Complications of UTI in pregnancy

• Pregnant women are at higher risk of developing lower urinary tract infections and pyelonephritis
• Urinary tract infections in pregnant women increase the risk of preterm delivery
• They may also increase the risk of other adverse pregnancy outcomes, such as low birth weight and pre-eclampsia

Asymptomatic bacteriuria

• Refers to bacteria present in the urine, without symptoms of infection
• Pregnant women are tested for asymptomatic bacteriuria  at booking and routinely throughout pregnancy
• Testing for bacteria in the urine of asymptomatic patients is not recommended as it may lead to unnecessary antibiotics; Pregnant women are an exception to this rule, due to the adverse outcomes associated with infection

Management

Antibiotics for UTI or asymptomatic bacteriuria during pregnancy

• First line:
  • 1st or 2nd trimester nitrofurantoin MR 100mg bd or 50mg qds
  • 3rd trimester trimethoprim 200mg bd
• 2nd line (any trimester) cefalexin 500mg tds or as per sensitivities
• Treat for 7 days and sample for test of cure