Chapter 6 – The Bladder and the Pelvic Floor

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Urinary tract infections in pregnancy

Asymptomatic bacteria occurs in small number of pregnant women (2-10 per cent), and requires treatment. If left untreated, 20-30 per cent of these women will develop acute pyelonephritis.(3) Pyelonephritis is associated with an increased risk of prematurity, a lower birth weight, intrauterine growth retardation and congenital anomalies. It is routine to send an MSU for MCS in the first trimester for all pregnant women. A second MSU may be necessary to confirm a positive result in an asymptomatic woman prior to treatment.

All pregnant women with a symptomatic UTI should be treated and an MSU sent for MCS. For first-line treatments see Table 6.1. If required, modify therapy based on susceptibility results. A urine culture 1-2 weeks post treatment is essential. If bacteriuria is still present, consider antibiotic prophylaxis for the pregnancy (e.g. cephalexin or nitrofurantoin, based on MCS results).

Continue to monitor urines monthly throughout the pregnancy. Avoid the use of tetracyclines and fluoroquinolones. Also note, if group B streptococcus is detected in the urine during pregnancy, prophylaxis during delivery is usually indicated. (3)

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