A urine test can tell a lot about the health of the expectant mother. With its help, hidden infections and pathologies of the genitourinary system are often detected. One of the conditions that a pregnant woman’s urine test will show is bacteriuria (presence of bacteria). What does this mean and in what situations does it occur? Is the pathology dangerous and should it be treated urgently?

Why is a urine test done during pregnancy?

The body of the expectant mother is constantly undergoing a restructuring of organs and systems, the purpose of which is comfortable gestation and preparation for childbirth. The growing uterus puts pressure on the kidneys, and they work with increased load, which disrupts the constant outflow of urine. The slightest infringement of the ureters or kidneys threatens stagnation of urine, and after a couple of weeks - infection.

A urine test allows you to determine whether everything is in order with the urinary system and how well other organs are functioning. Pregnant women have to donate urine quite often. In the first trimester, the analysis is done monthly, in the second – once every 2 weeks, in the later stages – weekly. Normally, the biomaterial is transparent. Turbidity allows one to suspect an infectious-inflammatory process in the body and requires diagnosis.

The detection of protein, red blood cells, ketone bodies, salt, and glucose in urine analysis is considered pathological. Protein in the urine (proteinuria) is a common sign of gestosis, which is dangerous in the third trimester. If glucose is found, this indicates endocrine pathologies and diabetes mellitus. Salts indicate the presence of stones or sand in the kidneys. Bacteria in urine during pregnancy is a consequence of improper urine collection or infectious pathology that needs correction.

Causes of bacteria in urine during pregnancy

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While carrying a child, immunity decreases, since a large amount of important vitamins and microelements goes towards the development of the baby. Attacks by infectious and bacterial agents are especially dangerous during this period. They lead to relapses of chronic diseases and the development of bacteriuria.

Why are bacteria found in the urine of pregnant women? Pathology is caused by the following ailments:

• Urethritis. With weakened immune defenses, staphylococci, enterococci, and streptococci, which are present on the mucous membrane of the genital organs, can penetrate into the urethra. When urine passes through the urethra, bacteria enter it, as can be seen from the results of the study.
• Non-infectious cystitis. It occurs against the background of hypothermia, weakened immune defense, overwork, and frequent constipation. The growing uterus puts pressure on the bladder, causing its capillaries to burst and the walls to expand. Subsequently, purulent inflammation occurs, a sign of which are microorganisms in the urine. An expectant mother can become infected with an infectious form of pathology through sexual contact.
• Pyelonephritis. The most common cause of the disease, which causes inflammation of the kidney tissue, is the pressure of the growing uterus on the organs of the urinary system. At the same time, staphylococci, Pseudomonas aeruginosa, and fungi of the genus Candida are active, which can provoke an abscess inside the kidneys. Pus along with bacteria is released into urine.
• Hormonal imbalances and structural features of the female genital organs.

Types of bacteriuria during pregnancy

Pathologies that cause the appearance of bacteria in the urine differ in their symptoms. Depending on the nature and degree of their manifestation, true and asymptomatic bacteriuria are distinguished. The true form is diagnosed in the presence of obvious inflammatory processes, when the formation and release of pus from the urinary tract occurs. Bacteria come out with urine and pus and choose urine as a suitable nutrient medium. They actively multiply and infect the urinary tract.

Main signs of the disease:

• cloudiness, change in urine color;
• flakes and mucus in biomaterial;
• pain when urinating;
• unpleasant smell of discharge.

It is worse when the disease is asymptomatic and can only be detected through a medical examination. In this case, the expectant mother is not bothered by pain in the kidneys and pelvis, and urination does not cause discomfort. However, the fetus in the womb is susceptible to intoxication and other negative consequences of asymptomatic bacteriuria. In addition, a pregnant woman herself can become a carrier of infection if she has unprotected sexual intercourse.

Bacteriuria is also divided into ascending and descending. The disease is also distinguished by the types of bacteria that cause it. There are staphylococcal, streptococcal, and gonococcal forms of the disease.

Methods for diagnosing bacteriuria

Bacteria are found in the urine of every fifth expectant mother. The quality of the analysis is largely influenced by the method of urine collection. The most accurate results will be shown by a urine test collected in the morning on an empty stomach using a catheter. When urinating naturally, there is a high risk of infection from the outside. Initially, the doctor gives a referral for biochemical analysis and general analysis according to Nechiporenko. The study allows you to clarify the composition of urine and reveal the presence of components that should not be present in a healthy body.

If bacteriuria is suspected (pathological microorganisms are detected in the urine), additional examination and the following tests are indicated: determination of the exact number of microorganisms in 1 ml of urine and Gould analysis, which allows us to identify the nature and extent of damage to the urinary system organ. In parallel, asymptomatic bacteriuria during pregnancy is diagnosed using:

• testing using triphenyltetrazolium chloride, when immersed in urine, the chemical composition of the salt is decomposed by bacteria;
• Griess test: allows you to identify bacteria that convert nitrate substances into toxic nitrites that cause intoxication;
• sediment analysis: microscopic examination allows you to identify bacteria if there are a lot of them (the amount in 1 ml of biomaterial exceeds 100 million), examination of urine sediment allows you to determine the presence of pathology in the early stages, when the volume of bacteria is insignificant.

Additionally, a biochemical blood test is performed. Kidney ultrasound and other studies may be prescribed.

How does the presence of bacteria in urine affect pregnancy?

Bacteriuria during pregnancy affects the course of pregnancy and the further development of the baby:

• placental disorders, fetal hypoxia;
• onset of early labor;
• abnormalities of the fetal nervous system, which in especially severe cases lead to cerebral palsy;
• deviations in the mental and physical development of the child after birth;
• intrauterine anomalies of internal organs, which in the future affect the health of the child.

Treatment, diet and drinking regimen

Therapy for bacteriuria during pregnancy is complex. Medication and alternative treatment, diet, and proper drinking regimen are necessary. The treatment plan includes:

• Taking antibacterial drugs that will stop the proliferation of bacteria and stop the inflammatory process. Medicines are chosen taking into account the nature of the pregnancy, age and health status of the expectant mother. These are Ificipro, Nitrofurantoin, Cephalosporin, etc. The selection of medications in the early stages is especially careful - they should not negatively affect the fetus. At the same time, taking probiotics is indicated.
• Maintenance medications that will help restore kidney health faster. Among them are Canephron, Phytolysin.

If the pathology is detected at the initial stage, doctors try to do without antibiotics. Measures are shown to normalize the pH of urine and increase its passage. For this purpose, cranberry juice, kidney infusions, decoctions of rose hips and lingonberry leaves are prescribed. If after 2 weeks the situation does not improve, proceed to drug treatment.

When the cause of the pathology is the pressure of the uterus on the kidneys, regular. It is advisable to avoid resting on your back, which can lead to compression of the renal pelvis and stagnation of urine.

The diet for bacteriuria is aimed at normalizing the pH of urine. For this purpose, easily digestible nutritious dishes are indicated - porridge, soups, lean meats. Spicy, spicy, salty foods should be excluded, and the consumption of dairy products should be reduced. It is recommended to eat more protein, which is found in meat and legumes.

The best ways to prepare food are baking, boiling, stewing, and steaming. Drinking regime is an important element of treatment. You should drink up to 2 liters of liquid per day, excluding soups and other dishes.

Preventive measures

A healthy lifestyle, avoiding hypothermia and promiscuous intimate relations will help prevent the development of pathology during pregnancy. It is important to get tested and examined by your obstetrician regularly. Additionally, it is recommended to take vitamin preparations and herbal teas, immunostimulants. It is necessary to maintain intimate hygiene, including with the help of wipes and cleansing creams. The absence of heavy physical activity, proper nutrition and drinking regime are important.

If the pathology cannot be avoided, you should entrust its treatment to a doctor. Independent selection of medications and self-medication are prohibited. It is necessary to follow medical recommendations and complete therapy to the end to avoid serious pregnancy complications.

This is a laboratory-determined pathological condition during gestation, in which repeated urine testing with a break of 24 hours or more allows the same microorganism to be detected in tests in a titer of 100,000 CFU/ml. There are no clinical symptoms. The disorder is diagnosed using a general urine test, bacteriological culture, and a screening photocolorimetric TTX test. Treatment is carried out using fosfomycins, semi-synthetic penicillins, cephalosporins, synthetic nitrofurans, and herbal uroantiseptics.

ICD-10

O23 Urinary tract infection during pregnancy

General information

Asymptomatic bacteriuria (ASB, asymptomatic or latent chronic bacteriuria) is detected in 2.5-26% of pregnant women. In patients with low socioeconomic status, the syndrome develops 5 times more often. Often, non-inflammatory bacterial colonization of the urinary tract precedes gestation. In 52.3% of pregnant women, asymptomatic bacteriuria is detected in the first trimester, in 35.4% in the second, and in 12.3% in the third. According to WHO recommendations, an increase in the content of bacterial agents to 100 thousand or more CFU/ml is clinically significant. However, according to the observations of specialists in the field of urology, obstetrics and gynecology, the risk of complicated gestation occurs even with titers from 100 to 10,000 CFU/ml.

Causes

The pathology is caused by commensal microorganisms that normally colonize the periurethral and perianal areas. In 95% of patients, a monoinfection is detected. In almost 2/3 of cases, etiopathogens are gram-negative: in 51.7% of pregnant women with asymptomatic bacteriuria, E. coli is detected in tests; Proteus, Klebsiella, Enterobacter, Citrobacter, pseudomonas, and non-fermenting bacteria are less common. Gram-positive microflora is represented by staphylococci (epidermal, hemolytic, saprophytic), pyogenic streptococcus, fecal enterococcus.

The risk of developing a pathological condition increases in women with bacterial vaginosis, previous urogenital infections, congenital anomalies of the urinary organs, a history of nephrolithiasis, long-term smoking, diabetes mellitus, frequent sore throats and acute respiratory infections. Specific factors contributing to the development of latent chronic bacteriuria in the gestational period are characteristic metabolic, urodynamic changes and mechanical effects:

• Stagnation and backflow of urine. In pregnant women, expansion of the collecting system, hypotension of the ureters and bladder, and relaxation of the urethral sphincter are observed, caused by the reaction of smooth muscle fibers to an increase in the concentration of progesterone. Some patients experience vesicoureteral and ureteropelvic reflux. The situation is aggravated by a 1.5-fold acceleration of glomerular filtration and mechanical compression of the urinary organs by the enlarged uterus.
• Changes in the chemical composition of urine. The influence of counter-insular hormones (cortisol, placental lactogen, human chorionic gonadotropin) contributes to the development of physiological insulin resistance in pregnant women. In combination with increased synthesis of glucose by the liver, this leads to the development of transient glucosuria, and if compensatory mechanisms are insufficient, gestational diabetes. Glucose serves as a suitable substrate for the nutrition and growth of microorganisms that enter the urothelium.
• Decreased immunity. Restructuring the pregnant woman’s immune system is aimed at preserving gestation. To prevent rejection of a genetically alien fetus, the activity of T-suppressors in a woman’s body doubles, T-killers, phagocytic blood neutrophils, and macrophages are inhibited, and the concentration of immunoglobulin G decreases. As a result, the patient’s susceptibility to bacterial infection increases, which contributes to the asymptomatic activation of commensals.

Pathogenesis

The mechanism of development of asymptomatic bacteriuria in pregnant women is based on the ascending spread of commensal microorganisms along the urinary tract. It is extremely rare that infection occurs through the hematogenous route. Typically, etiopathogens that persist on the mucous membranes of the periurethral zone enter the urinary system through a relaxed urethral sphincter. An insufficient immune response does not ensure complete elimination of bacteria, the concentration of which is insufficient to cause a classic inflammatory response. Due to the presence of adhesins, hemolysin and other virulence factors, infectious agents colonize the urothelium. Accelerated bacterial growth is facilitated by a physiological increase in urine pH and possible glycosuria.

Complications

Clinically hidden bacteriuria does not manifest itself in any way, however, even with a low titer of microorganisms (100-10,000 CFU/ml), a complicated course of pregnancy is significantly more often observed. In 20-40% of cases, against the background of asymptomatic bacteriuria, pregnant women develop acute gestational pyelonephritis. Increased local and systemic synthesis of prostaglandins, which are myometrial stimulants, provokes premature birth. The risk of gestosis, anemia of pregnant women, fetoplacental insufficiency, intrauterine fetal hypoxia, delayed fetal development, and infectious complications (chorioamnionitis, postpartum endometritis) increases. Indicators of prematurity and neonatal mortality in BBU increase by 2-2.9 times. It is significant that treatment of timely diagnosed asymptomatic bacteriuria significantly reduces the likelihood of complications.

Diagnostics

The difficulty of identifying the syndrome is due to the lack of symptoms and pathognomonic complaints. Asymptomatic bacteriuria in pregnant women is diagnosed laboratory. Diagnostic alertness is caused by accompanying disorders - increased frequency of urination due to possible transient or permanent glycosuria, vaginal discharge, pain, burning, pain, discomfort in the external genitalia, indicating a probable infectious-inflammatory process.

Taking into account the risk of complications, microbiological screening is recommended for all pregnant women upon registration at the antenatal clinic. The diagnosis of asymptomatic urinary infection is established only in cases where, when bacteria are detected in the urine, there are no clinical, laboratory and instrumental signs of infectious and inflammatory diseases of the urinary organs. The examination plan usually includes:

• General urine analysis. To exclude accidental contamination, an average portion of morning urine is examined. The analysis reveals bacteria, and in some pregnant women, leukocytes. Increased pH and glucose in the urine may also be detected.
• Urine culture for microflora. The analysis is performed twice with an interval of at least 24 hours between studies. The diagnosis of bacteriuria is made when the same bacterium is repeatedly detected at a concentration of 100 thousand CFU/ml.
• TTX test. The photocolorimetric screening diagnostic method allows you to detect increased levels of bacteria in the sample within 4 hours. The sensitivity of the reaction with triphenyltetrazolium chloride reaches 90%.

To exclude inflammatory urological diseases and assess the functional capabilities of the kidneys, urine analysis according to Nechiporenko, kidney tests (nephrological complex), general and biochemical blood tests, ultrasound of the kidneys, ultrasound of the renal vessels are recommended as additional studies. X-ray or endoscopic methods are used only in complex diagnostic cases, taking into account possible negative consequences for the woman or fetus. True asymptomatic urinary infection is differentiated from false bacteriuria due to contamination of the material, pyelonephritis, cystitis, urethritis. In addition to the obstetrician-gynecologist, the patient is examined by a therapist, urologist, and nephrologist.

Treatment of bacteriuria in pregnant women

Detection of microorganisms in urine during pregnancy, even in the absence of clinical symptoms and other signs of inflammation, serves as sufficient grounds for prescribing antibacterial therapy. Treatment is usually carried out on an outpatient basis with an empirical choice of one of the recommended regimens. Pregnant women may be prescribed:

• One day course. A single dose of a broad-spectrum antibiotic from the fosfomycin group eliminates most of the bacteria that colonize the urinary tract. Due to its ease of use, high efficiency, and safety, the method is considered preferable for pregnant women.
• Three day course. Semi-synthetic β-lactam penicillins and cephalosporins of the II-III generation are used as an antibacterial single drug. In the 1st-2nd trimester it is permissible to prescribe synthetic nitrofurans; in the 3rd trimester they can provoke hemolytic disease of the newborn.

14 days after the end of the course of taking the antibiotic, a repeat bacteriological examination of the urine is performed. If bacteriuria is absent, dynamic monitoring of the pregnant woman continues. To consolidate the therapeutic effect, non-drug methods are used: increasing urination by drinking plenty of fluids, lowering pH by drinking acidic drinks (cranberry juice, etc.). If factors are identified that increase the risk of developing asymptomatic urinary infection, herbal medicine using complex herbal antiseptics is indicated. If latent bacteriuria is detected again, another antibacterial regimen or drug is prescribed, selected taking into account the sensitivity of microorganisms. The preferred method of delivery for pregnant women who have had BBU is vaginal birth. Caesarean section is performed only if there are obstetric or extragenital indications.

Prognosis and prevention

The effectiveness of short antibacterial courses in the treatment of asymptomatic bacteriuria reaches 79-90%. The prognosis of pregnancy and childbirth with timely detection and adequate treatment of the syndrome is favorable: in 70-80% of pregnant women with signs of PBU, it is possible to prevent the development of pyelonephritis, in 5-10% - prematurity of the child. Primary prevention of asymptomatic urinary infection is aimed at eliminating factors contributing to the occurrence of bacteriuria: preconceptional sanitation of the urogenital organs, smoking cessation, weight correction to reduce the likelihood of developing insulin resistance, drinking fruit drinks to acidify urine, preventive use of urogenital antiseptics by pregnant women at risk.

Bacteria in urine during pregnancy is a signal from the body about pathological processes that require treatment and medical attention. Let's look at the main causes of bacteria in urine, diagnostic methods, symptoms and treatment methods.

During pregnancy, a woman has to undergo many tests that allow her to monitor the health of the expectant mother and her child. Urinalysis is considered one of the most important. Bacteria in urine occurs very often, but there is no clear explanation for this phenomenon. Therefore, there is such a thing as bacteriuria in pregnant women.

The presence of bacteria may indicate inflammation in the kidneys. This may be cystitis, pyelonephritis and other diseases, the risk of which increases during pregnancy. But such a condition is not beneficial either for the expectant mother or for her unborn child. And in some cases it can lead to pathological consequences. A particular danger arises with asymptomatic bacteriuria; in this case, the disease proceeds without any manifestations.

Many doctors claim that bacteria found in the urine during pregnancy indicate a high risk of premature birth. Very often the following are found in urine: Escherichia coli in 80% of cases, Klebsiella, Proteus, streptococci, Enterobacter, fecal enterococcus, staphylococci and others. Each case requires treatment and medical care.

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Causes of bacteria in urine during pregnancy

The causes of bacteria in urine during pregnancy are very varied. The constantly enlarging uterus puts pressure on the kidneys, disrupts their normal functioning, and leads to the appearance of harmful microorganisms. Bacteria can appear due to hormonal changes in a woman’s body and physiological characteristics: a short urethra, the ureter is located close to the rectum.

Bacteria appear in women who are sexually active with many partners and do not maintain personal hygiene at the proper level. In some cases, bacteriuria appears with STDs, diabetes mellitus, chronic lesions of the body and pathologies of the urinary system. Sometimes a weakened immune system and tooth decay lead to bacteria in the urine.

There are two types of bacteria in urine: true bacteriuria occurs when bacteria independently multiply and live in the urine. With false bacteriuria, bacteria enter the urine from distant foci of infection through the blood. An increased content of harmful microorganisms is accompanied by clinical manifestations, but in some cases they do not cause side symptoms.

Bacteria occur in chronic diseases that recur and worsen during pregnancy; let’s look at some of them:

• Cystitis during pregnancy

Inflammation of the walls of the bladder is the most common urological lesion, both infectious and infectious. Infectious cystitis occurs due to opportunistic microflora. Non-infectious cystitis appears with weakened immunity, hypothermia, intestinal dysbiosis, and overwork. In some cases, vaginal dysbiosis and bladder irritation from chemicals lead to bacteria in the urine.

If a woman had symptoms of cystitis before pregnancy, then bacteria found in the urine indicate its relapse. Symptoms of the disease manifest themselves as a frequent urge to urinate, which is very painful. A woman experiences nagging pain in the lower abdomen, blood in the urine and increased body temperature. If you experience such symptoms, you should seek medical help.

• Pyelonephritis during pregnancy

Inflammatory process in the renal pelvis. Escherichia coli, Staphylococcus aureus, Streptococcus, Candida fungi, Pseudomonas aeruginosa are the causes of the disease. An infectious focus is any inflammatory-purulent process. Pyelonephritis can be primary - occurs at the first signs of pregnancy and secondary - appears even before pregnancy and worsens against the background of hormonal changes.

Bacteria in the urine caused by kidney inflammation appear due to the growth of the uterus, which pushes away neighboring internal organs. When the disease worsens, a woman experiences acute pain in the lumbar region, chills, pain when urinating, and signs of intoxication. Pyelonephritis requires mandatory treatment, since the disease is dangerous for the expectant mother and her child.

In addition to the reasons described above, there are also risk groups. Thus, dental problems can lead to bacteria in the urine; irregular hygiene, diabetes mellitus, chronic genitourinary diseases, pathologies of the urinary system and sexually transmitted diseases are the main risk factors and causes of bacteriuria.

• Urethritis

A bacterial inflammatory disease that affects the walls of the urethra. The disease is very common and most often affects pregnant women, causing bacteria in the urine. Bacterial urethritis occurs due to the entry of harmful microorganisms into the urethra (Escherichia coli, enterococci, staphylococci and streptococci). If a pregnant woman has chlamydia, then this is another cause of urethritis, which can lead to damage to the amniotic fluid and the embryo.

The peculiarity of urethritis is that pathogens are constantly present on the mucous membranes of the urinary tract. Therefore, the task of the expectant mother and her doctor is to identify predisposing factors and eliminate them. The disease and bacteria in the urine against its background can appear due to injuries and narrowing of the urethra, bladder catheterization and cystoscopy. The bacterial form of the disease can be caused by specific pathogenic microorganisms that destroy the local defenses of the woman’s body.

Symptoms of bacteria in urine during pregnancy

Symptoms of bacteria in urine during pregnancy depend on the cause of the disease. Bacteriuria appears in 10% of pregnant women, the danger is that it can be asymptomatic. Against the background of bacteria in the urine, a woman develops nephrolithiasis and dilation of the ureter. Very often, this symptomatology occurs in the third trimester of pregnancy. Bacteria can cause low birth weight babies, miscarriages and premature births.

With bacteria, various harmful microflora are detected: Escherichia coli and Pseudomonas aeruginosa, Proteus, streptococci, staphylococci and other microorganisms. Very often, bacteria appear in inflammatory diseases of the kidneys and urinary system, infectious lesions of the body. Harmful microorganisms can enter the urinary tract and kidneys through the hematogenous route.

Symptoms of bacteria in urine during pregnancy are similar to those of cystitis and pyelonephritis. The woman’s temperature rises, there is a frequent and painful urge to urinate, and the urine is sedimented and cloudy. If such symptoms appear, it is necessary to seek medical help, determine the cause of the discomfort and eliminate it.

If bacteria in the urine arises due to urethritis, the woman experiences purulent and mucopurulent discharge from the urethra, pain and discomfort when urinating. With acute inflammation of the urethra, bacteria in the urine become chronic. Bacteria can hide in the Bartholin glands, which are located in the vestibule of the vagina. When the protective properties of the immune system decrease, bacteria become more active and cause painful symptoms and can be detected in a urine test.

Diagnosis of bacteria in urine during pregnancy

Diagnosis of bacteria in urine during pregnancy is carried out every month, as the expectant mother undergoes tests regularly. This allows you to maintain the health of the woman and her unborn baby. For diagnosis, a glucose reduction test, Griess nitrite test and other methods are used.

Since the diagnosis is carried out in a clinic, doctors perform chemical tests that give quick results. Bacteriological methods determine the number of microbial colonies and the degree of bacteriuria. If bacteriuria occurs against the background of colonization of the periurethral area that appeared before pregnancy, then the disease is considered a risk factor for acute pyelonephritis.

Let's consider the main stages of diagnosing bacteria in urine during pregnancy:

• Instrumental and laboratory studies - ultrasound examination of the kidneys, blood and urine tests, excretory and survey urography, Doppler ultrasound of the renal vessels, screening tests.
• Differential diagnosis - doctors conduct a complete diagnosis of the pregnant woman’s body in order to determine the diseases that cause bacteria in the urine and identify asymptomatic bacteriuria.

In addition to diagnostic methods, a woman should consult a nephrologist, therapist, urologist and gynecologist. This will provide a complete picture of the causes of the disease and will allow you to create an effective treatment plan.

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Treatment of bacteria in urine during pregnancy

Treatment for bacteria in urine during pregnancy depends on diagnostic results. But every expectant mother should undergo treatment. There are several treatment methods, let's look at the main ones:

• Non-drug treatment

• Drug treatment

This type of treatment is carried out for both obvious and asymptomatic bacteriuria. The woman is prescribed a course of treatment for 1-3 weeks with cephalosporins, antimicrobial agents and ampicillin. This course of treatment is explained by the fact that during pregnancy a single dose of drugs is not enough. All medications are selected empirically. Antibacterial therapy followed by monthly bacteriological urine tests is mandatory. A woman can be prescribed maintenance therapy until the end of pregnancy and for 14 days of the postpartum process. This will help prevent relapses of bacteriuria.

The specifics of treatment also depend on complications during pregnancy. Let's look at the complications of gestation by trimester:

• Bacteria in the urine detected in the first trimester can cause miscarriage. For therapeutic purposes, standard therapy is used.
• In case of bacteriuria in the second and third trimesters, the woman undergoes onco-osmotherapy to maintain pregnancy. If bacteria become a threat to premature birth, the pregnant woman is given tocolytic therapy.

If bacteria in the urine appear due to urethritis, then the woman is given antibacterial therapy and uroantiseptics. The drug Monural is highly effective and can only be taken if the therapeutic benefit to the mother is more important than the possible risk to the fetus. Urethritis and bacteria in the urine are treated with Azithromycin, Doxycycline, Phytolysin or Canephron. The drug is selected by the attending physician and its use is strictly controlled.

In many cases, bacteria in urine is detected before pregnancy. The frequency of occurrence of this disease is influenced by the condition of the urinary tract and the sphincter mechanism of the bladder. When treating bacteriuria in the early stages of pregnancy, in 80% of cases it is possible to cure the disease without consequences for the body of the mother and child; in 5-7% of cases, bacteria lead to miscarriages and prematurity.

Prevention of bacteria in urine during pregnancy

Prevention of bacteria in urine during pregnancy is a method to prevent the development of the disease and protect the body of the expectant mother. Taking care of your health and the health of your unborn child is the primary task of every woman. To prevent bacteriuria, the expectant mother needs to:

• Regularly submit your urine for testing; to ensure the reliability of the results, you must use only sterile containers. Before taking the test, it is prohibited to consume alcohol, spicy and salty foods. Urine should be collected after washing, in the morning. Please note that no more than 2 hours should pass from the moment of urine collection to laboratory testing, since the composition of urine changes.
• A pregnant woman should maintain genital hygiene and avoid synthetic underwear. Synthetic underwear provokes the growth of pathogenic microorganisms, promotes the development of candidiasis and the appearance of bacteria in the urine in an ascending manner.
• Following the doctor's recommendations, regular examinations and taking prescribed medications will help protect against pathological changes during pregnancy.
• Prevention of urethritis caused by urine bacteria should begin with compliance with hygiene rules and a healthy lifestyle. Regular examinations with a gynecologist and an orderly sex life are the best methods of prevention.

According to medical statistics, bacteria are found in the urine of every fifth woman during pregnancy. Timely diagnosis and treatment can successfully cure bacteriuria.

Forecast of bacteria in urine during pregnancy

The prognosis of bacteria in urine during pregnancy depends on when the pathology was discovered. If bacteria are detected in the early stages, the prognosis is favorable, as doctors prescribe treatment that prevents the threat of miscarriage. With bacteriuria in the last months of pregnancy, the prognosis depends on the type of bacterial lesion and its cause.

If bacteria appear due to exacerbation of chronic diseases or physiological characteristics of the body, then the expectant mother is prescribed maintenance therapy and the prognosis for bacteria in the urine is favorable. But if a woman does not treat bacteriuria, this can cause serious consequences. For bacteria and urethritis, the prognosis depends on early diagnosis and therapeutic therapy. The earlier the disease is detected, the better the prognosis, even with purulent and gonorrheal urethritis.

Bacteria in urine during pregnancy is a problem that requires special attention and treatment. Timely diagnosis and therapy are the key to the health of the expectant mother and her child.

It is important to know!

Forced diuresis as a method of detoxification is based on the use of drugs that promote a sharp increase in diuresis; this is the most common method of conservative treatment of poisoning, in which the elimination of hydrophilic toxicants is carried out primarily by the kidneys.

A broad-spectrum antibiotic that creates high concentrations only in the bladder.

The effectiveness of Monural has been confirmed by numerous studies conducted in Russia and EU countries. The experience of using Monural includes hundreds of thousands of patients.

Urinary tract infections in pregnant women. Modern approaches to treatment

Published in the magazine:
Effective pharmacotherapy in obstetrics and gynecology. No. 1 January 2008

L.A. SINYAKOVA Doctor of Medical Sciences, Professor
I.V. KOSOVA
RMAPO, Moscow

In the first Russian manual on obstetrics, compiled by N.M. Maksimovich-Ambodik, “The Art of Weaving, or the Science of Womanhood” (1784) indicated close anatomical connections between the genital and urinary organs in women. What are the tactics for nephroureterolithiasis, nephroptosis, and other diseases that require surgical correction in pregnant women? The answer is clear: it is advisable to eliminate urological diseases before pregnancy. Pregnancy is a risk factor for the development of both uncomplicated (in 4-10% of cases) and complicated urinary tract infections.

Urinary tract infections in pregnant women can manifest as asymptomatic bacteriuria, uncomplicated lower urinary tract infections (acute cystitis, recurrent cystitis) and upper urinary tract infections (acute pyelonephritis).

The prevalence of asymptomatic bacteriuria in the population of pregnant women averages 6%. Acute cystitis and acute pyelonephritis are somewhat less common - in 1-2.5%. However, 20-40% of pregnant women with asymptomatic bacteriuria develop acute pyelonephritis in the second and third trimester (13). Acute pyelonephritis develops in the third trimester in 60-75% of cases (7). Approximately 1/3 of patients suffering from chronic pyelonephritis develop an exacerbation during pregnancy (8).

Table 1. Prevalence of asymptomatic bacteriuria in the population

Population groups	Prevalence, %
Healthy premenopausal women	1,0-5,0
Pregnant	1,9-9,5
Postmenopausal women over 50-70 years of age	2,8-8,6
Diabetes patients
women	9,0-27
men	0,7-11
Elderly patients living in the community, 70 years old
women	10,8-16
men	3,6-19
Elderly patients living in nursing homes
women	25-50
men	15-40
Patients with spinal cord injury
with intermittently removable catheter	23-89
with sphincterotomy and condom catheter	57
Hemodialysis patients	28
Patients with an indwelling catheter
short	9-23
long-term	100

Urinary tract infections can cause a number of serious complications of pregnancy and childbirth: anemia, hypertension, premature birth, premature rupture of membranes, low birth weight babies (<2500 г), что в свою очередь приводит к повышению перинатальной смертности в 3 раза (1).

The indications for termination of pregnancy, regardless of the period, are as follows.

1. Progressive renal failure, established based on the following criteria:
- creatinine value more than 265 µmol/l (3 mg%);
- glomerular filtration below 30 ml/min.

2. Increasing severity of hypertension, especially in malignant forms of its course. The high prevalence of urinary tract infections in pregnant women is explained by the following factors: a short wide urethra, its proximity to natural reservoirs of infection (vagina, anus), mechanical compression of the ureters by the uterus, decreased tone of the urinary tract, glycosuria, immunosuppression, changes in urine pH, etc.

The most common etiological factor in the development of urinary tract infections in pregnant women is Escherichia coli. The data is presented in Figure 1.

Figure 1. Etiology of urinary tract infections in pregnant women (AP1/1MB 2003)

* - Paeruginosa - 2.2%, S. agalactiae - 2.2%, Candida spp. - 0.5%, etc. - 1%

However, in his work on urinary tract infections during pregnancy, A.P. Nikonov (2007) gives higher figures for the occurrence of E. coli as a causative agent of urinary tract infections - up to 80%.

DIAGNOSTICS

According to the guidelines of the European Association of Urology from 2001, severe bacteriuria in adults:
1. ≥ 10 3 pathogenic microorganisms/ml in the middle portion of urine in acute uncomplicated cystitis in women;
2. ≥ 10 4 pathogenic microorganisms/ml in the middle portion of urine in acute uncomplicated pyelonephritis in women;
3. 10 5 pathogenic microorganisms/ml in midstream urine in men (or in urine collected from women with a direct catheter) with complicated UTI;
4. in a urine sample obtained by suprapubic puncture of the bladder, any number of bacteria indicates bacteriuria.

Asymptomatic bacteriuria in pregnant women is a microbiological diagnosis that is based on the examination of urine, collected with maximum sterility and delivered to the laboratory in the shortest possible time, which allows the growth of bacteria to be limited to the greatest extent. The diagnosis of asymptomatic bacteriuria can be established by detecting 10 5 CFU/ml (B-II) of one strain of bacteria in two urine samples taken more than 24 hours apart in the absence of clinical manifestations of urinary tract infections.

Considering the high probability of developing an ascending urinary tract infection in pregnant women with asymptomatic bacteriuria, the possibility of developing complications during pregnancy with the risk of death for the mother and fetus, all patients are advised to undergo screening examination and treatment of asymptomatic bacteriuria in pregnant women. The algorithm is presented in Figure 2.

Figure 2. Screening examination of pregnant women to detect asymptomatic bacteriuria

Clinical symptoms of acute cystitis in pregnant women are manifested by dysuria, frequent imperative urge to urinate, and pain over the pubis. Laboratory tests reveal pyuria (10 or more leukocytes in 1 μl of centrifuged urine) and bacteriuria: 10 2 CFU/ml for coliform microorganisms and 10 5 CFU/ml for other uropathogens.

In acute pyelonephritis, fever, chills, nausea, vomiting, and pain in the lumbar region appear. Pyuria and bacteriuria of more than 10 4 CFU/ml persist. In this case, in 75% the right kidney is affected, in 10-15% - the left kidney, in 10-15% there is a bilateral process (1).

Particular attention should be paid to the diagnosis of frequently recurrent cystitis, since they can occur against the background of urogenital infections and in such cases, neither urine culture nor clinical urine analysis may reveal changes. Such patients need to undergo an examination aimed at excluding sexually transmitted infections: scraping from the urethra for STIs using PCR, ELISA, and, if necessary, the use of serological diagnostic methods.

The algorithm for diagnosing urinary tract infections in pregnant women is presented in Table 2.

Table 2. Diagnosis of UTI in pregnant women

TREATMENT

When choosing an antimicrobial drug (AMP) for the treatment of UTIs in pregnant women, in addition to microbiological activity, level of resistance, pharmacokinetic profile, proven effectiveness of the drug, we must take into account its safety and tolerability.

Rational and effective use of antimicrobial drugs during pregnancy requires the following conditions:
- it is necessary to use drugs only with established safety during pregnancy, with known metabolic pathways (FDA criteria);
- when prescribing drugs, the duration of pregnancy should be taken into account: early or late. Since the time period for the final completion of embryogenesis cannot be determined, it is necessary to be especially careful when prescribing an antimicrobial drug for up to 5 months. pregnancy;
- during treatment, careful monitoring of the condition of the mother and fetus is necessary.

If there is no objective information confirming the safety of using a drug, including antimicrobial drugs, during pregnancy or breastfeeding, they should not be prescribed to these categories of patients.

aminopenicillins/BLI

cephalosporins I-II-III generation

fosfomycin trometamol

The following risk categories for the use of drugs during pregnancy, developed by the American Food and Drug Administration (FDA), are widely used throughout the world:
A- as a result of adequate, strictly controlled studies, no risk of adverse effects on the fetus was identified in the first trimester of pregnancy (and there is no data indicating a similar risk in subsequent trimesters).
B- animal reproduction studies have not revealed a risk of adverse effects on the fetus, and adequate and strictly controlled studies have not been conducted in pregnant women.
C- animal reproduction studies have revealed adverse effects on the fetus, and adequate and strictly controlled studies have not been conducted in pregnant women, however, the potential benefits associated with the use of drugs in pregnant women may justify its use, despite the possible risks.
D- there is evidence of the risk of adverse effects of the drug on the human fetus, obtained during research or in practice, however, the potential benefits associated with the use of the drug in pregnant women may justify its use despite the possible risk.

Treatment of asymptomatic bacteriuria in early pregnancy can reduce the risk of developing acute pyelonephritis in later pregnancy from 28% to less than 3% (9). Considering that pregnancy is a risk factor for the development of complicated infections, the use of short courses of antimicrobial therapy for the treatment of asymptomatic bacteriuria and acute cystitis is ineffective. An exception is fosfomycin trometamol (Monural) in a standard dosage of 3 g once, since in concentrations close to the average and maximum level, Monural leads to the death of all pathogens that cause acute cystitis within 5 hours, the activity of Monural against E. coli exceeds the activity of norfloxacin and co-trimoxazole (4). In addition, the concentration of the drug in urine in doses exceeding the MIC is maintained for 24-80 hours.

Fosfomycin trometamol is an ideal first-line drug in the treatment of acute cystitis in pregnancy. It has the necessary spectrum of antimicrobial activity, minimal resistance of primary uropathogens, resistant clones of microbes are damaged. It overcomes acquired resistance to antibacterial drugs of other groups and has bactericidal activity. According to Zinner, when using fosfomycin trometamol (n=153) 3g once, the cure rate for asymptomatic bacteriuria after 1 month was 93%.

Thus, for the treatment of lower urinary tract infections and asymptomatic bacteriuria in pregnant women, the use of monodose therapy is indicated - fosfomycin trometamol at a dose of 3 g; cephalosporins for 3 days - cefuroxime axetil 250-500 mg 2-3 times / day, aminopenicillins / BLI for 7-10 days (amoxicillin / clavulanate 375-625 mg 2-3 times / day; nitrofurans - nitrofurantoin 100 mg 4 times / day - 7 days (2nd trimester only).

In Russia, a study was conducted on the use of various drugs for the treatment of uncomplicated lower urinary tract infections in pregnant women, the data is presented in Table 4. At the same time, the frequency of incorrect prescriptions was 48%!!!

Table 4. Antibacterial therapy for infections of the lower parts of the bladder in pregnant women in Russia (Chilova R.A., 2006)

Table 5 presents the main adverse events when a number of drugs are prescribed during pregnancy.

Table 5. Risk of using medications during pregnancy

When identifying atypical pathogens (urea-mycoplasma infection, chlamydial infection) in patients with frequently recurrent cystitis, the use of macrolides (josamycin, azithromycin in standard dosages) in the trimester of pregnancy is indicated.

Emergency hospitalization is indicated for patients with acute pyelonephritis. The complex of laboratory diagnostic methods must include: general analysis of urine, blood, bacteriological examination of urine; Ultrasound of the kidneys and bladder. Monitor vital functions. The cornerstone of treatment for patients with gestational pyelonephritis is to resolve the issue of the need for drainage of the urinary tract and the choice of drainage method.

The indication for drainage of the urinary tract during pregnancy is the presence of acute pyelonephritis in the patient against the background of impaired urodynamics.

The choice of method of drainage of the urinary tract during pregnancy depends on: the causes of urodynamic disturbances (urinary tract disease, decreased tone of the urinary tract, compression by the uterus, reflux); timing of pregnancy; stages of pyelonephritis (serous, purulent).

In Table 6 we present methods of drainage of the urinary tract depending on the stage of pyelonephritis.

Table 6. Methods of drainage of the urinary tract during pregnancy with acute pyelonephritis (5)

Acute serous pyelonephritis	Acute purulent pyelonephritis
Position therapy: sleep on the “healthy” side, knee-elbow position for 10-15 minutes 3-4 times a day	Percutaneous puncture nephrostomy
Catheterization of the ureter - in the early stages during the serous phase of pyelonephritis	Open surgery: nephrostomy, decapsulation, kidney revision, dissection or excision of carbuncles, opening of abscesses
Ureteral stenting: Covered stents for 4-6 months Stenting ends with the installation of a urethral catheter Frequent urination after catheter removal Dynamic observation by a urologist throughout pregnancy! Timely change of stents Ultrasound control once a month Delivery with a drained urinary tract Stent removal 4-6 weeks after birth
Percutaneous puncture nephrostomy: in case of ineffectiveness of retrograde kidney drainage and progression of the infectious and inflammatory process
Operative nephrostomy in the absence of technical capabilities to perform PPNS

Antibacterial therapy is carried out only parenterally, followed by monitoring the effectiveness of treatment after 48-72 hours. Subsequently, correction of antibacterial therapy is carried out based on the results of bacteriological examination. The duration of therapy for the serous stage of inflammation is 14 days: 5 days - parenterally, then switch to the oral regimen. Drugs approved for use in pregnant women for the treatment of acute pyelonephritis include:

Amoxicillin/clavulanate 1.2 g IV 3-4 times a day

Cefuroxime sodium 0.75-1.5 g IV 3 times a day

Ceftriaxone 1-2 g IV once a day

Cefotaxime 1-2 g IV 3-4 times a day The advantages of using amoxicillin/clavulanate are its high activity against the key causative agent of UTI - E. coli (the level of resistance is lower than for fluoroquinolones), the drug has proven effectiveness in uncomplicated and complicated urinary tract infections, and is also the drug of choice in the treatment of urinary tract infections in children. It should be emphasized that amoxicillin/clavulanate does not increase the risk of congenital anomalies and deformities, which makes its use possible in the first trimester of pregnancy.

A similar study of the use of antimicrobial drugs was conducted regarding the treatment of patients with acute pyelonephritis during pregnancy and found that the frequency of incorrect prescriptions of antibacterial drugs was 78%. The data is presented in Table 7.

Table 7. Antibacterial therapy for pyelonephritis in pregnant women in Russia (Chilova R.A., 2006)

In Russia, a high level of resistance of Escherichia coli to ampicillin, amoxicillin and co-trimoxazole has been identified, and therefore it is not advisable to use these drugs. Data on the level of resistance of Escherichia coli in Russia are presented in Table 8.

Table 8. Resistance of E.coli isolated from patients with outpatient UTIs in Russia to oral antibiotics, % Rafalsky V.V., 2005

Table 9. Grading system for evaluating recommendations in clinical practice guidelines proposed by the Infectious Diseases Society of America and the US Public Health Service

Category, degree	Definition
Degree of validity for use
A	Convincing data for application; must always be taken into account
B	The evidence is moderately convincing; should generally be taken into account
C	Inconclusive evidence for use; at the discretion of
D	Evidence of moderate strength against use; generally should not be taken into account
E	Convincing evidence against use; should never be taken into account
Category of evidence
I	Evidence from 1 or more valid randomized controlled trials
II	Data obtained from 1 or more properly designed non-randomized clinical trials; cohort study or case-control study (preferably more than 1 center); multiple studies at certain intervals; impressive results obtained in uncontrolled experiments
III	Data based on the opinion of respected experts, clinical experience, presented in publications or reports of expert commissions

Currently, infectious diseases of the genitourinary system in women are characterized by polyetiology, a blurred clinical picture, a high frequency of mixed infections and a tendency to recur, which requires an integrated approach to diagnosis and treatment. The solution to the problem of antibacterial therapy in obstetrics and gynecology can be facilitated by: the creation of state standards and their strict compliance; creation of an expert council to revise standards; physicians' awareness of the principles of evidence-based medicine (1).

During pregnancy, the expectant mother is especially sensitive to her well-being. However, this cannot save the fairer sex from various pathologies and diseases. Often, expectant mothers encounter infections and diseases of the genitourinary system. This article will discuss what bacteriuria is during pregnancy. You will find out the main causes of this pathology, you will also be able to find out what asymptomatic bacteriuria during pregnancy is and understand whether it is worth treating. It is definitely worth talking about ways to correct this condition.

What is bacteriuria during pregnancy and why is it dangerous?

Under normal conditions, human urine is completely sterile. It doesn't even contain beneficial bacteria. While carrying a child, a woman's body undergoes very strong changes. The growing uterus puts pressure on neighboring organs and interferes with their normal functioning.

So, while carrying a baby, the expectant mother may experience constipation due to intestinal displacement, pain in the stomach, liver and gall bladder due to being pushed to the side. Bacteriuria is also a common concomitant of fetal development. During pregnancy, this condition can be very dangerous. It develops due to compression of the kidneys and urinary ducts. The situation is aggravated by the pathology of this system.

Why is bacteriuria dangerous during pregnancy? This is the question that is primarily asked by women who have been given this diagnosis. Since the uterus is located very close, pathological microorganisms can move from one membrane to another. When the reproductive organ becomes infected, an inflammatory process can develop, which will inevitably have a negative effect on the fetus.

Diagnosis of pathology

Bacteriuria during pregnancy is detected quite simply. The doctor may suspect the presence of the disease based on certain signs that the expectant mother pays attention to. However, in most cases, bacteriuria during pregnancy does not show any symptoms. That is why all women expecting a baby are often prescribed a urine test.

Bacteria in human waste can be detected through routine testing. Most often, doctors prescribe bacteriological culture.

Signs and symptoms of pathology

As mentioned above, asymptomatic bacteriuria during pregnancy is not unusual. Very often, the expectant mother does not suspect that pathological microorganisms live in her bladder and excretory system. Signs begin to appear only in particularly advanced situations.

• Most often, the symptoms of bacteriuria are pain and in this case we can talk about cystitis, which is a consequence of the proliferation of pathogenic microorganisms.
• A woman may also notice pain in the lower abdomen. During pregnancy, it spreads to the lateral areas. In this case, we may be talking about blockage of the urinary canals.
• The formation of stones and sand in the urine may be a consequence of the proliferation of pathogenic microflora. In this case, bacteriuria during pregnancy can cause inflammation of the kidneys and their adnexal zone. At the same time, doctors talk about the development of pyelonephritis.
• may cause false urges. However, most expectant mothers attribute this symptom to the growth of the uterus and its pressure on the bladder.
• Often the pathology is manifested by increased body temperature, weakness and a general broken state. At the same time, the woman does not even suspect that the reason lies in the proliferation of bacteria.

Bacteriuria during pregnancy: treatment

If a pathology is detected, it is worth starting treatment as early as possible. Only in this case is there a chance of a successful outcome. Otherwise, bacteriuria during pregnancy will only have a negative effect on the fetus.

The method of treatment is always chosen by the doctor. Before starting the correction, a woman needs to be tested to determine the sensitivity of microorganisms to one or another. Without this study, treatment may be useless.

Correction is always carried out taking into account the symptoms. In some cases, doctors use natural and safe remedies that can be taken throughout pregnancy. Most often, this method is chosen for asymptomatic bacteriuria. Also, antimicrobial drugs can be prescribed for treatment, which can only be used in the second and Let's consider some treatment methods.

Antimicrobial therapy

Antibacterial drugs are prescribed to women only after the 14-16th week of pregnancy. During this period, the fetus is reliably protected by the placental barrier. Most often, doctors prescribe the following drugs: Amoxicillin, Cefuroxime, Ceftibuten, Cephalexin, Nitrofurantoin, etc.

For expectant mothers, these drugs are usually prescribed for 3-5 days. Such treatment is quite sufficient. In this case, after the correction, it is worth taking a second test, which will show the effectiveness of the treatment or lack of benefit.

Safe treatment

Bacteriuria during pregnancy can be treated with some safe remedies. However, this method will only be effective in mild cases or in the absence of symptoms.

Most often, doctors prescribe medicinal and diuretic teas. These products include “Kidney tea”, “Brusniver” and so on. Capsules made from herbal ingredients are also used, for example, Canephron. These drugs can be used throughout the entire period of pregnancy. They do not have a negative effect on the baby’s health, but only alleviate the mother’s condition.

Healthy drink

For the treatment of bacteriuria during pregnancy, the expectant mother should drink at least two liters of clean liquid per day. This does not take into account tea, soup, milk and other products.

In addition, it is very useful to drink cranberry and lingonberry juice. It is better to prepare this drink yourself from frozen or fresh berries. If you do not have the necessary ingredients, you can buy a ready-made product in the supermarket.

Diet

During treatment of bacteriuria, you need to follow a certain diet. Expectant mothers should avoid salty and peppery foods. You should also avoid eating fatty and fried foods. It is strictly forbidden to drink vitamins containing calcium. This can provoke the formation of sand and kidney stones, which will aggravate the course of the disease.

Try to give preference to light vegetable dishes that contain a lot of fiber and coarse fibers. Eat boiled, baked and steamed foods.

Additional measures

To treat bacteriuria, it is necessary to relieve the kidneys and urinary tract as much as possible. This can be done with simple gymnastics. Take a knee-elbow position and stand in this position for about five minutes. Repeat the gymnastics several times a day.

Avoid sleeping and resting on your back. In this position, the uterus puts great pressure on the kidneys and promotes stagnation of urine in them. As a result of this process, active proliferation of bacteria occurs.

Take it regularly and monitor the condition of your bladder. This will allow you to start timely treatment if necessary and avoid complications.

Conclusion

Now you know what bacteriuria during pregnancy is. Remember that treatment of pathology should always be prescribed by a specialist. Independent choice of drugs may turn out to be incorrect and only cause a negative effect on the fetus. Be healthy!

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