UTI during pregnancy

Urinary tract infections during pregnancy

What is a urinary tract infection?

When you hear the phrase "urinary tract infection" or its acronym, UTI, you're likely to think of a bladder infection and its accompanying symptoms ­– such as a frequent urge to urinate and a burning sensation when you do. This condition, also called cystitis, is fairly common among sexually active women between 20 and 50. But it's not the whole UTI story.

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In fact, you can have a UTI in any part of your urinary tract, which starts at the kidneys, where urine is made; continues through tubes called ureters down to the bladder, where urine accumulates until you pee; and ends with the urethra, a short tube that carries the urine outside your body.

UTIs are generally caused by bacteria from your skin, vagina, or rectum that enter your urethra and travel upstream. Often, the bacteria stop in your bladder and multiply there, causing inflammation and triggering those familiar symptoms.

But bacteria may also travel from your bladder, up through the ureters, to infect one or both kidneys. A kidney infection (also called pyelonephritis) is the most common serious medical complication of pregnancy. The infection can spread to your bloodstream and become life-threatening for you.

A kidney infection may also have serious consequences for your baby. It increases your risk of preterm labor and having a low-birth-weight baby, and it has been linked to an increased risk of fetal or newborn mortality.

It's also possible to have bacteria in your urinary tract and have no symptoms. This is known as "asymptomatic bacteriuria." When you're not pregnant, this condition generally doesn't cause problems and often clears on its own.

During pregnancy, however, asymptomatic bacteriuria that's left untreated significantly increases your risk of getting a kidney infection and is associated with preterm labor and low birth weight. This is one reason your urine is routinely tested during pregnancy.

Does pregnancy make me more likely to get a UTI?

It's not clear that pregnancy increases your risk of cystitis, and there's a fair amount of research showing that pregnancy does not make you more likely to have asymptomatic bacteriuria. However, pregnancy greatly increases the risk of getting a kidney infection.

Here's why: Higher levels of the hormone progesterone decrease the muscle tone of the ureters (the tubes between the kidneys and the bladder), causing them to dilate and slowing the flow of urine. Plus, as your uterus enlarges it may compress the ureters, making it that much more difficult for urine to flow through them as quickly and as freely as usual. 

Your bladder also loses tone during pregnancy. It becomes more difficult to completely empty your bladder, and your bladder becomes more prone to reflux, a condition where some urine flows back up the ureters toward the kidneys.

The upshot of these changes is that it takes longer for urine to pass through your urinary tract, giving bacteria more time to multiply and take hold before being flushed out, and it also becomes easier for the bacteria to travel up to your kidneys. What's more, during pregnancy your urine becomes less acidic and more likely to contain glucose, both of which boost the potential for bacterial growth.

What are the symptoms of a bladder infection?

Symptoms of a bladder infection (cystitis) vary from woman to woman. Common symptoms include:

• Pain, discomfort, or burning when urinating and possibly during sexual intercourse
• Pelvic discomfort or lower abdominal pain (often just above the pubic bone)
• A frequent or uncontrollable urge to pee, even when there's very little urine in the bladder

You may also find that your urine is foul smelling or looks cloudy. You may see blood in it as well. You might run a low-grade fever, but more often than not, your temperature will remain normal.

Since the frequent urge to pee is common during pregnancy, it may be hard to know for sure whether you have cystitis, especially if your symptoms are mild. If you think you might have an infection, be sure to call your healthcare provider so your urine can be tested.

What are the symptoms of a kidney infection?

If you have any signs pointing to a possible kidney infection, you need to get medical attention immediately. Symptoms often come on quite abruptly and commonly include: 

• A high fever (often with shaking, chills, or sweats)
• Pain in your lower back or side just under your ribs, on one or both sides, and possibly in your abdomen
• Nausea and vomiting

You may also notice blood or pus in your urine and may have some symptoms of cystitis as well.

What happens if I have asymptomatic bacteriuria while I'm pregnant?

Asymptomatic bacteriuria is associated with preterm birth and low birth weight. And if the bacteriuria isn't treated, your chance of developing a kidney infection may be as high as 40 percent. However, with adequate treatment your risk goes down dramatically, to between 1 and 4 percent.

To find out whether there's bacteria in your urinary tract, your practitioner will collect urine at your first prenatal visit and send it to a lab for testing, whether you have symptoms or not. If this initial urine culture is negative, your chances of developing a UTI later in pregnancy are small.

If the culture is positive, you'll be treated with oral antibiotics that are safe to take during pregnancy. Taking the full course of antibiotics, usually for a week, should clear the infection.

After treatment, you'll be tested again to make sure the infection is gone. (If it's not, you'll be retreated using a different antibiotic.) Repeat urine cultures should be done at regular intervals throughout your pregnancy to make sure you don't have another infection. If the bacteriuria recurs, you'll be treated again and likely be put on a continuous low dose of antibiotics for the remainder of your pregnancy to prevent yet another recurrence.

What happens if I get a bladder infection?

If you develop a bladder infection (cystitis) during your pregnancy, the drill is similar, though you might be given a slightly shorter course of oral antibiotics. The antibiotics will probably relieve your symptoms within a few days, but it's important to complete the entire course that your caregiver prescribed in order to get rid of all of the bacteria in your urinary tract.

You'll be tested after treatment and periodically thereafter (as well as any time symptoms recur) and retreated if necessary. If you keep getting bladder infections, you'll need to take a low dose of antibiotics daily for prevention.

What happens if I develop a kidney infection?

If you develop a kidney infection during pregnancy, you'll be hospitalized and started on intravenous fluid and antibiotics, and you and your baby will be carefully monitored.  Your caregivers will be assessing a variety of things, including your temperature, blood pressure, pulse, breathing, and ability to make urine; your baby's heart rate; and whether you have any signs of premature labor. 

The length of hospitalization for a kidney infection varies, depending on your individual situation. If, after an initial 12- to 24-hour assessment, it's clear that you have a mild case, you're responding well to treatment, and preterm labor is not a concern, your caregiver may decide to discharge you from the hospital and switch you to oral antibiotics for the remainder of your treatment.

On the other hand, if you have a severe case, you'll need to remain in the hospital for further treatment and monitoring, and you won't be discharged until 24 to 48 hours after your temperature returns to normal and you no longer have any symptoms. 

Once you complete your treatment, you'll be put on a regimen of low-dose antibiotics for the remainder of your pregnancy to help prevent another infection. Without daily suppressive therapy, your risk of getting another kidney infection is very high.

What can I do to avoid getting a UTI?

Take these steps to minimize your chances of getting a urinary tract infection:

• Drink plenty of water, at least eight 8-ounce glasses a day.
• Don't ignore the urge to pee. And try to empty your bladder completely when you urinate.
• After a bowel movement, wipe yourself from front to back to prevent bacteria in the stool from getting near the urethra.
• Keep your genital area clean with mild soap and water.
• Clean your genital area and pee before and after sexual intercourse.
• Drink cranberry juice. Studies show that cranberry juice – and its relative, lingonberry juice – can reduce bacteria levels and discourage new bacteria from taking hold in the urinary tract. (Drinking cranberry juice won't cure an existing infection, though, so if you're having symptoms, you still need to see your practitioner right away to get a prescription for antibiotics.)
• Avoid feminine hygiene products (sprays or powders) and strong soaps that can irritate your urethra and genitals, making them a better breeding ground for bacteria. And don't use douches during pregnancy.

This article is from babycenter.  View it here