Urinary Tract Infections and Pregnancy: What are the symptoms and treatment?

The nurse at my midwife's office told me that my urine showed a UTI. I got a peek at my records and read the lab report, which had a notation explaining that the "low" level of the "infection" showed that the test may have been contaminated by germs on my outer genitals. When I asked them to re-test, the refused to let me see the second lab report, but insist that I have a bladder infection. I am now 16 weeks and still have shown no signs -- no pain, no frequent urination, no bleeding, nothing at all. I am allergic to many antibiotics and this is why I insisted on being thorough.

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Peg Plumbo CNM

Peg Plumbo has been a certified nurse-midwife (CNM) since 1976. She has assisted at over 1,000 births and currently teaches in the... Read more

It always makes me angry when I hear a client say that they had to "sneak a peak" at their medical record or especially when a care provider refuses to let a client see what rightfully belongs to that client. Can you take your business elsewhere? Most women are locked into a system where seeking an alternate provider is difficult or impossible, but I would certainly try.

No one wants to be treated unnecessarily with antibiotics, but I'm sure that if your provider sat down with you and explained what the lab analysis showed, that you would not be averse to taking them if they were really necessary.

Of course, I cannot say if antibiotics are necessary, but I can speak to a condition known as asymptomatic bacteriuria.

Urinary tract infections (asymptomatic bacteriuria, cystitis and pyelonephritis) are frequently encountered medical complications of pregnancy. The majority of infections in pregnancy are asymptomatic; and if bacteria are found in the urine (greater than 100,000 colonies is the general rule), then this bacteriuria places the mother at risk for low birth weight and preterm birth. Pyelonephritis (when the disease has progressed into the maternal kidneys) can result in significant maternal and fetal morbidity and mortality.

All pregnant women should be screened for asymptomatic bacteriuria. Group B streptococcus, a significant pathogen for both mother and child, can be identified in a routine urine culture and should be ordered at the first visit. Group B strep is a form of asymptomatic bacteriuria.

Nitrofurantoin or Ampicillin are common drugs of choice for asymptomatic bacteriuria and there has never been any demonstrated correlation between these medications and fetal malformation. Acute pyelonephritis requires a two-week antibiotic course, often with initial injection therapy. The selection of an agent will depend on the likely pathogen, stage of pregnancy, safety of the drug and cost.

Some classes of antibiotics can be taken throughout the three trimesters (e.g., beta-lactams), while others are completely contraindicated (e.g., tetracyclines) and others are to be avoided in certain trimesters (e.g., sulphas are contraindicated in the third trimester).

The choice of an appropriate antimicrobial agent must be weighed against the potential adverse outcome of a particular infection, the drug safety and spectrum of activity.

Non-treated asymptomatic bacteriuria does represent a considerable risk factor since it may lead to the onset of acute pyelonephritis in approximately five percent of pregnant women and may increase the risk of fetal mortality. I recommend that you be treated but I agree that it is hard to trust a provider who refuses you vital information -- information you need to make an informed choice.

I hope you get better satisfaction from your medical care providers in the future. I wish you the best with the pregnancy and birth.

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