Asymptomatic Bacteruria in Pregnancy

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Definition

-  Positive urine culture (MCS) in pregnancy without S/S of UTI

 

Features

-  2-7% pregnancies

-  Picked up on routine MCS during antenatal screening

-  Screening at 12-16/40

-  Usually in 1st month of pregnancy

-  Increased incidence of pyelonephritis (smooth m. relaxation + urethral dilation)

 

Risk Factors

-  Low socioeconomic group

-  Multiparous

-  Recurrent UTIs

-  UTI prior to pregnancy

 

Complications

-  40% risk acute cystitis (UTI)

-  20-40% risk pyelonephritis (UTI)

-  Preterm delivery 10%

-  Low birth weight 54% higher risk

-  Increased perinatal mortality

 

Associated S/S

-  Asymptomatic

 

Ix

-  +/- Disptick: leukocyte esterase, nitrites

-  90% specificity, 50% sensitivity

-  MSU for MCS: >10(5) organisms/ml

-  Gold standard 

 

Mx

-  Abx

-  Decrease incidence of pyelonephritis, preterm delivery & low birth weight

-  Cephalexin 500mg PO 12/24 for 5/7

-  OR Nitrofurantoin 100mg PO 12/12 for 5/7

-  OR Amoxycillin + Clavulanic Acid (Augmentin Duo) 500/125mg PO 12/24 for 5/7

-  Repeat MCS 48hrs+ post completion of 5/7 Abx to confirm clearance

 

 

 

References

 

Upto Date: UTI & Aymptomatic Bacteruria in Pregnancy, 19/12/2011

emedicine.medscae.com/article/452604-overview

3Centres: Antenatal Screening for Asymptomatic Bacteruria, 06/08/2010