• Dr Peter Chew

UTI in Pregnancy: A Concern

M, a 28-year-old mum was taken aback when she saw traces of blood in her urine. She was at her 15th week of gestation and this was her first pregnancy.


She also noticed that she peed more often than usual for the past few days and there was a slight burning sensation during urination. Her urine appeared cloudy with a pungent smell. Microscopic examination of the urine revealed a large number of white and red blood cells. Urine culture grew the bacteria, E. coli. 


M was suffering from urinary tract infection (UTI).


What is UTI?

UTI is a bacterial infection of the urinary tract, which comprises the kidneys, where urine is produced; the ureters, which carry urine to the bladder, the reservoir for the urine; and the urethra, the final passage that sends the urine out of the body.


How common is UTI during pregnancy?

UTI is not uncommon, occurring in about one in 20 pregnant mums. The recurrence rate in those who have had the infection once is about 30%. Most UTIs occur in the bladder and urethra. They are usually mild. But occasionally, the infection may spread along the ureter to the kidney and the results can be more severe.


In about 2 to 7% pregnancies, UTI has no symptoms. It is known as asymptomatic bacteriuria (ASB). The infection is only discovered by urine culture where more than 100,000 organisms/mL on a clean catch urine are found. Untreated asymptomatic bacteriuria can lead to the development of symptomatic bladder infection(cystitis) in approximately 30 percent of patients and the development of kidney infection (pyelonephritis) in up to 50 percent.


Why is UTI More Common During Pregnancy?

Several factors can contribute to UTI during pregnancy. They include:

  • Changes in the body during pregnancy: The growing uterus can compress the ureters and bladder, making urine more difficult to empty completely. This will give bacteria an opportunity to grow in the urinary tract.

  • Changes in hormones: The rising levels of the pregnancy hormones would relax the muscles in the urinary tract which again cause slow emptying of the urine.

  • Proximity to the bowel. The most common bacteria in UTI is E. coli, which comes from the bowel. Because the urethra is close to the anus, the bacteria can invade the urinary tract easily, especially when the perineal region is not easy to clean thoroughly during pregnancy.

  • Sexual intercourse during pregnancy may lead to UTI, as bacteria in the perineum may be driven into the urethra.


What are the symptoms?

Typical symptoms include:

  • Frequency and urgency of urination

  • Burning sensation during urination

  • Cloudy, dark, bloody or foul-smelling urine

  • Fever with chills and rigors

  • Lower abdominal pain or discomfort

  • Pain on one or both sides of the upper abdomen or at the back


How will UTI affect the pregnancy?

UTI during pregnancy can cause serious problems to the mother and the foetus. For the mother, the risks of developing high blood pressure (preeclampsia), anemia and life-threatening sepsis and shock are increased.


For the foetus, premature birth, intrauterine growth restriction and low birth weight babies are more common. Risks of infection and pneumonia in the newborn are also raised.


How is UTI diagnosed?

The gold standard for the diagnosis is a urine culture. This is done by collecting the midstream urine after the mother has carefully cleaned the perineal area.


In patients with recurrent UTI or when there is blood in the urine, an ultrasound of the kidneys and bladder should be done to rule out tumors or stones.


How is UTI treated?

UTI should be treated with appropriate antibiotics after the urine culture and sensitivity test. The antibiotic should not have any adverse effect to the foetus. It is usually given over 7 to 14 days. A repeat urine culture should be done to make sure that the bacteria is eliminated.

In severe cases involving the kidneys, intravenous antibiotics may be given.


For M, an oral antibiotic was given promptly. She was asked to drink plenty of water as this will dilute the urine and help flush bacteria out of the urinary tract.


Besides water, she also drank cranberry juice frequently. Cranberries are known to contain compounds that may help prevent bacteria from attaching to the lining of the urinary tract.


Every time she used the toilet, she was advised to wipe her perineum from front to back This would help keep bacteria away from this area. She was told not to wear tight fitting pants. With all these measures, M did not have recurrent UTI and she delivered  a healthy boy at full term without complications.

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