I saw S, a first-time mum in her second trimester who complained of chills, shivering, fever and excessive sweating for the past 3 days. She had frequent urination accompanied with pain and a burning sensation. The urine was cloudy with an unusually strong smell. She also felt her womb tighten quite frequently.
She was having a high fever of 39-degree C. She looked dehydrated with cracked lips and a dry tongue. Her abdomen was soft with frequent uterine contractions. The foetal heart rates were rapid at 180/min. Both her loins and the lower abdomen were tender to touch. She was quickly admitted to the hospital for observation.
S was having a severe urinary tract infection (UTI) affecting both her bladder and kidneys.
UTI is a common medical complication during pregnancy. It is estimated that bladder infections and kidney infections affect 1-4% and 0.5-2 % of pregnant women respectively. However, in up to 2 to10 % of pregnancies, the bacteria may remain dormant in the urine without manifestation of symptoms (asymptomatic bacteriuria).
UTI is more prevalent in the pregnant than in the non-pregnant state, as the muscles of the tubes (ureters) that connect the kidneys to the bladder are relaxed due to the hormonal changes during pregnancy. This slows down the passage of the urine and allows bacteria time to multiply before they are flushed out. Similarly, urinary drainage is also impeded when the growing womb presses directly on the bladder and the ureters as pregnancy progresses.
If the UTI goes untreated, the health of the mother and the baby may be affected.
For the mother, an infection in the kidney may lead to scarring, with consequent high blood pressure and kidney failure later in life. For the baby, UTI can irritate the womb and cause premature birth. It is also associated with hypertension in pregnancy (pre-eclampsia), premature rupture of membranes (water bag) and low birth weight of the baby. UTI can be safely treated with appropriate antibiotics during pregnancy. Microscopic examination of S’s urine showed a large number of white blood cells. Urine sample sent for the culture and sensitivity tests revealed that she had E. coli bacterial infection which was sensitive to penicillin. S responded well to the antibiotic and her fever subsided within the next two days.
To prevent relapse of UTI,
S was advised to drink at least 6-8 glasses of water every day. Unsweetened cranberry juice is a good beverage to consume as it reduces bacterial growth.
She was advised not to hold her urine in. She should pass urine and empty her bladder completely as soon as there is an urge to pee.
She should urinate before and after having sex
After urination, she should wipe her vulva from the front towards the back to reduce the spread of bacteria from the anus. The genital area should be blotted dry and kept clean.
A mild unscented cleanser should be used to wash the genital area while showering.
She should wear cotton rather than synthetic underwear and avoid tight jeans and trousers.
S was well during a subsequent review. Another urine culture showed that the bacteria were completely cleared. She had no further episodes of UTI and has since delivered a healthy baby girl at term.