UTI DURING PREGNANCY_PRESENTED AT HMAI 2010

8/8/2019 UTI DURING PREGNANCY_PRESENTED AT HMAI 2010

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-DR ARCHANA NARANG, MEDICAL OFFICER (T), MD, ISM & H,

-DR SAURAV ARORA, SENIOR RESEARCH FELLOW, SHMC & H

[email protected]


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UTI:-

Common afliction to seek medicalattention

Infancy to old age

The most common infections during

pregnancy In pregnancy, the rate of progression of

lower UTI to pyleonephritis is reported tobe as high as 40 %


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UTI is defined as the presence of at least100,000 organisms per milliliter of urine

in an asymptomatic patient or as morethan 100 organisms per milliliter of urine

with accompanying pyuria (>7 WBCs/ml)in a symptomatic patient


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Usually Acute

Majority due to a single pathogen

Usually an Enterobacteriaceae 90% of all UTI

Gram negative bacilli

Common intestinal flora

Escherichia coli most commonly isolatedpathogen ~80% of all UTI


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Increased frequency and urgency of urination

Dysuria

Retropubic/suprapubic/renal area pain duringor after urination

Sudden onset of pain in one or both of the loinsradiating to iliac fossae and suprapubic area

Cloudy urine with unpleasant odor

Hematuria

Fever with rigors and vomiting


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Asymptomatic bacteriuria (ASB) More than 100,000 organisms/ml in 2 consecutive urine

samples in the absence of symptoms (found in 2-10% ofcases)

Most common pathogen-E coli. (Isolated in 80-85% ofcultures). Others are: Klebsiella pneumoniae (5%),Enterobacter species (3%), Group B beta-hemolytic

streptococcus (1%) Upper urinary tract infection (Cystitis)

Lower urinary tract infection (Acutepyelonephritis)


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Physiological changes during pregnancy

Hormonal and mechanical changesincrease the risk of urinary stasis inpregnancy resulting in urinanry tractinfections(UTI)

Difficulty in maintaining hygiene may alsolead to increase in frequency of urinarytract infections (UTI) in pregnant women


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Virulence Host factors

Infection No infection


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Fetal complications

Preterm labor, prematurity, low birthweight

Intrauterine growth retardation,neonatal death

Maternal complications

Anemia, hypertension, transient renalfailure

Acute respiratory distress syndrome,sepsis


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Untreated upper UTIs have been associatedwith a low birth weight, prematurity,premature labor, hypertension and/orpreeclampsia, anemia

There is increased tendency in progressionof lower UTIs (cystitis) to pyelonephritis inpregnant patients (40%of cases)


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A 27 year old pregnant female, dentist byprofession, in 30thweeks of gestation

presented with following symptoms: Pain in pubic region after urination

Increased frequency of urination

Increased urgency of urination

Cloudy urine with unpleasent smell

Her routine lab investigations done 15 days back were normal

On the basis of above symptoms Urinary Tract Infection was

suspected


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Urine: routine/microscopic

Dipstick to detect white blood cells

Reports revealed:

Turbid urine with traces of albumin

Pus cells 35-40/hpf

Epithelial cells many/hpf

Bacetria 1+/HPF


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URINARY TRACT INFECTION


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Homoeopathic treatment: Patient was puton Equisetum 30 on the basis of symptomsimilarity

Following symptoms were taken into

consideration:


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Severe dull pain in the bladder region as from distension,not better after urinating.

Frequent and intolerable urging to urinate, with severe pain

at close of urination; urine flows only drop by drop. Passes large quantity of clear, watery urine, without relief.

Sharp, burning, cutting pain in urethra while urinating.

Retention and dysuria during pregnancy and after delivery.

Albuminuria and involuntary urination.

Pain deep in region of right kidney, extending to lowerabdomen, with urgent desire to micturate; right lumbarregion painful.


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Auxillary methods adopted

Advise to increase fluid intake

Advise to empty bladder as soon as thereis urge to urinate

Review after 7 days with urine test -routine and microscopic


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Therapeutic, preventive and auxillarymeasures are to be continued

Follow up every week with urine routineinvestigation

Advise to report immediately if symptoms

worsen or she develops fever with rigors& vomiting, sudden severe pain in loins orrenal region


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Improvement in symptoms of dysuria

No Pain in pubic region

Urine examination after 2wks:

Albumin - Absent

Pus cells Ocassional

RBCs Absent

Bacteria - Absent


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UTIs are common complications ofpregnancy and may lead to significantmorbidity for both mother and fetus

All pregnant women should be screened forbacteriuria in the first trimester

Women with a history of recurrent UTI orurinary tract anomalies should have repeat

bacteriuria screening throughout pregnancy

All bacteriuria should be treated duringpregnancy


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Homoeopathic treatment of pregnant women forASB may prevent morbidity associated withsymptomatic UTIs

Treatment with Homoeopathic medicines is costeffective, safe and nontoxic to the fetus

If symptoms worsens or there is no improvementin lab parameters even after 10-15days of

treatment, patient should be referredWomen should be followed closely after

treatment of bacteriuria because recurrence mayoccur in up to one third of patients


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UTI DURING PREGNANCY_PRESENTED AT HMAI 2010

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