal opening and anus, plus vaginal discharge secretions, often make the perineum more humid, and there are from vaginal inflammatory secretions and feces, skin bacteria breeding and reproduction, so that the urethra is contaminated, because the female urethra is born straight, wide and short, only 3 to 5 cm long.
2, ureteral dilatation: pressed by the gradually increasing uterus, the ureter will passively dilate, while the muscle tone of the ureteral wall decreases under the effect of progesterone, and peristalsis weakens and slows down, making it favorable for the retrograde flow of bacteria upward.
3, urine containing high sugar: pregnant women’s urine contains glucose, amino acids and other nutrients, which are conducive to bacterial growth.
4, poor urination: by late pregnancy, the enlarged uterus compresses the bladder and ureter, and these can cause poor urine flow and urine retention. The retained urine not only irritates the mucous membrane of the urinary tract, but also tends to create convenient conditions for bacterial breeding.
5, displacement of bacteria: constipation caused by the squeezing of the intestinal canal by the pregnant uterus, which makes it easy for bacteria in the large intestine to invade the urethra, bladder, ureter and renal pelvis from the intestinal canal via the lymphatic system.
6, weakened resistance: after pregnancy, the mother-to-be needs to provide part of the body’s nutrition to the baby, the body’s resistance is reduced during pregnancy, easy to be pathogenic bacteria “to take advantage of the situation”. The bacteria from other parts of the body can spread to the urinary tract through the blood circulation and cause urinary tract infection.
Clinical symptoms
Urinary tract infections during pregnancy can cause cystitis in mild cases, manifesting as frequent urination, urgent urination, painful urination and hematuria. In severe cases, it is acute pyelonephritis, and in addition to obvious symptoms of cystitis, there may be systemic symptoms such as back pain, fever and chills.
1.In case of lower urinary tract infection, pregnant women may have symptoms such as frequent urination, urgent urination, painful urination and sometimes hematuria.
2.If lower urinary tract infection is not actively treated, bacteria can invade the ureter and renal pelvis and produce upper urinary tract infection.
3, upper urinary tract infections produce pyelonephritis, and some even produce acute pyelonephritis.
4. When suffering from acute pyelonephritis, pregnant women may have symptoms of systemic toxicity, such as chills, high fever, and back pain, etc. A large amount of medication is used to treat this condition, and if the pregnancy continues, the fetus may be deformed or lead to congenital diseases.
5.Acute pyelonephritis can induce gestational toxicity, resulting in premature birth, weight loss and even death of the fetus.
6.Even if the delivery is successful, it will continue to affect the mother and child, and even lead to the mother’s kidney function decay.
Treatment of urinary tract infection during pregnancy
Women in pregnancy: asymptomatic bacteriuria is one of the first subclinical infections that has been clearly identified as being closely associated with adverse perinatal outcomes. Pregnant women with asymptomatic bacteriuria are 20-30 times more likely to produce a preterm or low birth weight infant than women without bacteriuria. Urine culture testing is recommended once a month for each of the first 3 months of pregnancy. Treatment of asymptomatic bacteriuria during pregnancy may reduce the risk of pyelonephritis from 20-35% to 1-4%, and may improve the condition of the fetus and reduce the likelihood of low birth weight and preterm birth. Pregnant women with asymptomatic bacteriuria or symptomatic urinary tract infections should be treated with oral antimicrobials and reviewed regularly. The choice and regimen of antibacterial drugs include: Amoxicillin 500g orally every 8 hours for 3-5 d; Amoxicillin? Clavulanic acid potassium 500mg orally every 12 hours for 3-5d; Cephalexin 500mg orally every 8 hours for 3-5d or Phosphomycin aminotriol 3g orally as a single dose treatment.
There are two differences in the treatment of urinary tract infections in pregnancy compared to non-pregnant women: the medication must be safe and have few side effects, which greatly limits the selection of drugs; and preventive treatment in pregnancy must be closely followed.
In the treatment of urinary tract infections in pregnancy, active anti-infective treatment based on urine culture and drug sensitivity test results is the key, so the selection and rational application of antibiotics is particularly important. The choice of antibiotics should take into account not only the effectiveness of the drug and low drug resistance, but also the avoidance of adverse effects on the pregnant woman and the fetus, and try to choose drugs that are not toxic or teratogenic to the fetus. Before using antibiotics, urine culture should be used and antibiotics should be selected according to the drug sensitivity test. Referring to the U.S. Food and Drug Administration (FDA), the risk classification of antibiotics in pregnancy is divided into A, B, C, D and X. Use A and B drugs as much as possible.
1, β-lactams: bactericidal antibiotics, inhibit bacterial cell wall synthesis, have low toxicity as well as very low teratogenicity or risk of fetal toxicity, can be used as usual during pregnancy, belong to category B. Among them, penicillins and cephalosporins, no teratogenic effect on the fetus has been found so far and can be used throughout pregnancy. Other beta-lactam antibiotics, such as aminoglutethimide and carbapenems and beta-lactamase inhibitors, can cross the placenta and reach high blood levels in the fetus. If strongly needed, they can be used during pregnancy.
2. Fosfomycin: a bactericidal antibiotic that inhibits bacterial cell wall synthesis. These drugs are almost completely excreted by the kidneys and can be maintained in high concentrations in the urine, making them particularly suitable for the treatment of lower urinary tract infections. Current research shows that fosfomycin is safe and belongs to class B.
3.Furantoin: belongs to class B. It is a bacteriostatic antibiotic, which can change the sugar metabolism of bacteria. The highest concentration of this type of drug appears in the urinary tract, and the blood concentration is low. Furantoin is prohibited in late pregnancy, and it can cause erythrocyte lysis in newborns, resulting in hyperbilirubinemia and bilirubin encephalopathy.
Urinary tract infections in pregnancy should be treated with caution
Urinary tract infections in pregnancy are different from those in non-pregnant cases because, in addition to the mother, there is a developing baby. Both the doctor and the pregnant woman must have an added string to their bow and be aware of the immediate and long term effects of medications on their little one. –Fearing the adverse effects of medications and not taking them is not an option! Because infection is a threat to both mother and child. It is also not acceptable to pursue sterilization or even abuse inappropriate drugs without considering the tolerance of the fetus! This is because it is a sin to “burn both stones and stones”.
The main drug for the treatment of urinary tract infections can not be separated from antibacterial drugs, should be aware of the adverse effects of various types of antibacterial drugs on pregnant women and fetuses, in order to avoid evil, to ensure the safety of mother and child.
The first category: aminoglycosides: belongs to category D. It can pass through the placenta and cause side effects such as nephrotoxicity and ototoxicity to the fetus, and is not recommended for the treatment of urinary tract infections in pregnant women during pregnancy.
The second category: quinolones (commonly used are haloperidol, telbivudol, and various “so-and-so fascias”), belongs to category C. These drugs have been found in animal experiments to cause bone development disorders and even cartilage necrosis in mice, but no studies have been reported in humans. Therefore, it is not appropriate to use, if you really want to use, the duration of the drug should not be too long.
The third category: tetracyclines (commonly used are tetracycline, oxytetracycline, doxycycline, etc.) can cause fetal skeletal dysplasia and future dental dysplasia. Fortunately, such drugs have been gradually eliminated and used sparingly, but in some remote areas, due to the slow acceptance of medical information by medical personnel, there are still users, which should be noted. It belongs to C and D category. It can inhibit bacterial protein production and produce bacteriostatic properties. Considering that tetracyclines can cross the placenta and bind calcium firmly, their use is contraindicated after the fourth month of pregnancy. Tetracyclines can attach to developing teeth and bones producing black deposits leading to tooth loss and inhibition of bone growth; they can also cause fetal left ventricular outflow tract obstruction, mild fetal dysfunction and severe maternal hepatotoxicity. Tetracyclines are used as second-line antibiotics in the first trimester of pregnancy.
Category IV: Chloramphenicol, which causes gray baby syndrome, that is, death at birth with a grayish purple body and lack of oxygen.
Class V: Sulfonamides: belongs to Class D. This class of drugs can inhibit the metabolism of bacteria. Its can cross the placenta to reach high serum levels in the fetus. It can cause anencephaly, hypoplastic left heart, aortic constriction, posterior nasal atresia, lateral limb defects, and increased probability of diaphragmatic hernia. Sulfonamides (including a variety of sulfonamides, commonly used as Synthroid, also known as Benadryl), taken at 6 months of pregnancy or more, predispose the future fetus to kernicterus (a more serious neonatal disease) at birth.
Prevention: 6 good habits to stay away from urinary tract infections
1, pro-water: urinary tract flushing. After a mother-to-be has a urinary tract infection, she should drink more water and urinate more often. Drink at least 1500 to 2000 ml of water every day and urinate every 2 to 3 hours. The flushing of large amounts of urine can remove some of the bacteria and inflammatory secretions, and is an important method of treating urinary tract infections.
2, dietary taboos: after suffering from urinary tract infection, the mother-to-be should pay extra attention to diet, spicy food will aggravate the symptoms of urinary tract irritation, making urination more difficult, and should be eaten sparingly.
3, diligent cleaning: before going to bed, after the stool with warm water to wash the lower body. Washing order should be first wash the external genitalia, after washing the anus, to avoid cross-infection. Both husband and wife should develop the habit of washing every night, towels, water basins, foot cloths should be separated, wash the feet and wash the vulva towels should also be separated.
4, abstain from sex: frequent or unclean sex can lead to urinary tract infections. Especially pregnant women with a history of urinary tract infections, it is best to avoid sexual intercourse during pregnancy. If possible, both men and women should take a shower before intercourse, or wash their lower body with warm water. The woman should empty her bladder after intercourse, which can play a role in flushing the urethra and reducing infection.
5, do not hold urine: excessive urine holding can cause urine concentration and stimulate the bladder mucosa, leading to morbidity.
6.Side lying: In the middle and late pregnancy, the enlarged uterus compresses the bilateral ureters in the supine position, which makes urine stay and easy to get infected. Take the side lying position, especially the left side lying position, can release the uterus on the ureter compression, not only conducive to urine flow, prevention of urinary tract infection, but also beneficial to increase the blood supply of the fetus.
7, loose: pants should be loose, too tight pants will bundle pressure on the vulva, making it easy for bacteria to invade the urethra. Keep your bowels open to reduce the pressure on the ureter.
8, timely consultation: after the disease must go to the hospital, do not delay to wait for self-healing. The acute phase should generally be bed rest within 1 week. Usually pay attention to the combination of work and rest, overexertion or poor rest after the disease can lead to recurrence of infection and change to chronic.