Urinalysis for asymptomatic bacteriuria in pregnant women, treatment. Reasons for the appearance of bacteria in urine during pregnancy - effects on the fetus and treatment

Bacteria in urine during pregnancy is a signal from the body about pathological processes that require treatment and medical attention. Let's look at the main causes of bacteria in urine, diagnostic methods, symptoms and treatment methods.

During pregnancy, a woman has to undergo many tests that allow her to monitor the health of the expectant mother and her child. Urinalysis is considered one of the most important. Bacteria in urine occurs very often, but there is no clear explanation for this phenomenon. Therefore, there is such a thing as bacteriuria in pregnant women.

The presence of bacteria may indicate inflammation in the kidneys. This may be cystitis, pyelonephritis and other diseases, the risk of which increases during pregnancy. But such a condition is not beneficial either for the expectant mother or for her unborn child. And in some cases it can lead to pathological consequences. A particular danger arises with asymptomatic bacteriuria; in this case, the disease proceeds without any manifestations.

Many doctors claim that bacteria found in the urine during pregnancy indicate a high risk of premature birth. Very often the following are found in urine: Escherichia coli in 80% of cases, Klebsiella, Proteus, streptococci, Enterobacter, fecal enterococcus, staphylococci and others. Each case requires treatment and medical care.

Causes of bacteria in urine during pregnancy

The causes of bacteria in urine during pregnancy are very varied. The constantly enlarging uterus puts pressure on the kidneys, disrupts their normal functioning, and leads to the appearance of harmful microorganisms. Bacteria can appear due to hormonal changes in a woman’s body and physiological characteristics: a short urethra, the ureter is located close to the rectum.

Bacteria appear in women who are sexually active with many partners and do not maintain personal hygiene at the proper level. In some cases, bacteriuria appears with STDs, diabetes mellitus, chronic lesions of the body and pathologies of the urinary system. Sometimes a weakened immune system and tooth decay lead to bacteria in the urine.

There are two types of bacteria in urine: true bacteriuria occurs when bacteria independently multiply and live in the urine. With false bacteriuria, bacteria enter the urine from distant foci of infection through the blood. An increased content of harmful microorganisms is accompanied by clinical manifestations, but in some cases they do not cause side symptoms.

Bacteria occur in chronic diseases that recur and worsen during pregnancy; let’s look at some of them:

Cystitis during pregnancy

Inflammation of the walls of the bladder is the most common urological lesion, both infectious and infectious. Infectious cystitis occurs due to opportunistic microflora. Non-infectious cystitis appears with weakened immunity, hypothermia, intestinal dysbiosis, and overwork. In some cases, vaginal dysbiosis and bladder irritation from chemicals lead to bacteria in the urine.

If a woman had symptoms of cystitis before pregnancy, then bacteria found in the urine indicate its relapse. Symptoms of the disease manifest themselves as a frequent urge to urinate, which is very painful. A woman experiences nagging pain in the lower abdomen, blood in the urine and increased body temperature. If you experience such symptoms, you should seek medical help.

Pyelonephritis during pregnancy

Inflammatory process in the renal pelvis. Escherichia coli, Staphylococcus aureus, Streptococcus, Candida fungi, Pseudomonas aeruginosa are the causes of the disease. An infectious focus is any inflammatory-purulent process. Pyelonephritis can be primary - occurs at the first signs of pregnancy and secondary - appears even before pregnancy and worsens against the background of hormonal changes.

Bacteria in the urine caused by kidney inflammation appear due to the growth of the uterus, which pushes away neighboring internal organs. When the disease worsens, a woman experiences acute pain in the lumbar region, chills, pain when urinating, and signs of intoxication. Pyelonephritis requires mandatory treatment, since the disease is dangerous for the expectant mother and her child.

In addition to the reasons described above, there are also risk groups. Thus, dental problems can lead to bacteria in the urine; irregular hygiene, diabetes mellitus, chronic genitourinary diseases, pathologies of the urinary system and sexually transmitted diseases are the main risk factors and causes of bacteriuria.

Urethritis

A bacterial inflammatory disease that affects the walls of the urethra. The disease is very common and most often affects pregnant women, causing bacteria in the urine. Bacterial urethritis occurs due to the entry of harmful microorganisms into the urethra (Escherichia coli, enterococci, staphylococci and streptococci). If a pregnant woman has chlamydia, then this is another cause of urethritis, which can lead to damage to the amniotic fluid and the embryo.

The peculiarity of urethritis is that pathogens are constantly present on the mucous membranes of the urinary tract. Therefore, the task of the expectant mother and her doctor is to identify predisposing factors and eliminate them. The disease and bacteria in the urine against its background can appear due to injuries and narrowing of the urethra, bladder catheterization and cystoscopy. The bacterial form of the disease can be caused by specific pathogenic microorganisms that destroy the local defenses of the woman’s body.

Symptoms of bacteria in urine during pregnancy

Symptoms of bacteria in urine during pregnancy depend on the cause of the disease. Bacteriuria appears in 10% of pregnant women, the danger is that it can be asymptomatic. Against the background of bacteria in the urine, a woman develops nephrolithiasis and dilation of the ureter. Very often, this symptomatology occurs in the third trimester of pregnancy. Bacteria can cause low birth weight babies, miscarriages and premature births.

With bacteria, various harmful microflora are detected: Escherichia coli and Pseudomonas aeruginosa, Proteus, streptococci, staphylococci and other microorganisms. Very often, bacteria appear in inflammatory diseases of the kidneys and urinary system, infectious lesions of the body. Harmful microorganisms can enter the urinary tract and kidneys through the hematogenous route.

Symptoms of bacteria in urine during pregnancy are similar to those of cystitis and pyelonephritis. The woman’s temperature rises, there is a frequent and painful urge to urinate, and the urine is sedimented and cloudy. If such symptoms appear, it is necessary to seek medical help, determine the cause of the discomfort and eliminate it.

If bacteria in the urine arises due to urethritis, the woman experiences purulent and mucopurulent discharge from the urethra, pain and discomfort when urinating. With acute inflammation of the urethra, bacteria in the urine become chronic. Bacteria can hide in the Bartholin glands, which are located in the vestibule of the vagina. When the protective properties of the immune system decrease, bacteria become more active and cause painful symptoms and can be detected in a urine test.

Diagnosis of bacteria in urine during pregnancy

Diagnosis of bacteria in urine during pregnancy is carried out every month, as the expectant mother undergoes tests regularly. This allows you to maintain the health of the woman and her unborn baby. For diagnosis, a glucose reduction test, Griess nitrite test and other methods are used.

Since the diagnosis is carried out in a clinic, doctors perform chemical tests that give quick results. Bacteriological methods determine the number of microbial colonies and the degree of bacteriuria. If bacteriuria occurs against the background of colonization of the periurethral area that appeared before pregnancy, then the disease is considered a risk factor for acute pyelonephritis.

Let's consider the main stages of diagnosing bacteria in urine during pregnancy:

Instrumental and laboratory studies - ultrasound examination of the kidneys, blood and urine tests, excretory and survey urography, Doppler ultrasound of the renal vessels, screening tests.
Differential diagnosis - doctors conduct a complete diagnosis of the pregnant woman’s body in order to determine the diseases that cause bacteria in the urine and identify asymptomatic bacteriuria.

In addition to diagnostic methods, a woman should consult a nephrologist, therapist, urologist and gynecologist. This will provide a complete picture of the causes of the disease and will allow you to create an effective treatment plan.

Treatment of bacteria in urine during pregnancy

Treatment for bacteria in urine during pregnancy depends on diagnostic results. But every expectant mother should undergo treatment. There are several treatment methods, let's look at the main ones:

Non-drug treatment

Drug treatment

This type of treatment is carried out for both obvious and asymptomatic bacteriuria. The woman is prescribed a course of treatment for 1-3 weeks with cephalosporins, antimicrobial agents and ampicillin. This course of treatment is explained by the fact that during pregnancy a single dose of drugs is not enough. All medications are selected empirically. Antibacterial therapy followed by monthly bacteriological urine tests is mandatory. A woman can be prescribed maintenance therapy until the end of pregnancy and for 14 days of the postpartum process. This will help prevent relapses of bacteriuria.

The specifics of treatment also depend on complications during pregnancy. Let's look at the complications of gestation by trimester:

Bacteria in the urine detected in the first trimester can cause miscarriage. For therapeutic purposes, standard therapy is used.
In case of bacteriuria in the second and third trimesters, the woman undergoes onco-osmotherapy to maintain pregnancy. If bacteria become a threat to premature birth, the pregnant woman is given tocolytic therapy.

If bacteria in the urine appear due to urethritis, then the woman is given antibacterial therapy and uroantiseptics. The drug Monural is highly effective and can only be taken if the therapeutic benefit to the mother is more important than the possible risk to the fetus. Urethritis and bacteria in the urine are treated with Azithromycin, Doxycycline, Phytolysin or Canephron. The drug is selected by the attending physician and its use is strictly controlled.

In many cases, bacteria in urine is detected before pregnancy. The frequency of occurrence of this disease is influenced by the condition of the urinary tract and the sphincter mechanism of the bladder. When treating bacteriuria in the early stages of pregnancy, in 80% of cases it is possible to cure the disease without consequences for the body of the mother and child; in 5-7% of cases, bacteria lead to miscarriages and prematurity.

Prevention of bacteria in urine during pregnancy

Prevention of bacteria in urine during pregnancy is a method to prevent the development of the disease and protect the body of the expectant mother. Taking care of your health and the health of your unborn child is the primary task of every woman. To prevent bacteriuria, the expectant mother needs to:

Regularly submit your urine for testing; to ensure the reliability of the results, you must use only sterile containers. Before taking the test, it is prohibited to consume alcohol, spicy and salty foods. Urine should be collected after washing, in the morning. Please note that no more than 2 hours should pass from the moment of urine collection to laboratory testing, since the composition of urine changes.
A pregnant woman should maintain genital hygiene and avoid synthetic underwear. Synthetic underwear provokes the growth of pathogenic microorganisms, promotes the development of candidiasis and the appearance of bacteria in the urine in an ascending manner.
Following the doctor's recommendations, regular examinations and taking prescribed medications will help protect against pathological changes during pregnancy.
Prevention of urethritis caused by urine bacteria should begin with compliance with hygiene rules and a healthy lifestyle. Regular examinations with a gynecologist and an orderly sex life are the best methods of prevention.

According to medical statistics, bacteria are found in the urine of every fifth woman during pregnancy. Timely diagnosis and treatment can successfully cure bacteriuria.

Forecast of bacteria in urine during pregnancy

The prognosis of bacteria in urine during pregnancy depends on when the pathology was discovered. If bacteria are detected in the early stages, the prognosis is favorable, as doctors prescribe treatment that prevents the threat of miscarriage. With bacteriuria in the last months of pregnancy, the prognosis depends on the type of bacterial lesion and its cause.

If bacteria appear due to exacerbation of chronic diseases or physiological characteristics of the body, then the expectant mother is prescribed maintenance therapy and the prognosis for bacteria in the urine is favorable. But if a woman does not treat bacteriuria, this can cause serious consequences. For bacteria and urethritis, the prognosis depends on early diagnosis and therapeutic therapy. The earlier the disease is detected, the better the prognosis, even with purulent and gonorrheal urethritis.

Bacteria in urine during pregnancy is a problem that requires special attention and treatment. Timely diagnosis and therapy are the key to the health of the expectant mother and her child.

Detection of bacteria in urine can be observed in three cases: contamination of the material collected for analysis, infection of the urinary system, and the presence of asymptomatic bacteriuria in the patient. It is the latter that we will devote this material to.

According to the definition of the Infectious Diseases Society of America, asymptomatic bacteriuria is the isolation of more than 10x5 (for men more than 10x3) bacteria per 1 milliliter of urine in individuals without clinical symptoms of a urinary tract infection.

Let's try to explain it more simply. If bacteria are found in the patient’s urine in quantities exceeding the norm, but the person is not bothered by any symptoms from the urinary system (no cutting or burning when urinating, no pain in the bladder and kidneys, no leukocytes in the urine and no temperature), then this situation is called asymptomatic bacteriuria.

In different countries, the incidence of bacteriuria is 3-25% among the general population. In people who initially have a dysfunction of the urinary system, chronic diseases of the urological tract, as well as congenital anomalies of the structure of the urinary organs, the prevalence of bacteriuria is much higher and can reach 40-50%.

Asymptomatic bacteriuria is most often observed in the following groups (see Table 1 below).

Category of persons	Frequency of occurrence
Preschool girls	Less than 2%
Pregnant	2-9,5%
Elderly women 65-80 years old	18-43%
Elderly men 65-80 years old	1,5-15,3%
Women over 80 years old	18-43%
Men over 80 years old	5,4-21%
Patients with spinal cord injury	70-100%
Patients with diabetes mellitus	up to 17.7%
Patients after kidney transplantation	up to 41% in the first month, up to 21% in the second
Bladder catheterization	Increases by 2-7% for each additional day of catheterization

Table 1 - Frequency of asymptomatic bacteriuria in different categories of the population (Source - Medscape)

When is bacteriuria dangerous?

In most cases, asymptomatic excretion of bacteria in the urine does not pose any harm to the human body and rarely leads to negative consequences.

The only exceptions are certain groups of the population, whose risk of complications of urological infection is much higher than in the general population.

Those at risk for developing complications of bacteriuria are:

1 Pregnant women.
2 Persons with planned surgical intervention on the organs of the urinary system.
3 Persons who have undergone surgery on the urinary system and kidney transplantation.
4 Patients with a urinary catheter, especially one installed for a long time.
5 Patients with spinal injury.
6 Persons with diabetes mellitus, especially in the stage of decompensation.

However, not all patients from the listed risk groups need to be screened for bacteriuria and prescribed treatment. Why?

Dynamic observation of these patients allowed us to establish the following points:

1 Screening for bacteriuria and its treatment during pregnancy can reliably reduce the risk of developing pyelonephritis.
2 Detection of bacteriuria and its treatment in patients with diabetes does not reduce the incidence of cystitis and pyelonephritis, however, this approach contributes to the emergence of resistant strains of microorganisms. Therefore, in this case, the approach “choose the lesser of two evils” is justified.
3 Detecting bacteria in urine and prescribing antibiotic therapy does not improve the prognosis or reduce the risk of urological complications in patients with spinal injury. Therefore, screening in this case is not justified.
4 In persons with a long-term urinary catheter, screening for bacteriuria is not necessary for the same reason as in patients with diabetes mellitus. If the catheter is installed for a short period of time (2-3 days), then antibacterial therapy for bacteriuria may be justified.

Thus, detection of asymptomatic bacteriuria and its antibacterial therapy are justified in three main groups:

1 In pregnant women.
2 In persons with planned surgery on the urinary system.
3 In persons who have undergone surgery on the urinary system and kidney transplantation (in the first months).

1 Non-pregnant premenopausal women;
2 Women with concomitant diabetes mellitus;
3 Elderly patients, including those living in nursing homes;
4 Persons with spinal cord injuries;
5 Patients with a permanent urinary catheter;
6 Patients with a functioning nephrostomy;
7 In patients with Candida yeast in the urine;
8 In renal transplant patients more than 6 months after transplantation.

2. Bacteria in the urine of pregnant women

Increased interest in the presence of bacteria in urine during pregnancy is due not only to the widespread prevalence of urinary tract infections, but also to the fact that asymptomatic bacteriuria often causes complications during pregnancy and infection of the mother-fetus system.

According to the literature, pregnant women with an infectious process in the urinary system are approximately 20-50% more likely to have children with signs of intrauterine infection.

Asymptomatic bacteriuria during pregnancy is one of the most common types of urinary tract infections and reaches a frequency of 16.5% (11). Most often, bacteriuria is considered as a risk factor for pyelonephritis.

The main aspects of the negative impact of asymptomatic bacteriuria in pregnant women:

1 During gestation, bacteriuria can develop into a clinically manifested urological disease (usually pyelonephritis). Thus, the incidence of pyelonephritis in healthy pregnant women is only 2.8%, while in women with asymptomatic bacteriuria in the absence of treatment this figure can reach up to 30%. A number of authors claim that treatment of asymptomatic bacteriuria during early pregnancy prevents the occurrence of acute pyelonephritis in 80% of cases.
2 The presence of a focus of chronic infection, even in the absence of symptoms, often leads to intrauterine infection of the fetus, threat of miscarriage, impaired placental attachment, polyhydramnios, and uteroplacental insufficiency.
3 Pregnant women with bacteriuria have a higher incidence of miscarriage, risk of late delivery and low birth weight babies.
4 In the presence of asymptomatic bacteriuria, the risk of placental pathology is higher, which can be expressed in impaired differentiation of chorionic villi, thrombosis of the intervillous space and inflammation of the membranes.
5 The effect of bacteriuria in pregnant women on the fetus is reduced to an increased risk of infection (IUI) and an increased risk of intrauterine growth retardation.

2.1. Diagnostic criteria

The proven negative impact of bacteriuria on the body of the mother and fetus makes it important for its timely detection using the following criteria:

1 Detection of more than 10x5 CFU/ml of bacteria of the same species in two different bacteriological cultures of urine prescribed at least 24 hours (days) apart in pregnant women who do not have signs of a urinary tract infection.
2 Single detection of more than 10x5 CFU/ml of pathogenic bacteria when collecting urine using a urinary catheter.

The severity of the listed diagnostic criteria is due to the fact that with a single culture of urine in pregnant women, in approximately 35-40% of cases, contamination with microorganisms from the skin of the perineum is possible.

Today, the most important criterion for asymptomatic bacteriuria (the presence of bacteria in the urine of more than 10x5 CFU/ml) has been criticized as overly strict for pregnant women, but is justified as rational, in connection with the results of studies in which the excretion of bacteria in the urine in a titer of 10x4 led to increase in the number of pregnancy complications.

In Russia, clinical examination of pregnant women with double urine culture for the presence of bacteriuria is still not carried out due to the relative high cost, however, it is planned to introduce more accessible diagnostic methods and test systems (Display, paper rapid tests) in the near future.

3. Patient management tactics

The widespread prescription of antibiotics for the treatment of asymptomatic bacteriuria is not justified and can lead to complications such as:

1 Increased frequency of infections involving microorganisms resistant to antibacterial therapy;
2 Development of adverse reactions (including antibiotic-associated diarrhea);
3 Reinitiation of the organism by antibiotic-resistant flora;
4 Toxic damage to internal organs.

According to Russian and European urological guidelines, treatment of asymptomatic bacteriuria is recommended ONLY in certain population groups, which include:

1 Pregnant women (Ib, recommendation A);
2 Persons with planned resection (transurethral) of the prostate gland (Ib, recommendation A);
3 Persons with other planned traumatic urological interventions (IIa, recommendation B);
4 Women with catheter-associated bacteriuria persisting for more than 48 hours (in this case, it is necessary to consider the possibility of prescribing a short course of antibiotic therapy) - IIa, recommendation B).

The choice of drug is made after determining the sensitivity of the pathogen to antibiotics. This study certainly accompanies.

3.1. Features of treatment for pregnant women

The choice of an antibacterial drug for the treatment of bacteriuria in a pregnant woman directly depends on the degree of its passage through the placenta, which limits the negative impact on the fetus.

Among the antibiotics used during pregnancy, the most commonly used and safe are B-lactams (penicillins, cephalosporins, carbapenems and monobactams).

It is preferable to use antibiotics with a narrow spectrum of antimicrobial activity, which provides less negative impact on the state of the intestinal microflora, and therefore less often leads to the development of antibiotic-associated diarrhea.

Choosing a treatment regimen for the treatment of asymptomatic bacteriuria during pregnancy:

1 The drug of choice is fosfomycin 3 g once (preferably at night). Fosfomycin has high clinical activity against most uropathogens. The concentration of antibiotic in the urine sufficient to ensure an antimicrobial effect is maintained for 3 days after administration. It has been proven that even a single dose of fosfomycin for asymptomatic bacteriuria is equivalent to a 7-day dose of amoxicillin clavulanate. If the concentration of pathogens is initially high, then it is possible to re-administer the drug after 24 hours. Longer use of fosfomycin is not recommended, which limits its use for pyelonephritis;
2 Alternative drugs – amoxicillin clavulanate, cefuroxime axetil, nitrofurantoin. The drugs are prescribed orally in standard dosages for a course of 7 days.

Modern therapy for bacteriuria in Russia is far from perfect. According to multicenter studies, in 100% of cases, pregnant women with bacteriuria are prescribed herbal uroseptics. Only in 14.8% of cases were additional antibiotics prescribed.

This approach to therapy can hardly be called optimal. The main mistakes are:

1 Prescription of medications with no proven effectiveness (dietary supplements, herbal preparations);
2 Prescription of antibiotics with a level of resistance to them in pathogens of urological infections of more than 20%;
3 Prescription of antibiotics that are dangerous for fetal development (for example, fluoroquinolones).

3.2. Asymptomatic bacteriuria in children

This pathology in childhood is extremely rare, mainly among children with congenital anomalies of the urinary tract.

Asymptomatic bacteriuria can be detected in 30% of patients on hemodialysis. This is due to a decrease in diuresis, which promotes the proliferation of bacteria.

Bacteria in the urine of a child without symptoms of infection of the urological tract can be detected when the material is collected incorrectly using non-sterile containers (for example, urine from a potty into a non-sterile container).

The main signs of contamination of the test material are:

1 Isolation of more than one type of bacteria in urine analysis.
2 Presence of signs of contamination (vaginal epithelial cells, feces, etc.).

If contamination of the material with bacteria from the outside is suspected (from the skin of the perineum, non-sterile containers), it should be repeated.

To determine the management strategy for a child with bacteriuria, additional information must be collected.

The issue of treatment for asymptomatic bacteriuria in children with diabetes mellitus, immunodeficiency, and those planning to undergo invasive urological procedures is controversial. In these cases, the issue of antibacterial therapy is decided individually by the attending physician.

Bacteria in the urine during pregnancy is a very alarming symptom, indicating the likely onset of an inflammatory process in the organs of the genitourinary system. We will talk about the reasons for this phenomenon, about the characteristic symptoms, the appearance of which should cause alarm in the expectant mother, about the essence of the laboratory tests being carried out and about the methods of treating bacteriuria.

Why do pregnant women have their urine tested so often?

Urinalysis is one of the most important and objective indicators of a pregnant woman’s health. It is with its help that doctors are able to timely detect the onset of development of pathological processes in the genitourinary system of the expectant mother long before the appearance of the first clinical symptoms of the disease (and even in their complete absence).

The urine of a healthy person, which is formed in the kidneys and is sterile, does not contain any pathogenic microflora. If the number of bacteria found as a result of a laboratory urine test is insignificant, this is not evidence of pathology. Microorganisms could enter it as they pass through the urethra (urethra).

A high content of pathogenic microorganisms (staphylococci, streptococci, Klebsiella, fecal enterococci, enterobacters) in the urine of the expectant mother, called bacteriuria of pregnant women, may be due to the onset of an inflammatory disease of the genitourinary organs. The most common ailments caused by them are: urethritis, etc. A monthly laboratory test of urine helps not to miss a malfunction of the genitourinary system.

Causes of bacteria in urine

Bacteria in the urine of expectant mothers can appear due to a number of reasons:

Most often this occurs due to stagnation of urine in the bladder. The reason for this is the physiological processes occurring in the body of a pregnant woman. The continuous growth of the uterus puts pressure on the kidneys and ureters, making it difficult for them to function and to empty the bladder. This clinical picture is typical for the last trimester of pregnancy, when the uterus has already reached an impressive size.
The cause of bacteriuria in early pregnancy can be hormonal changes in the mother's body. Due to the high content, the tone and peristalsis of the organs of the excretory system (primarily the bladder and ureters) are significantly reduced. Reduced tone of the ureters leads to a slower rate of urine excretion (passage), and the bladder leads to an increase in the amount of urine stagnant in it. Stagnant urine, which often changes its physical and chemical characteristics during pregnancy, is an excellent breeding ground for the development of different types of pathogenic bacteria.
Bacteria in the urine of a pregnant woman may be due to her failure to comply with basic hygiene rules. Pathogenic microorganisms accumulated on a woman’s external genitalia easily penetrate the urinary canal, giving rise to the process of ascending infection. It is quite easy to prevent it if you perform intimate toilet regularly and correctly (the stream of water washing the genitals should be directed from front to back). Another preventive factor is the frequent change of underwear made from natural materials that allow the skin to “breathe.”
The cause of bacteriuria may be sexual promiscuity. Intimate intimacy of a pregnant woman with a casual sexual partner can lead to infection of her body not only with pathogens of sexually transmitted diseases, but also with E. coli - the most common culprit of bad urine tests.
Another channel for the penetration of bacteria into the urine of the expectant mother can be a chronic infection dormant in her body (long-standing caries, untreated diseases of the genitourinary organs, furunculosis). A significant weakening of the immune system that occurs during pregnancy leads to the rapid proliferation of pathogenic microflora.
Bacteria are often found in the urine of pregnant women with diabetes.

What is the danger of bacteriuria?

The greatest danger to the proper course of pregnancy and even the life of the gestating fetus is asymptomatic bacteriuria, which occurs without any external signs. If not detected in a timely manner, it can lead to:

to the birth of a child with low birth weight;
to termination of pregnancy due to the development of placental insufficiency.

Bacteriuria, which is an indispensable companion to pyelonephritis, can lead to spontaneous miscarriage, premature birth or stillbirth.

Symptoms of bacteria in urine

A woman carrying a child should be concerned and contact a specialist managing her pregnancy if:

During urination, she experiences pain or a strong burning sensation.
She feels the need to empty her bladder frequently, accompanied by little urine output.
She was faced with the problem of spontaneous urine leakage.
She experienced pain in the lumbar region, perineum, lower abdomen, kidneys and bladder.
Pus is released from the urethra (urethra).
Her cloudy urine gives off an unpleasant odor and produces sediment.
Some admixture of blood and inclusions of pus are noticeable in the urine.
She has been experiencing an increase in body temperature at the subfebrile level for one to two weeks.

Bacteriuria is often accompanied by nausea, sudden urge to vomit and severe physical weakness.

Diagnostics

The main method for detecting bacteriuria in pregnant women is laboratory testing of their urine. Performed monthly, it is performed through rapid diagnosis and urine culture.

Express diagnostics of urine

Carried out using:

TTX test. This technique is based on the ability of bacteria to give colorless tetrazolium crystals a blue color.
Reduction glucose test. This study, related to rapid rapid diagnostic methods, is based on the ability of pathogenic microflora to reduce (absorb) small amounts of glucose. When testing a portion of morning urine, the laboratory technician puts a paper strip with a reagent into it, which shows whether there is glucose in this urine sample. If the glucose level does not reach the standard, it is believed that it has been absorbed by bacteria. This test does not belong to the category of studies that give 100% results. It is used only for initial diagnosis.
Griess nitrite test. The essence of this method is the use of a complex of so-called Griess reagents, which detect the presence of nitrites in the urine. Their presence indicates that pathogenic bacteria contained in the urine of a pregnant woman interacted with nitrates, transforming them into nitrites.

Urine culture

A more reliable and reliable way to detect bacteriuria is urine culture.

Culture of urine for bacteriuria, during which the laboratory assistant calculates the rate of bacterial reproduction, is the most informative. The main disadvantage of this method is the length of the process (the analysis is performed within forty-eight hours).
A more simplified method is sowing performed using the Gould method. The test urine sample is placed in a Petri dish consisting of four sections and containing a nutrient substrate made of agar. To transfer the sample to the next sector, a sterile platinum loop is used each time. After a day (this is exactly the time enough for the incubation of pathogenic microflora at a temperature of thirty-seven degrees), using a special table, the number of microorganisms is counted.
Another option for accelerated inoculation is that glass plates coated with a nutrient substrate are first immersed in the urine sample being tested, and then immediately transferred to special containers. The incubation time of bacteria is no more than sixteen hours. By comparing the results of the analysis with the data of the normative scale, the degree of bacteriuria is determined. The reliability of this test is 95%.

An adequately selected method of urine examination allows not only to determine the true culprit of infection of the genitourinary system of a pregnant woman, but also its sensitivity to drugs, which is necessary for choosing the only correct treatment tactics.

Additional diagnostic methods

If a laboratory urine test confirms the presence of bacteriuria, the pregnant woman’s body is subjected to a thorough examination. She is prescribed:

Ultrasound of the kidneys.
Survey and excretory urography.
Doppler measurements of the renal vessels.
A series of screening tests.
Laboratory blood test.

After laboratory and hardware diagnostics, the expectant mother is examined and advised by a whole group of specialists:

urologist;
nephrologist;
gynecologist;
therapist.

Having compiled a complete picture of the causes and clinical manifestations of the disease, the specialist managing the pregnancy outlines effective tactics for its treatment.

Treatment

What should an expectant mother do if bacteria are found in her urine? The answer is clear: start treatment immediately under the supervision of a qualified specialist.

The goal of the first stage of therapy is to normalize the pH level in the urine and enhance its excretion from the body of a pregnant woman. This effect can be produced by the combined effect of diuretic herbs and natural herbal remedies (cyston is also considered the safest and most effective). Drinking cranberry juice has an excellent diuretic effect. The treating specialist will definitely prescribe a diet that does not allow the consumption of fatty, spicy, spicy and pickled foods.
The next stage of treatment is a single attack of pathogenic microflora with antibiotics of the cephalosporin or penicillin group. The maximum duration of such a course is no more than five days. Bacteriuria of the first trimester is treated with semisynthetic drugs: ampicillin or amoxicillin. In the second trimester, new generation antibiotics are added - macrolides. Antibacterial drugs (nitrofurans) taken at night have a supporting effect. After completing treatment, its effectiveness is monitored by repeated urine culture for bacteriuria.
To treat asymptomatic bacteriuria, more gentle methods are used: the use of herbal medicine and harmless homeopathic remedies (the same canephron and cystone). The uroantiseptic monural has a powerful effect on the body of the expectant mother. Its massive effect is allowed for only one day (three grams in the morning, afternoon and evening). If such treatment is ineffective, the expectant mother is prescribed a weekly (sometimes longer) course of cephalosporins. An integral part of treatment is strict control of the timeliness of emptying the bladder, preventing stagnation of urine. For this purpose, a pregnant woman must take diuretic infusions and fruit drinks made from rose hips and cranberries.

Basic principles of treatment
Strict medical supervision with mandatory screening tests of urine and blood.
The main criterion for choosing medications for the treatment of pregnant women is their complete safety.
When prescribing medications, it is necessary to take into account the duration of pregnancy.

A urine test can tell a lot about the health of the expectant mother. With its help, hidden infections and pathologies of the genitourinary system are often detected. One of the conditions that a pregnant woman’s urine test will show is bacteriuria (presence of bacteria). What does this mean and in what situations does it occur? Is the pathology dangerous and should it be treated urgently?

Why is a urine test done during pregnancy?

The body of the expectant mother is constantly undergoing a restructuring of organs and systems, the purpose of which is comfortable gestation and preparation for childbirth. The growing uterus puts pressure on the kidneys, and they work with increased load, which disrupts the constant outflow of urine. The slightest infringement of the ureters or kidneys threatens stagnation of urine, and after a couple of weeks - infection.

A urine test allows you to determine whether everything is in order with the urinary system and how well other organs are functioning. Pregnant women have to donate urine quite often. In the first trimester, the analysis is done monthly, in the second – once every 2 weeks, in the later stages – weekly. Normally, the biomaterial is transparent. Turbidity allows one to suspect an infectious-inflammatory process in the body and requires diagnosis.

The detection of protein, red blood cells, ketone bodies, salt, and glucose in urine analysis is considered pathological. Protein in the urine (proteinuria) is a common sign of gestosis, which is dangerous in the third trimester. If glucose is found, this indicates endocrine pathologies and diabetes mellitus. Salts indicate the presence of stones or sand in the kidneys. Bacteria in urine during pregnancy is a consequence of improper urine collection or infectious pathology that needs correction.

Causes of bacteria in urine during pregnancy

Dear reader!
This article talks about typical ways to solve your issues, but each case is unique! If you want to know how to solve your particular problem, ask your question. It's fast and free!
While carrying a child, immunity decreases, since a large amount of important vitamins and microelements goes towards the development of the baby. Attacks by infectious and bacterial agents are especially dangerous during this period. They lead to relapses of chronic diseases and the development of bacteriuria.
Why are bacteria found in the urine of pregnant women? Pathology is caused by the following ailments:
Urethritis. With weakened immune defenses, staphylococci, enterococci, and streptococci, which are present on the mucous membrane of the genital organs, can penetrate into the urethra. When urine passes through the urethra, bacteria enter it, as can be seen from the results of the study.
Non-infectious cystitis. It occurs against the background of hypothermia, weakened immune defense, overwork, and frequent constipation. The growing uterus puts pressure on the bladder, causing its capillaries to burst and the walls to expand. Subsequently, purulent inflammation occurs, a sign of which are microorganisms in the urine. An expectant mother can become infected with an infectious form of pathology through sexual contact.
Pyelonephritis. The most common cause of the disease, which causes inflammation of the kidney tissue, is the pressure of the growing uterus on the organs of the urinary system. At the same time, staphylococci, Pseudomonas aeruginosa, and fungi of the genus Candida are active, which can provoke an abscess inside the kidneys. Pus along with bacteria is released into urine.
Hormonal imbalances and structural features of the female genital organs.

Types of bacteriuria during pregnancy
Pathologies that cause the appearance of bacteria in the urine differ in their symptoms. Depending on the nature and degree of their manifestation, true and asymptomatic bacteriuria are distinguished. The true form is diagnosed in the presence of obvious inflammatory processes, when the formation and release of pus from the urinary tract occurs. Bacteria come out with urine and pus and choose urine as a suitable nutrient medium. They actively multiply and infect the urinary tract.
Main signs of the disease:
cloudiness, change in urine color;
flakes and mucus in biomaterial;
pain when urinating;
unpleasant smell of discharge.

It is worse when the disease is asymptomatic and can only be detected through a medical examination. In this case, the expectant mother is not bothered by pain in the kidneys and pelvis, and urination does not cause discomfort. However, the fetus in the womb is susceptible to intoxication and other negative consequences of asymptomatic bacteriuria. In addition, a pregnant woman herself can become a carrier of infection if she has unprotected sexual intercourse.
Bacteriuria is also divided into ascending and descending. The disease is also distinguished by the types of bacteria that cause it. There are staphylococcal, streptococcal, and gonococcal forms of the disease.
Methods for diagnosing bacteriuria
Bacteria are found in the urine of every fifth expectant mother. The quality of the analysis is largely influenced by the method of urine collection. The most accurate results will be shown by a urine test collected in the morning on an empty stomach using a catheter. When urinating naturally, there is a high risk of infection from the outside. Initially, the doctor gives a referral for biochemical analysis and general analysis according to Nechiporenko. The study allows you to clarify the composition of urine and reveal the presence of components that should not be present in a healthy body.

If bacteriuria is suspected (pathological microorganisms are detected in the urine), additional examination and the following tests are indicated: determination of the exact number of microorganisms in 1 ml of urine and Gould analysis, which allows us to identify the nature and extent of damage to the urinary system organ. In parallel, asymptomatic bacteriuria during pregnancy is diagnosed using:
testing using triphenyltetrazolium chloride, when immersed in urine, the chemical composition of the salt is decomposed by bacteria;
Griess test: allows you to identify bacteria that convert nitrate substances into toxic nitrites that cause intoxication;
sediment analysis: microscopic examination allows you to identify bacteria if there are a lot of them (the amount in 1 ml of biomaterial exceeds 100 million), examination of urine sediment allows you to determine the presence of pathology in the early stages, when the volume of bacteria is insignificant.

Additionally, a biochemical blood test is performed. Kidney ultrasound and other studies may be prescribed.
How does the presence of bacteria in urine affect pregnancy?
Bacteriuria during pregnancy affects the course of pregnancy and the further development of the baby:
placental disorders, fetal hypoxia;
onset of early labor;
abnormalities of the fetal nervous system, which in especially severe cases lead to cerebral palsy;
deviations in the mental and physical development of the child after birth;
intrauterine anomalies of internal organs, which in the future affect the health of the child.

Treatment, diet and drinking regimen
Therapy for bacteriuria during pregnancy is complex. Medication and alternative treatment, diet, and proper drinking regimen are necessary. The treatment plan includes:
Taking antibacterial drugs that will stop the proliferation of bacteria and stop the inflammatory process. Medicines are chosen taking into account the nature of the pregnancy, age and health status of the expectant mother. These are Ificipro, Nitrofurantoin, Cephalosporin, etc. The selection of medications in the early stages is especially careful - they should not negatively affect the fetus. At the same time, taking probiotics is indicated.
Maintenance medications that will help restore kidney health faster. Among them are Canephron, Phytolysin.

If the pathology is detected at the initial stage, doctors try to do without antibiotics. Measures are shown to normalize the pH of urine and increase its passage. For this purpose, cranberry juice, kidney infusions, decoctions of rose hips and lingonberry leaves are prescribed. If after 2 weeks the situation does not improve, proceed to drug treatment.
When the cause of the pathology is the pressure of the uterus on the kidneys, regular. It is advisable to avoid resting on your back, which can lead to compression of the renal pelvis and stagnation of urine.
The diet for bacteriuria is aimed at normalizing the pH of urine. For this purpose, easily digestible nutritious dishes are indicated - porridge, soups, lean meats. Spicy, spicy, salty foods should be excluded, and the consumption of dairy products should be reduced. It is recommended to eat more protein, which is found in meat and legumes.

The best ways to prepare food are baking, boiling, stewing, and steaming. Drinking regime is an important element of treatment. You should drink up to 2 liters of liquid per day, excluding soups and other dishes.
Preventive measures
A healthy lifestyle, avoiding hypothermia and promiscuous intimate relations will help prevent the development of pathology during pregnancy. It is important to get tested and examined by your obstetrician regularly. Additionally, it is recommended to take vitamin preparations and herbal teas, immunostimulants. It is necessary to maintain intimate hygiene, including with the help of wipes and cleansing creams. The absence of heavy physical activity, proper nutrition and drinking regime are important.
If the pathology cannot be avoided, you should entrust its treatment to a doctor. Independent selection of medications and self-medication are prohibited. It is necessary to follow medical recommendations and complete therapy to the end to avoid serious pregnancy complications.

For pregnant women, urine analysis is one of the main diagnostic methods. It is carried out before almost every visit to the gynecologist. This is due to the fact that changes in the composition of urine indicate not only disorders in the urinary system, but also the condition of the entire organism. Bacteria in urine during pregnancy can be either a sign of a serious illness or a consequence of an incorrectly performed procedure for collecting material.

Therefore, when they are detected, the doctor always conducts a clarifying conversation and prescribes a retake of the analysis. Sometimes additional diagnostic procedures are necessary.

Pregnancy is accompanied by constant changes in a woman’s body. The fetus grows and this leads not only to an increase in the abdomen, but also to compression of nearby organs. The kidneys are also compressed.

During normal operation of these paired organs, the resulting urine is constantly filtered and discharged into the bladder. When the kidneys are pinched, it begins to stagnate. Under these conditions, bacteria multiply quickly. Their spread leads to inflammation of organ tissues, most often the mucous membranes.

A urine test can detect the disease before it develops and manifests symptoms. Early diagnosis helps to avoid many negative consequences of an infectious disease and prevent the development of gestosis.

Causes of bacteria in urine during pregnancy

The reasons for the proliferation of bacteria in the urine of pregnant women may be different. The spread of microorganisms is facilitated by changes occurring in a woman’s body: the uterus grows and begins to put pressure on the kidneys, as a result of which their work is disrupted. Delayed urine flow promotes the growth of bacteria in it.

Bacteriuria can be true or false. In the first case, microorganisms multiply and live in the urine, in the second they come from other foci of infection through the bloodstream. This condition may be a sign of a sexually transmitted infection, diabetes mellitus, caries, or a chronic inflammatory process in the body (usually in combination with reduced immunity).

Most often, bacteria in the urine during pregnancy indicate a disease of the urinary system. Depending on the accompanying symptoms, it is determined:

cystitis – inflammation of the inner layer of the bladder with the addition of an infectious component (most often E. coli);

pyelonephritis - an inflammatory process in the renal pelvis caused by Escherichia coli, Staphylococcus aureus, fungus or other pathogens;

urethritis is an inflammation of the mucous membrane of the urethra, often accompanied by a bacterial infection: enterococci, streptococci, Escherichia coli, chlamydia.

How does bacteria in urine affect pregnancy?

Bacteria in urine negatively affects both the course of pregnancy and the health of the unborn child. Most often, infection indicates an inflammatory disease in the urinary organs. Laboratory analysis reveals streptococcus, Staphylococcus aureus, Escherichia coli and other pathogens.

The genital organs and uterus are located close to the source of infection, so there is a high risk of its spread through the birth canal. A woman's urine flow is disrupted, which can result in cystitis, pyelonephritis or urethritis. Lack of treatment leads to severe forms of gestosis (late toxicosis) with the risk of miscarriage or premature birth.

In addition, the infection enters the amniotic fluid, which the child swallows. Bacteriuria can cause disturbances in intrauterine development: lead to pathologies of the nervous, immune and other systems, and in some cases, to fetal death.

Symptoms

Most often, bacteriuria is accompanied by certain symptoms, but in some cases it develops latently and is detected only during laboratory testing. The clinical picture may include:

pain during urination;

pain of various types in the lower abdomen;

strong unpleasant odor of urine;

impurities of blood and/or pus in the urine (cloudy, flaky, brownish);

fever (if kidney infection);

nausea and vomiting;

pain in the lumbar region.

These symptoms may appear in various combinations depending on the disease. Sometimes they disappear temporarily, creating the illusion of recovery, but the lack of treatment only leads to a greater spread of infection.

Diagnostics

Urine testing for the presence of bacteria is carried out monthly. Thanks to this, emerging infectious and inflammatory diseases are detected in the early stages and successfully treated. Bacteriological tests (reducing glucose, nitrite and others) help determine the type and number of microorganisms.

After a urine test, additional research methods are prescribed to help determine the underlying disease:

Ultrasound of the kidneys and urinary tract;

Doppler ultrasound of the renal vascular system;

additional blood and urine testing;

microscopic examination of a smear from the urethra.

In addition to these procedures, the pregnant woman may be given referrals for consultations with specialists: urologist, nephrologist, therapist. This contributes to a faster and more accurate diagnosis, as well as timely initiation of treatment.

Treatment

What treatment will be prescribed for bacteriuria is determined by the established diagnosis. But in any case, it is complex and includes:

correction of the diet with the introduction of foods and drinks that reduce the pH of urine (vegetables, cereals, lean meat);

drinking plenty of fluids to increase the volume of urine and bacteria excreted;

taking medications.

Drug treatment is necessary both for obvious symptoms of bacteriuria and in their absence. Antibiotics are prescribed without fail: Ceftazidime, Cefoperazone, Cefuroxime, Ampicillin, Azithromycin, Doxycyline and others. All drugs in this group can be taken only as prescribed by a doctor and strictly in the dosage prescribed by him. Herbal preparations of complex action may also be recommended: Phytolysin, Canephron.

The duration of treatment is 1-3 weeks. If necessary, medication can be continued until the end of pregnancy and for two weeks after birth.

Bacteria in urine are often detected before pregnancy. Diseases occur chronically and under favorable conditions, such as a natural decrease in immunity, hormonal changes, and compression of the kidneys by the uterus, become aggravated. The prognosis of treatment depends on the severity of the infection and the duration of pregnancy. Treatment of bacteriuria in the first trimester has a positive outcome in 80% of women, and 5% have miscarriages.

Prevention

In order to avoid the development of bacteriuria during pregnancy, you must adhere to several rules:

Regularly submit urine for analysis. This diagnostic procedure should not be neglected, despite its frequency. Sometimes bacteria are found in urine during pregnancy due to improper collection of the material. To prevent this from happening, you must use sterile containers and comply with all hygiene requirements. For analysis, a fresh (no more than two hours) morning urine sample is required. The day before, you should avoid salty and spicy foods.

Carefully observe genital hygiene. You need to wash yourself in the morning and evening, as well as after each act of bowel movement. Movements when wiping should go from front to back, otherwise you can spread an infection from the anus to the urethra. You should avoid underwear made from synthetic materials: they do not allow air to pass through well and create a damp environment, ideal for the spread of bacteria.

Attend scheduled consultations with your doctor and follow all of his appointments. This will help identify the problem at an early stage and quickly resolve it.

Preventive measures help reduce the risk of developing infectious and inflammatory diseases in the genitourinary system. During pregnancy, this becomes not only a guarantee of the mother’s health, but also a necessary condition for the proper development of the child.