- Asymptomatic bacteriuria occurs in 2-7% of pregnant women.
- If they are not treated as many as 40-50% of these women will develop symptomatic UTI including pyelonephritis.
- Maternal complication of pyelonephritis include anemia, sepsis, RDS and ARDS.
- Untreated Bacteriuria has been associated with an increased risk of preterm birth, Low Birth Weight, and perinatal morbidity and mortality
- All Pregnant women should be screened twice during pregnancy for asymptomatic bacteriuria & all bacteriuric patient should be treated for 7 days with follow up cultures to identify relapses
- Penicillin and cephalosporin are deemed safe in pregnancy, Nitrofurantoin is bacteriostatic, it is ineffective against proteus species. Trimethoprim in first trimester has resulted in cardiovascular defect in new born.
- Fluroquinolones, Aminoglycoside, Sulphonamide should be avoided in pregnancy.
- Follow up – Due to 30% chances of persistence of infection, a follow up culture is done one week after antibiotic course.
- Acute pyelonephritis in pregnancy- Hospitalization should be done, I/V antibiotic are given until there is symptomatic improvement and no fever for 24-48 hour. I/V cephalosporin have equivalent efficacy to I/V Ampicillin plus gentamycin. In infections with extended spectrum Beta lactamase producing Enterobacteriaceae-carbapenem is antibiotic choice for empirical therapy.
- Persistence symptoms and fever beyond first 24-48 hour of treatment warrants a urine culture and renal ultrasound to rule out persistence infection and urinary tract pathology.
- Recurrent Pyelonephritis occurs in 6-8% hence low dose antimicrobial suppressive therapy with Nitrofurantoin or Cephalexin as in acute cystitis should be continued for rest of the pregnancy.
- Monthly cultures are not necessary during preventive therapy.
- However at least one culture should be done in later gestation.
- Oral antibiotic therapy can be switched over to according to C/S report once there is no fever for 48 hours and is continued for 10-14 days.
- Once they are afebrile, pregnant women can be discharged.
Dr. Sadhana Gupta.
FOGSI Presidential Candidate Election Year 2023.
Director & Senior Consultant,
Jeevan Jyoti Hospital & Medical Research Centre, Gorakhpur.