Urinary Tract Infection (UTI) in pregnancy

28.06.2020

Urinary tract infections (UTIs) occur commonly during pregnancy. We treat UTIs more aggressively in pregnant women than in non-pregnant women. Urine samples should be sent for culture and empiric treatment is given while awaiting results. Only some antibiotics can be used during pregnancy to not to harm the fetus.

UTIs include acute cystitis, pyelonephritis and asymptomatic bacteriuria (positive urine culture without symptoms). Approximately 1-4 % of pregnant women may have acute cystitis and the incidence of asymptomatic bacteriuria during pregnancy is 2-10 %.

Many factors may increase the risk of developing UTIs during pregnancy. One of them is ureteral dilatation thought to occur due to hormonal effects and mechanical compression from the growing uterus. Ureteral dilation can cause bacteria to spread from the bladder to the kidneys, increasing the risk of pyelonephritis.

Acute cystitis in pregnancy

Pregnant women can have symptoms of cystitis even without an infection. That is why, in order to prevent potentially harmful antibiotic abuse, a urine sample should be sent for culture and, in the case of a pregnant woman. Empiric antibiotic treatment while awaiting the culture results and antibiotic sensitivity, should be considered case by case.

A seven day antibiotic treatment period is required to ensure eradication. Recurrent infections may have serious consequences for pregnant women, therefore, a longer course of antibiotics is used to avoid the higher rate of relapse with short courses. A follow-up urine culture can be requested one to two weeks after the antibiotic course has been completed to ensure eradication.

Paracetamol can be used to relieve pain associated with acute cystitis. Other measures to relieve symptoms such as urinary alkalinisation products and cranberry products are not recommended because evidence of their effectiveness is lacking and some products may interact with antibiotic treatment.