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Urinary tract infections during pregnancy

by Urology Today
September 8, 2020
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What is a urinary tract infection?
When you hear the phrase “urinary tract infection” or its acronym, UTI, you’re likely to think of a bladder infection and its accompanying symptoms ­– such as a frequent urge to urinate and a burning sensation when you do. This condition, also called cystitis, is fairly common among sexually active women between 20 and 50. But it’s not the whole UTI story.

In fact, you can have a UTI in any part of your urinary tract, which starts at the kidneys, where urine is made; continues through tubes called ureters down to the bladder, where urine accumulates until you pee; and ends with the urethra, a short tube that carries the urine outside your body.

UTIs are generally caused by bacteria from your skin, vagina, or rectum that enter your urethra and travel upstream. Often, the bacteria stop in your bladder and multiply there, causing inflammation and triggering those familiar symptoms.

But bacteria may also travel from your bladder, up through the ureters, to infect one or both kidneys. A kidney infection (also called pyelonephritis) is the most common serious medical complication of pregnancy. The infection can spread to your bloodstream and become life-threatening for you.

A kidney infection may also have serious consequences for your baby. It increases your risk of preterm labor and having a low-birth-weight baby, and it has been linked to an increased risk of fetal or newborn mortality.

It’s also possible to have bacteria in your urinary tract and have no symptoms. This is known as “asymptomatic bacteriuria.” When you’re not pregnant, this condition generally doesn’t cause problems and often clears on its own.

During pregnancy, however, asymptomatic bacteriuria that’s left untreated significantly increases your risk of getting a kidney infection and is associated with preterm labor and low birth weight. This is one reason your urine is routinely tested during pregnancy.

Does pregnancy make me more likely to get a UTI?
It’s not clear that pregnancy increases your risk of cystitis, and there’s a fair amount of research showing that pregnancy does not make you more likely to have asymptomatic bacteriuria. However, pregnancy greatly increases the risk of getting a kidney infection.

Are UTIs serious?
Most UTIs are not serious, but some infections can lead to serious problems, such as kidney infections. Chronic kidney infections – infections that recur or last a long time-can cause permanent damage, including kidney scars, poor kidney function, high blood pressure, and other problems. Some acute kidney infections – infections that develop suddenly – can be life threatening, especially if the bacteria enter the bloodstream, a condition called septicemia.

Here’s why: Higher levels of the hormone progesterone decrease the muscle tone of the ureters (the tubes between the kidneys and the bladder), causing them to dilate and slowing the flow of urine. Plus, as your uterus enlarges it may compress the ureters, making it that much more difficult for urine to flow through them as quickly and as freely as usual.

AMOXICILLIN Adverse Reactions

AMOXICILLIN is one of the most commonly used antibiotics in the world. It belongs to the spectrum of β-lactam antibiotics, and is the drug of choice when it comes to treating bacterial infections, as it is well absorbed even when given orally. Hence, it is used to treat a variety of infections, including infections of the ear, nose throat, skin infections, urinary tract infections, lower respiratory tract infections, gonorrhea and other sexually transmitted infections etc. AMOXICILLIN for sinus infection treatment is also a very well-known use of this drug. Thus, its multipurpose use makes this drug a very popular one among medical practitioners. However, amoxicillin side effects are something that doctors need to be well aware of, so as to prevent them from occurring, as they can be life-threatening at times.

One of the most serious and dangerous of all side effects is anaphylactic reaction. An anaphylactic reaction is defined as a life-threatening type 1 hypersensitivity reaction to a drug which is given internally or orally. Around 1500 patients die yearly due to an anaphylactic reaction in the United States. However, this serious allergic response of the body only occurs in those patients that have a true allergy to penicillin and its derivatives, as opposed to people who present with pseudo-anaphylaxis or an anaphylactoid reaction. An anaphylactic reaction is characterized by the following signs and symptoms:

  – Normally, a true anaphylactic reaction with systemic signs and symptoms begin showing within 72 hours of exposure to the allergen, without the need of further exposure. Skin involvement is one of the first signs seen. This includes generalized hives, skin rashes, itchiness, flushing. Fever is often experienced by people, along with the skin rashes.
  – Swelling of lips, tongue and/or throat is also seen, as this is the body’s way of responding and fighting the inflammation.
  – Respiratory distress, in the form of difficulty in breathing, shortness of breath, wheezing etc. may also be seen.
  – Some patients may also complain of gastrointestinal problems like severe abdominal cramps, stomach pain, diarrhea etc.
  – Other serious effects that may occur if immediate action is not taken to deal with the symptoms includes coronary artery spasms, which may lead to myocardial infarction. Consequently, there may also be a sudden drop in blood pressure, which may lead to lightheadedness and fatigue, along with loss of consciousness.

Your bladder also loses tone during pregnancy. It becomes more difficult to completely empty your bladder, and your bladder becomes more prone to reflux, a condition where some urine flows back up the ureters toward the kidneys.

How are UTIs diagnosed?
To find out whether a person has a UTI, the health care provider will ask about urinary symptoms and then test a sample of urine for the presence of bacteria and white blood cells, which are produced by the body to fight infection. Because bacteria can be found in the urine of healthy individuals, a UTI is diagnosed based both on symptoms and a laboratory test. The person will be asked to give a “clean catch” urine sample by washing the genital area and collecting a “midstream” sample of urine in a sterile container. This method of collecting urine helps prevent bacteria around the genital area from getting into the sample and confusing the test results. Usually, the sample is sent to a laboratory, although some health care providers’ offices are equipped to do the testing. For people with recurring infections and patients in the hospital, the urine may be cultured. The culture is performed by placing part of the urine sample in a tube or dish with a substance that encourages any bacteria present to grow. Once the bacteria have multiplied, which usually takes 1 to 3 days, they can be identified. The health care provider may also order a sensitivity test, which tests the bacteria for sensitivity to different antibiotics to see which medication is best for treating the infection.

The upshot of these changes is that it takes longer for urine to pass through your urinary tract, giving bacteria more time to multiply and take hold before being flushed out, and it also becomes easier for the bacteria to travel up to your kidneys. What’s more, during pregnancy your urine becomes less acidic and more likely to contain glucose, both of which boost the potential for bacterial growth.

“The Patch is birth control that works with my busy life.”

What is ORTHO EVRA®

–  ORTHO EVRA® is a contraceptive patch used for the prevention of pregnancy.
–  ORTHO EVRA® is available by prescription only.
–  ORTHO EVRA® does not protect against HIV (AIDS) or other sexually transmitted diseases.
–  ORTHO EVRA® should not be used if you smoke cigarettes and are over 35 years old.

The ORTHO EVRA patch is used as follows: it is applied on the first day of your menstrual cycle or the first Sunday following that day, whichever is preferred. From this time on, that day is considered “patch change day.” When patch change day rolls around the following week, the first patch is removed and replaced with another. This happens once more. On the fourth patch change day the patch is removed and left off for one week, until the next patch change day when the cycle begins again.

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What are the symptoms of a bladder infection?
Symptoms of a bladder infection (cystitis) vary from woman to woman. Common symptoms include:
– Pain, discomfort, or burning when urinating and possibly during sexual intercourse
– Pelvic discomfort or lower abdominal pain (often just above the pubic bone)
– A frequent or uncontrollable urge to pee, even when there’s very little urine in the bladder

You may also find that your urine is foul smelling or looks cloudy. You may see blood in it as well. You might run a low-grade fever, but more often than not, your temperature will remain normal.

Since the frequent urge to pee is common during pregnancy, it may be hard to know for sure whether you have cystitis, especially if your symptoms are mild. If you think you might have an infection, be sure to call your healthcare provider so your urine can be tested.

What are the symptoms of a kidney infection?
If you have any signs pointing to a possible kidney infection, you need to get medical attention immediately. Symptoms often come on quite abruptly and commonly include:
– A high fever (often with shaking, chills, or sweats)
– Pain in your lower back or side just under your ribs, on one or both sides, and possibly in your abdomen
– Nausea and vomiting

You may also notice blood or pus in your urine and may have some symptoms of cystitis as well.

What happens if I have asymptomatic bacteriuria while I’m pregnant?
Asymptomatic bacteriuria is associated with preterm birth and low birth weight. And if the bacteriuria isn’t treated, your chance of developing a kidney infection may be as high as 40 percent. However, with adequate treatment your risk goes down dramatically, to between 1 and 4 percent.

To find out whether there’s bacteria in your urinary tract, your practitioner will collect urine at your first prenatal visit and send it to a lab for testing, whether you have symptoms or not. If this initial urine culture is negative, your chances of developing a UTI later in pregnancy are small.

If the culture is positive, you’ll be treated with oral antibiotics that are safe to take during pregnancy. Taking the full course of antibiotics, usually for a week, should clear the infection.

After treatment, you’ll be tested again to make sure the infection is gone. (If it’s not, you’ll be retreated using a different antibiotic.) Repeat urine cultures should be done at regular intervals throughout your pregnancy to make sure you don’t have another infection. If the bacteriuria recurs, you’ll be treated again and likely be put on a continuous low dose of antibiotics for the remainder of your pregnancy to prevent yet another recurrence.

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What happens if I get a bladder infection?
If you develop a bladder infection (cystitis) during your pregnancy, the drill is similar, though you might be given a slightly shorter course of oral antibiotics. The antibiotics will probably relieve your symptoms within a few days, but it’s important to complete the entire course that your caregiver prescribed in order to get rid of all of the bacteria in your urinary tract.

You’ll be tested after treatment and periodically thereafter (as well as any time symptoms recur) and retreated if necessary. If you keep getting bladder infections, you’ll need to take a low dose of antibiotics daily for prevention.

What happens if I develop a kidney infection?

If you develop a kidney infection during pregnancy, you’ll be hospitalized and started on intravenous fluid and antibiotics, and you and your baby will be carefully monitored.  Your caregivers will be assessing a variety of things, including your temperature, blood pressure, pulse, breathing, and ability to make urine; your baby’s heart rate; and whether you have any signs of premature labor.

The length of hospitalization for a kidney infection varies, depending on your individual situation. If, after an initial 12- to 24-hour assessment, it’s clear that you have a mild case, you’re responding well to treatment, and preterm labor is not a concern, your caregiver may decide to discharge you from the hospital and switch you to oral antibiotics for the remainder of your treatment.

On the other hand, if you have a severe case, you’ll need to remain in the hospital for further treatment and monitoring, and you won’t be discharged until 24 to 48 hours after your temperature returns to normal and you no longer have any symptoms.

Once you complete your treatment, you’ll be put on a regimen of low-dose antibiotics for the remainder of your pregnancy to help prevent another infection. Without daily suppressive therapy, your risk of getting another kidney infection is very high.

What can I do to avoid getting a UTI?
Take these steps to minimize your chances of getting a urinary tract infection:
– Drink plenty of water, at least eight 8-ounce glasses a day.
– Don’t ignore the urge to pee. And try to empty your bladder completely when you urinate.
– After a bowel movement, wipe yourself from front to back to prevent bacteria in the stool from getting near the urethra.
– Keep your genital area clean with mild soap and water.
– Clean your genital area and pee before and after sexual intercourse.
– Drink cranberry juice. Studies show that cranberry juice – and its relative, lingonberry juice – can reduce bacteria levels and discourage new bacteria from taking hold in the urinary tract. (Drinking cranberry juice won’t cure an existing infection, though, so if you’re having symptoms, you still need to see your practitioner right away to get a prescription for antibiotics.)
– Avoid feminine hygiene products (sprays or powders) and strong soaps that can irritate your urethra and genitals, making them a better breeding ground for bacteria. And don’t use douches during pregnancy.

###

BabyCenter, L.L.C.

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