UTI in pregnancy

Dr Bronwyn Sinclair talks about urinary tract infection (UTI) in pregnancy. Bronwyn is an obstetric physician at Waitemata DHB and National Women’s Hospital in Auckland. She has an interest in the delivery of high end medical care for both general and obstetric patients at the front end of the hospital and works as an Acute Care (General) Physician at North Shore Hospital.

Topics

Why is UTI more common in pregnancy?
When should we test a pregnant woman’s urine?
What constitutes a significant result? A UTI?
When selecting an antibiotic what do we need to consider?
Asymptomatic bacteriuria - why do we need to worry?
The significance of Group B streptococcus
Uncomplicated cystitis- what symptoms do woman present with and management?
Pyelonephritis – clinical significance, symptoms and presentation on clinical examination
Should we ever treat women with pyelonephritis in the community?
Post discharge follow up of pyelonephritis
Are there any other measures a woman can do to prevent UTI?

Take home messages

All pregnant woman should have a midstream urine culture and sensitivity test at booking
Communication of UTI treatment and results should be communicated with the woman’s lead maternity carer
Group B Streptococcus needs prophylactic antibiotics in labour
Selection of antibiotic depends on gestation, local sensitivities and tissue penetration. Duration depends on indication and clinical response.
A follow up midstream urine should always been done post treatment of UTI 7/7 post-treatment and every four weeks for remainder of pregnancy.
Suspected pyelonephritis requires hospital admission