Urinary tract infections during pregnancy are not rare, as they affect about 10% of all pregnant women. Besides that, they are dangerous for both – the mother and the fetus as urinary tract infections can cause miscarriage or premature birth. Pregnancy is a specific physiological state, during which the body undergoes various anatomical, physiological and hormonal changes that are the reasons for more infections of the pregnant woman.
Enlarged uterus, which presses the bladder, is the cause pregnant women urinate more frequently being compared to non-pregnant women. However, the bladder can not empty completely and there remains a certain amount of residual urine, which stays on longer and is prerequisite for infections. On the other hand, this compression leads to a change of the angle of injection of the urethras into the bladder, which in turn is the cause of the so called vesicoureteral reflux, whereby a part of the urine during urination is back to the kidneys, and may be reason for the spread of urine from the bladder to the kidneys which is the reason the cystitis to go to pyelonephritis.
Urinary Tract Infections – Hormonal factors
Progesterone, which is secreted in large amounts during pregnancy, results in relaxation of the muscles of the urinary tract. This is the reason for the low tone of the bladder sphincter, which further facilitates the penetration of bacteria from outside into the bladder, as well as reduced motility of the ureter, which in turn further enhances vesicoureteral reflux and residence time of urine in the urinary tract.
Urinary Tract Infections – Physiological factors
During pregnancy the urine of women is more alkaline (normal is acidic) and it is excreted in large amounts, sugars and glucose and becomes a very favorable environment for bacteria. On the other hand, during pregnancy the amount of bacteria in the vagina and the perineum respectively is larger, and in combination with good broth, as is the high sugar urine, further increases the risk of infection.
The most common form of infection in pregnant women (5-10% of pregnancies) is called asymptomatic bacteriuria in which complaints are missing or much less pronounced. Asymptomatic bacteriuria occurs most frequently in the first two months of pregnancy and about 10% of cases can be complicated and lead to pyelonephritis. It is proved by the microbiological examination of sterile urine (more than 100 000 cells / ml.) And this is the reason for the active and demand among pregnant by monthly urine testing since it can not rely on the lack of complaints.
Another common form of urinary tract infection in women is cystitis (bladder infection), which is manifested by typical frequent and painful urination, but in pregnancy are not as severe as in the case of non-pregnant and sometimes wrong can be attributed to frequent urination by pressing bladder enlarged uterus. Diagnosis is based on typical symptoms and microbiological testing of sterile urine.
Untreated cystitis and asymptomatic bacteriuria can be complicated with pyelonephritis (1-2% of pregnancies) in which the infection has affected and kidney. Usually the beginning of pyelonephritis is an acute pain in the lumbar region, accompanied with fever and frequent and painful urination and others.Pyelonephritis is the most common cause of fever in pregnancy. Like other forms of urinary tract infection and pyelonephritis proves microbiological, as it leads us to appropriate clinical symptoms.
Of course, a suspected infection is advisable to do ultrasound of the kidneys and bladder, not so much to prove the infection as to exclude other predisposing to her condition or complications (kidney stones, blockage of the kidney congenital anomalies, etc.).
Urinary Tract Infections Treatment
Treatment of urinary tract infections during pregnancy is really individual and depends mainly on the type of infection (cystitis, pyelonephritis, etc.) and must be selected such antibacterial agents that do not cross the placental barrier and therefore do not harm fetus. Usually the treatment of cystitis and asymptomatic bacteriuria begins immediately after giving sterile urine, and subsequently can be adjusted according to bacteriologic. It lasts between 3 and 10 days, it is advised to control microbiology one week after completion of therapy and subsequently every three months to the end of pregnancy. It is especially important that patients should be given recommendations for preserving optimal fluid intake and good intimate hygiene because most infections become next to bacteria coming from the vagina or rectum.