Sunday, 24 July 2011

Urinary Tract Infection in Pregnant Women

Published in Panorama

Treating Urinary Tract Infection in Pregnant Women

Of late Samira was often complaining of feeling tired, having lower abdominal pains and pain while urinating. She was expecting her first baby and wondered if something was going wrong with her pregnancy. She decided not to wait for her monthly checkup and decided to see her gynaecologist earlier. She was diagnosed as suffering from Urinary Tract Infection (UTI) and thanks to her presence of mind in consulting her doctor, she was immediately given appropriate treatment for the condition which saved her and her baby from any complication associated with the UTI.

57 year old Seema was having increased frequency of urination which she attributed to her diabetes. In addition, she began having low back pain also. However, on undergoing medical checkup for elevated blood sugar, she was diagnosed as having UTI also.

During the course of a routine annual checkup, Vibha was diagnosed as having UTI of the lower tract, though she did not have any symptoms of the condition at all! Not satisfied with the report, she went in for a second opinion and underwent a second urine examination. This also confirmed UTI.

UTIs are the most common of all infections and can occur at any time in the life of an individual. However, UTI is more common in women because of the urethra being short and even in this category of individuals, it is likely to be commoner in recently married women, in women past their menopause, in pregnant women and in women who have a history of diabetes, kidney stones or any other bladder disease. The reason for UTI being common in pregnancy is because the immunity level of women is lowered during this period, reveals Dr.Anitha George Agnel, Obstetrician and Gynaecologist, Al Musalla Medical Centre, Dubai.

UTI is an inflammation in the urinary tract caused by bacteria that multiply and spread in the urinary passage. The infection may involve the lower urinary tract (LUT) comprising the urethra (the tube draining the urine from the bladder) and bladder, or the upper urinary tract (UUT) as well, comprising the ureter and kidney as well. Explaining the course of the disease, Dr.Anitha clarifies that the infection-causing bacteria spread from the rectum to the urethra and then to the bladder or kidneys as the case may be. When infection is restricted to the bladder, there will be constant contraction of the bladder, leading to a constant urge to urinate and the condition is termed cystitis. If left untreated, the infection can travel upwards from the bladder and spread to the kidneys, thus resulting in pyelonephritis.

Besides the lowered immunity level during pregnancy, in early pregnancy because of excessive vomiting, intake of water is reduced and there is dehydration. And this is one cause of UTI in pregnancy.

While a person having UTI can present with absolutely no symptoms initially, general symptoms of UTI include frequent urination, pain and burning while urinating, lower abdominal pain, chills and fever, sweating, nausea and vomiting, leaking of urine or passing of urine frequently in small quantities and blood in the urine.

However, there are other disease conditions which can present with similar symptoms. For instance, lower abdominal pains may be present in women when they have pelvic inflammatory disease or endometriosis or even appendicitis. Similarly, fever is also present in appendicitis. Also, vomiting may be present in both appendicitis and UTI. Excessive urination is also present in diabetes. However, burning sensation while urinating is more specific to UTI, explains Dr.Anitha.

Diagnosis of UTI requires proper history taking and routine urine analysis. Besides, clinical examinations would include a pelvic examination and to check for tenderness of the bladder or the kidney area of the back.

If the routine urine analysis reveals infection, then a urine culture test is done to identify the exact strain of bacteria causing the infection. Further, a culture sensitivity test is also done which will identify the antibiotics that the bacteria are susceptible to.

Some women may develop recurrent infection or symptoms even after taking treatment. In such instances, it is important for additional diagnostic measures in them. These would include a cystoscopy, which is an examination of the inside of the bladder, an intravenous pyelogram, a special type of X Ray of the upper urinary tract with the kidneys, ureters and bladder and an ultrasound scan of the urinary tract.

While UTI patients are more prone to anemia, the other way round is equally true: individuals suffering from anaemia, are more prone to UTI. Routine blood test should also be done to see if the women are anemic. In the case of pregnant women, blood test is again a part of routine checkup and this is an additional reason that it should not be missed, says Dr.Anitha.

Untreated UTI can lead to the infection spreading upwards to the UUT. It can even cause total loss of urine and renal failure, reveals Dr.Anitha. In the case of pregnant women, if an UTI is not treated properly it can even cause pregnancy loss in early pregnancy. Also, it can induce pre-term labour and intra-uterine growth retardation of the baby. Other complications may set in if the kidneys also become infected. UTI in the mother can cause growth retardation in the baby and other problems of prematurity as well.

Hence it is very important to treat UTI in pregnancy even if it is very mild, emphasizes Dr.Anitha. “This is the reason why, even though a woman may not complain of any symptoms, we have to do a proper urine analysis each time she comes for a check up. This is done regardless of whether a pregnant woman is classified as high risk or no risk of UTI, because pregnancy itself increases the risk of UTI!”

If UTI is discovered during routine urine analysis or even otherwise because of presenting symptoms, treatment of the pregnant women is a must. Dr.Anita emphasizes, “First and foremost we advise her to take plenty of fluids, particularly water, to prevent her body from getting dehydrated. There are certain antibiotics that can be safely taken during pregnancy for UTI. These drugs are very safe for the foetus also. But to exercise caution, even these medications are best avoided during the first trimester of pregnancy. However, if the UTI is very severe, the benefits of treating the woman with these antibiotics is greater, than not treating the condition at all and thus putting the mother and child at risk of other complications.”

Drinking plenty of fluids – water, fresh juices, buttermilk, would help keep UTI at bay. Also, totally evacuation of the bladder while urinating, would prevent infection from happening.


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