What can be wrong with the urinary tract during pregnancy?
During pregnancy check-ups, regular urine tests are often recommended to check for protein in the urine and for signs of urine infections, such as leukocytosis. As pregnancy progresses, changes in hormone levels, increased levels of diabetes and amino acids in the urine, and the “pressure” of the enlarged uterus on the surrounding tissues and organs also tend to cause urine retention, inter-vesical reflux and ureteral obstruction (mostly in the right ureter) leading to dilation of the urinary tract.
Tip: False infection
Due to the anatomical characteristics of women, the urethral opening, vaginal opening and anus are adjacent to each other in the vulva, so if urine is not taken properly during urinalysis, often the urine will be mixed with leukorrhea, causing a false sign of “infection” because the vaginal environment is not sterile and contains bacteria, so the leukorrhea will contain leukocytes, squamous epithelial cells, etc. The leukorrhea contains white blood cells, squamous epithelial cells, etc.
What is asymptomatic bacteriuria?
Normally, urine is sterile, and when a urinary tract infection occurs, the type of pathogenic bacteria is often obtained in the urine by microscopic examination and urine bacterial culture. However, there is a condition called “asymptomatic bacteriuria”, which means that these people do not have obvious symptoms of urinary tract infection, such as frequent, urgent, painful urination, and no increase in WBC in urine examination, but a certain amount of bacteria can be detected in urine. And this is not uncommon, with a detection rate of about 2% to 9% in the urine of pregnant women in early pregnancy, a rate close to that of non-pregnancy.
Why should we pay attention to asymptomatic bacteriuria?
The study concluded that pregnant women with asymptomatic bacteriuria have a significantly higher chance of developing symptomatic urinary tract infections (17% to 20% of urinary tract infections in pregnant women), 40% can develop cystitis, and 25% to 30% can progress to pyelonephritis, with patients experiencing high fever and urinary tract irritation, urine examination can reveal pus urine, and urine bacterial culture is mostly The urinalysis may reveal pus and the urine culture is mostly positive.
The impact of urinary tract infections, whether secondary to asymptomatic bacteriuria or primary during pregnancy, on the mother and fetus is not only in the discomfort of the urinary tract infection itself, but also significantly increases the incidence of preterm labor and premature rupture of membranes, and the birth of preterm infants, which can further lead to a range of problems such as complications in preterm infants, affecting life expectancy and survival treatment.
Of course, no association has yet been reported that seriously endangers maternal life.
Based on the above, we know the importance of urine screening during pregnancy, even early in pregnancy, for asymptomatic bacteriuria. In many countries, urine culture during the first pregnancy test is already one of the routine pregnancy tests, and pregnant women only need to clean their vulva and keep the middle part of urine, and send it to the laboratory for urine culture. However, in China, this test has not been included in the routine pregnancy test program.
How to treat urinary tract infections during pregnancy?
Both asymptomatic bacteriuria and symptomatic urinary infections should be treated aggressively if they are detected. Your obstetrician may ask you to go to a nephrology or anti-infection unit for treatment, especially in cases of recurrent infections or long-standing infections, with emphasis on coordinated multidisciplinary treatment.
Get adequate rest and drink plenty of fluids. Adequate rest after diagnosis is most important. In addition, drinking plenty of water to increase the volume of urine is also very good for flushing bacteria from the urinary tract. On the contrary, drinking too little water, low urine volume and concentrated urine will aggravate the reproduction of bacteria, which is not conducive to disease control.
It is important to pay attention to the cleanliness of the vulva and wash it with water every day. It is also important to pay attention to the active treatment of inflammation of the genital tract and/or inflammation of the intestinal tract, because we know that the urethral opening, the vaginal opening and the anus are adjacent to each other and bacteria and pathogens can contaminate and infect each other.
Medication. Pregnancy is a special period for women and medication should be given special consideration due to the presence of the baby, especially during the critical period of its development.
If you go to a nephrologist, etc. for treatment, you should also be clearly informed that you are a pregnant mom, your baby’s current gestational age, and that medications that were clinically powerful for urinary tract infections become contraindicated during pregnancy, such as quinolones, etc.
Your doctor will most likely recommend cephalosporins first. Oral antibiotic therapy may be recommended for patients with asymptomatic bacteriuria or cystitis, and short courses (3 days) are now found to be about as effective as long courses (7 days). In the case of upper urinary tract infections, which are usually accompanied by high fever, low back pain and urinary tract irritation, at this time, infusion therapy is often required.
The purpose of infusion is, on the one hand, to increase the dosage of antibiotics at this time, if oral, generally not easy to tolerate, on the other hand, through the infusion, can achieve the purpose of increasing urine volume and lowering body temperature. The course of antibiotics for upper urinary tract infections generally takes 7 days or longer.
In the selection of antibiotics, doctors will not only consider the type of drug that has as little effect on the baby as possible, but also choose the drug based on urine culture and drug sensitivity tests (especially for patients with recurrent infections), so as to “destroy” the bacteria and control the inflammation in a more targeted manner.
Special note from the doctor.
In the process of treating urinary tract infections, it is very important to adhere to the medication and regular review as prescribed by the doctor, and active cooperation is required. Sometimes, the fear of affecting the baby on their own to reduce the amount of drugs or shorten the course of treatment, or self-perception of symptoms have been significantly improved (but in fact, laboratory tests are still abnormal), then stop the drug, but will cause incomplete treatment or bacterial resistance, causing problems for future treatment. Because of the presence of bacteria, even asymptomatic bacteriuria should be treated with standard medication once it is diagnosed. It is not right to take medication or refuse to take it if you are overly concerned about the effect of medication on your baby.
Key points in the treatment of bacteriuria during pregnancy
Maintain personal hygiene, clean the vulva daily, drink more water and urinate more often.
Actively treat inflammation of the reproductive tract and intestinal tract.
If possible, have a urine culture done early in pregnancy and if the diagnosis is “asymptomatic bacteriuria”, treat it actively.
If you have obvious symptoms of urinary tract irritation, such as frequent urination, urgency, painful urination and other discomforts, you should actively see your doctor for routine urinalysis.
If necessary, do urine culture test and drug sensitivity test.
Urinary tract infections require standardized treatment and regular review during treatment.