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(See also Urinary Tract Infections (UTI).)
UTI is common during pregnancy, apparently because of urinary stasis, which results from hormonal ureteral dilation, hormonal ureteral hypoperistalsis, and pressure of the expanding uterus against the ureters. Asymptomatic bacteriuria occurs in about 15% of pregnancies and sometimes progresses to symptomatic cystitis or pyelonephritis. Frank UTI is not always preceded by asymptomatic bacteriuria. Asymptomatic bacteriuria, UTI, and pyelonephritis increase risk of preterm labor and premature rupture of the membranes.
Urinalysis and culture at initial evaluation are routinely done to check for asymptomatic UTI. Diagnosis and treatment of symptomatic UTI is not changed by pregnancy, except drugs that may harm the fetus are avoided (see Table 2: Pregnancy Complicated by Disease: Drugs With Adverse Effects During Pregnancy  ). Antibacterial drug selection is based on individual and local susceptibility and resistance patterns, but cephalexin , nitrofurantoin , or trimethoprim-sulfamethoxazole are usually good initial empiric choices. After treatment, proof-of-cure cultures are required. Women who have pyelonephritis or have had > 1 UTI may require suppressive therapy, usually with trimethoprim-sulfamethoxazole or nitrofurantoin , for the rest of the pregnancy. In women who have bacteriuria with or without UTI or pyelonephritis, urine should be cultured monthly.
Last full review/revision November 2005
Content last modified November 2005
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