Bacteria in urine in pregnancy

A general urine analysis is a standard, common test that begins the diagnosis of pregnant women. Such an analysis will indicate the presence of problems with the urinary system, will help to assess the state of the water-electrolyte balance. Unfortunately, the results of such a study may not always be pleasing - for example, if the indicators do not correspond to the norm. What can be suspected if bacteria are detected in urine during pregnancy? Should you worry, and what measures should you take?

What does bacteria in urine mean during pregnancy?

The composition of the urine fluid must be sterile - without microbes and other infectious agents. If bacteria are detected during pregnancy, this condition is considered dangerous due to the high probability of infection spreading through the urinary system.

Most often, the analysis reveals E. coli, streptococci and staphylococci, Klebsiella, enterococci - that is, bacteria that live in the intestinal cavity or on the integumentary tissues of the body. However, we repeat, such bacteria should not be present in the urine of a healthy person. [ 1 ]

Normal levels of bacteria in urine during pregnancy

In a normal state of health of a pregnant woman, urine is always sterile - that is, it does not contain any bacteria or other infectious agents. If a certain amount of bacteria is found in the urine, this condition is called bacteriuria. Microbes can get into the urine from the vagina or from the urinary tract. Such flora can be either pathogenic or opportunistic.

If a doctor detects the presence of bacteria, his task is to determine where exactly the source of infection is “hiding” in order to neutralize it later.

It is customary to distinguish two types of bacteriuria:

• asymptomatic bacteriuria, in which there are no other clinical signs other than the detection of bacteria in the urine of a pregnant woman;
• bacteriuria with the corresponding clinical picture of pathology.

False bacteriuria is also distinguished. It is spoken about in the case when the presence of bacteria in the urine is caused by insufficient hygiene of the genitals of a pregnant woman. In such a situation, the analysis must be repeated after a thorough toilet of the genitals.

Bacteriuria is considered error-free if more than 100 thousand bacteria are detected in one milliliter of urine, or more than 10 ⁵ bacteria in a milliliter. In this case, it is necessary to take the test twice to exclude errors.

Causes bacteria in the urine during pregnancy

Pregnancy is a condition that in itself serves as a risk factor for the appearance of bacteria in the urine, since the anatomical characteristics and functionality of many organs in the body change. For example, the renal calyces and pelvis expand, the function of the urinary sphincter becomes difficult. At the same time, even hidden bacteriuria, without any clinical symptoms, can eventually reveal itself as acute pyelonephritis.

Bacteria can end up in a pregnant woman's urine in several ways:

• via the lymphatic route - for example, if the infection is located near the urinary organs or kidneys;
• by the ascending route, when bacteria enter the urinary system through the urethral canal - for example, when a catheter is inserted, during cystoscopy;
• via the hematogenous route - that is, with the blood flow from other inflamed organs;
• in a descending direction, when the main source of infection is in the renal organs.

Depending on what other changes are present in the urine analysis results, the following diseases associated with bacteriuria can be suspected:

• pyelonephritis, nephritis, urolithiasis;
• vasculitis, atheroembolism of renal arterial vessels;
• inflammatory process in the ureter, bladder;
• nephrosclerosis.

However, most often the appearance of bacteria in urine during pregnancy is associated with improper collection of fluid for analysis, when a woman ignores the rules of hygiene and does not perform the necessary hygiene procedures, or does not perform them sufficiently. [ 2 ]

Risk factors

Bacteria in urine during pregnancy can be detected under the influence of certain predisposing factors:

• an increase in the size of the uterus, compression of nearby structures, including the kidneys and ureters;
• difficulty with defecation, slow intestinal motility;
• deterioration of ureteral tone;
• weakening of the immune system;
• slow outflow of urine;
• changes in the renal pelvis and ureters;
• increase in urine pH.

Pathogenesis

Most often, the mechanism of bacteria appearance in urine during pregnancy is associated with the ascending spread of pathogenic microorganisms through the urinary system. Very rarely, such spread occurs by the hematogenous type - through the bloodstream. As a rule, bacteria inhabiting the mucous tissues of the periurethral region pass into the urinary tract through a poorly fitting urinary sphincter. With a weak immune response, complete elimination of bacteria does not occur, and their content becomes such that an inflammatory process occurs (or a latent course of bacteriuria begins). [ 3 ]

Acceleration of bacterial growth occurs under the influence of the physiological increase in urine pH during pregnancy, as well as the possible presence of sugar in the urine.

Symptoms bacteria in the urine during pregnancy

The presence of bacteria in urine during pregnancy does not always manifest itself with any symptoms. Quite often, bacteriuria is hidden and is detected only during diagnostics. At the same time, women themselves may feel well and not complain about their health. However, this does not mean that there is no problem: it exists and worsens, and symptoms may appear a little later.

In some cases, the pathology arises even before pregnancy, the woman simply begins to take tests after registering. As a result, the doctor has to diagnose many diseases already in the process of bearing the baby: among the most common pathologies are chronic pyelonephritis, urolithiasis.

The first signs of bacteria in the urine are usually mild and not very intense. These may include the following symptoms:

• cutting, burning sensations during or at the end of urination (for example, with cystitis);
• pain in the lower abdomen, possibly radiating to the left or right side;
• episodic urinary incontinence, urinary dysfunction;
• slight or significant increase in temperature;
• general deterioration of health, feeling of fatigue and weakness;
• cloudiness of urine, change in color, appearance of flakes and mucus.

Conducting a urine analysis allows you to determine the presence and quantity of bacteria in the urinary tract. These can be pathogenic, non-pathogenic and opportunistic microorganisms, and neither the first, nor the second, nor the third microbes should normally be in the urine.

What can a urine test tell us? Usually, the sector culture method is used for research: biological fluid is placed on a special nutrient medium, after which the number of bacterial cells in 1 ml of urine is assessed. Let us recall that it is considered normal if bacterial growth is not detected in the material. [ 4 ]

• If the results of the analysis reveal single bacteria in the urine during pregnancy +, this means that their number does not exceed 10 ³ CFU/ml. Such bacterial growth does not always cause an inflammatory reaction and can proceed latently.
• Bacteria in urine during pregnancy ++ correspond to the number of microbial cells 10 ⁴ CFU/ml. This result may be considered by the doctor as doubtful, so it is advisable to take the urine test again.
• Bacteria in urine during pregnancy +++ correspond to the number of microbial cells 10 ⁵ CFU/ml. As a rule, such a number of bacteria always causes the development of inflammation.

Many bacteria in the urine during pregnancy indicate the presence of an inflammatory reaction in the kidneys or in the urinary tract. The degree of pathogenicity of the detected bacteria is assessed by the doctor: he takes into account both clinical data and the patient's complaints. [ 5 ]

If leukocytes and bacteria are present in the urine during pregnancy, this clearly indicates the presence of an inflammatory process in the urinary tract. The presence of more than five leukocytes in the field of view indicates the development of the body's immune response to the penetration of infection. The presence of more than 104 leukocytes in one milliliter of non-centrifuged urine is considered an unconditional indication of pathology.

Protein and bacteria in urine during pregnancy is an unfavorable sign that indicates various diseases and pathological conditions, such as:

• glomerulonephropathy;
• glomerulonephritis;
• amyloidosis;
• preeclampsia;
• infectious diseases.

The doctor makes an accurate diagnosis only after carrying out all the required diagnostic procedures.

Large amounts of bacteria and mucus in the urine during pregnancy are also a sign of pathology. The causes of such a problem may be:

• urinary tract infections;
• urinary retention.

If there is little mucus, but bacteria are found in significant quantities, then it makes sense to retake the test: perhaps the fluid was collected incorrectly, and bacteria got into the material from the outer skin and mucous membranes.

Complications and consequences

Even if bacteria in the urine during pregnancy do not reveal themselves in any way, their presence can seriously complicate the process. According to statistics, in approximately 30% of cases, latent bacteriuria in pregnant women transforms into acute gestational pyelonephritis, and increased local and general production of prostaglandins - activators of the endometrium - can cause premature birth. [ 6 ]

With the appearance of bacteria in the urine, the risk of developing gestosis and anemia increases. Fetoplacental insufficiency, intrauterine oxygen deficiency, fetal developmental disorders, and infectious complications (for example, postpartum endometritis or chorioamnionitis) often occur.

Bacteria in the urine during pregnancy should be diagnosed as early as possible in order to promptly recognize the pathology and prevent complications. [ 7 ]

Why are bacteria in urine dangerous during pregnancy?

Since the urinary system is in close proximity to the reproductive organs, there is a risk of infection spreading to the uterus and fetus. Intrauterine infection and the development of inflammatory reactions are especially dangerous. Among other possible dangers, the following complications are distinguished:

• premature birth;
• low birth weight of the child (less than 2.5 kg);
• premature rupture of membranes.

To prevent unfavorable developments, the gynecologist regularly prescribes a urine test for the pregnant woman. This is a necessary measure for the timely detection of various problems - in particular, the appearance of bacteria in the urine. Timely prescribed treatment will help prevent further development of the infection and carry a healthy pregnancy.

Diagnostics bacteria in the urine during pregnancy

If bacteria are found in the urine of a pregnant woman, the doctor should interview and examine the patient, assess the symptoms present and listen to the complaints. Sometimes bacteriuria occurs without any symptoms: in this case, further diagnostics are based on laboratory and instrumental examination results. Symptoms such as vaginal discharge, pain syndrome, burning and itching should be especially alarming - all these signs indicate the presence of an infectious and inflammatory process.

The further diagnostic plan most often includes laboratory tests:

• a general urine analysis, which is repeated with a study of the middle portion to exclude accidental entry of bacteria into the urine;
• urine culture for microflora - this is performed twice, with an interval of at least 24 hours;
• Photocolorimetric screening, or TTX test, helps to determine a high concentration of bacteria in urine fluid over a period of 4 hours.

Instrumental diagnostics in the form of ultrasound examination of the kidneys, ultrasound Doppler imaging of the renal vessels, as well as radiography and endoscopic methods are prescribed only in diagnostically complex situations, taking into account the possible negative impact of some methods on the course of pregnancy and the condition of the fetus. [ 8 ]

Differential diagnosis

Differential diagnostics are carried out with inflammatory genitourinary diseases. To assess the functional capacity of the kidneys, the Nechiporenko urine collection method, a number of renal tests, clinical blood analysis and blood biochemistry are used as an addition.

Latent bacteriuria should be differentiated from the false form, as well as from cystitis, pyelonephritis, urethritis.

Quite often, a gynecologist resorts to consultation with other specialists - for example, a nephrologist, urologist, therapist.

Treatment bacteria in the urine during pregnancy

Detection of bacteria in urine during pregnancy is a basis for prescribing treatment, even if there are no complaints or symptoms.

The doctor decides which therapy to choose based not only on the results of the antibiotic sensitivity test, but also on the woman's well-being and the pregnancy period. The probable benefit to the patient and the degree of harm to the fetus should also be carefully weighed.

If the presence of bacteria in the urine during pregnancy is not accompanied by any symptoms, then most often the doctor will prefer to use safer drugs that are permitted during pregnancy. Such drugs include Canephron, kidney tea, Cyston, Fitolizin: they are prescribed in combination with uroseptic and antibacterial agents - for example, with Monural, penicillin or cephalosporin antibiotics (they are permitted to be used in the II-III trimester). [ 9 ]

At the end of the treatment – approximately after 1-2 weeks – the urine test is repeated. If everything is in order and bacteria are not detected in the urine, then further prophylactic use of individual drugs is possible – for example, Canephron or Aflazin.

Medicines

• Antibiotic therapy is most often represented by Monural: a single dose of this drug helps eliminate bacteria that accumulate in the urinary tract. This antibiotic is safe and effective, and it is easy to use. [ 10 ]
• Monotherapy with antibiotics can also be represented by semi-synthetic β-lactam penicillins, cephalosporin drugs of the II-III generation. Except for the third trimester, the use of synthetic nitrofuran agents is prohibited, since they can cause hemolytic disease in the child.

Monural	A drug based on fosfomycin. Taken in the evening, on an empty stomach and empty bladder, after dissolving the granules in 100 ml of water. The dose is one-time, so it is rarely accompanied by side effects. Sometimes diarrhea may occur.
Amoxiclav	A drug that combines amoxicillin and clavulanic acid. Taken three times a day, in individually prescribed dosages. The duration of therapy is determined by the doctor. Possible side effects: dysbacteriosis, candidiasis, headache, diarrhea.
Augmentin	A drug of amoxicillin and clavulanic acid. The dosage is determined by the doctor on an individual basis. Possible side effects: candidiasis, allergy, dyspepsia.
Cystone	A herbal preparation that improves the condition of the urinary system. Tablets are taken orally, 2 tablets three times a day. The duration of therapy is determined by the doctor. Side effects: allergic rashes, digestive disorders, lumbar pain.
Phytolysin	A herbal preparation that is available as a paste for making a suspension. The preparation is taken three times a day, after meals, 1 teaspoon of paste in 100 ml of water. Duration of treatment is from 2 weeks to one month. Possible side effects: allergic reaction, dizziness, photosensitivity, diarrhea.

Antibiotics are allowed to be used no earlier than 14-16 weeks of pregnancy, since during the first trimester the fetus is actively forming organs and systems, and the future child does not have placental protection at this stage. As a rule, antibiotics are used in the minimum possible course - no more than three or five days. For treatment, extremely safe drugs are selected that do not cause harm during pregnancy.

Canephron for bacteria in urine during pregnancy

One of the safest medications recommended to improve the urinary tract during pregnancy is Canephron. This herbal remedy does not have a teratogenic effect, but does have a number of useful properties:

• diuretic;
• antispasmodic;
• antimicrobial;
• anti-inflammatory.

The composition of the drug is represented by the plants centaury, lovage and rosemary.

In pharmacies, Kanefron can be purchased in the form of drops or tablets, however, if you have bacteria in your urine during pregnancy, it is better to opt for the tablet drug, since the drops contain a certain amount of ethyl alcohol.

Canephron is approved for use at any stage of pregnancy, and even during breastfeeding. The duration of treatment is usually at least two weeks: take one tablet in the morning and one in the evening, regardless of meal time. The tablet is washed down with a sufficient amount of liquid and swallowed without chewing. As a rule, the medication is well received by the body, and only in rare cases can an allergic reaction occur. This point should be taken into account if the patient's body is prone to allergic processes. [ 11 ]

Vitamins

Vitamins are important substances for maintaining the health of the urinary tract. However, if bacteria appear in the urine during pregnancy, self-medication (even with vitamins) should not be started, because this can lead to the most unfavorable consequences. The best vitamin supplements for pregnant women are those prescribed by a doctor. Vitamins, like other medications, are selected individually, based on the results of diagnostics and a medical examination.

During pregnancy, the best vitamin complex is considered to be a complete and varied diet. And only in case of a real vitamin deficiency can the doctor insist on additional intake of certain drugs. We can talk about the following vitamin components:

• vitamin D in combination with calcium;
• Vitamin A (strictly under the supervision of a physician to avoid overdose);
• vitamin E (one of the most powerful antioxidants);
• Vitamin K (supports kidney function);
• B vitamins (improves metabolic processes);
• ascorbic acid (helps to inhibit the development of the inflammatory reaction).

Perhaps the doctor will choose one vitamin, or will immediately prescribe a complete vitamin-mineral complex created specifically for pregnant women - for example, it could be Vitrum prenatal, Elevit pronatal, Complivit Trimestrum or Complivit Mama, Pregnavit or Multitabs perinatal.

Physiotherapy treatment

Physiotherapy is used extremely rarely when bacteria appear in urine during pregnancy – mainly in chronic forms of urological pathology. It is possible to use magneto or electrophoresis, inductothermy, UHF therapy, ultrasound and laser treatment. However, the need for such procedures is carefully weighed in each specific case. Most often, the doctor decides to use medication and herbal therapy, and physiotherapy is postponed until the postpartum period.

Folk remedies

You can supplement the main treatment with folk remedies - of course, with the consent of the doctor. If bacteria appear in the urine during pregnancy, it is recommended to pay attention to such simple recipes:

• Try to drink at least a couple of glasses of cranberry or blueberry juice daily (you can replace the juice with fruit drink). These drinks will prevent accumulation and reduce the viability of bacteria in the urinary system.
• Eat 1 tablespoon of natural coconut oil daily, or drink a glass of coconut milk, which has an antimicrobial effect against many bacteria.
• Add asparagus to your food – this plant perfectly cleanses the urinary tract.
• Drink natural apple cider vinegar – 2 tablespoons per day, with water.
• Add celery, pineapple, basil to your meals. The right food ingredients will help maintain the health of your urinary system.

Herbal treatment

You can consult with your doctor about the use of herbal medicines, because many plants are famous for their pronounced activity against pathogenic bacteria. Of course, not all herbs are allowed for pregnant women, but some of them may be recommended by your doctor:

• chamomile flower;
• birch buds and leaves;
• bearberry leaf;
• juniper berries;
• parsley (leaves and shoots).

In addition to the above, you can buy so-called “kidney tea” and Nephrophyte tea at the pharmacy: these herbal preparations enhance the effect of antibacterial medications and also help to cope with the inflammatory reaction more quickly.

Homeopathy

Homeopathic medicines are relatively safe and effective during pregnancy. Why is such safety relative? The fact is that the only possible side effect of such medicines is an allergic reaction. Therefore, before using homeopathic medicines, you need to make sure that the woman is not allergic to the drug. If there is no such allergy, then homeopathy is allowed.

Homeopathic remedies are not intended to get rid of certain symptoms. Their task is to promote and accelerate the healing process. The therapeutic effect consists in stimulating the self-regulation system - that is, in activating the body's own defenses.

If bacteria appear in the urine during pregnancy, the following homeopathic remedies may be recommended:

• Berberis Homaccord - 10 drops three times a day, can be taken for a long time;
• Populus compositum - 10 drops three times a day, and in case of exacerbation, hourly;
• Renel - one tablet three times a day (dissolve in the mouth);
• Uroregulan – 5-7 granules up to five times a day 20 minutes before meals.

The use of homeopathic medicines should not replace the medical treatment prescribed by the doctor. However, it can successfully complement it, as it is perfectly combined with the use of other medicines.

Prevention

• Every day, a woman should drink sufficient amounts of liquid, excluding soups, dairy products and juices.
• It is best to choose purified drinking water or rosehip infusion for drinking.
• It is better to exclude or greatly limit pickles, hot sauces, fried and fatty foods, and sugar from your diet. You cannot "prescribe" calcium supplements to yourself, as this can cause increased kidney stone formation.
• It is preferable to eat light plant foods and porridge.
• It is better to boil, steam or bake food products for dishes.
• It is important for a pregnant woman to spend enough time outdoors. Moderate physical activity, yoga, and breathing exercises are encouraged.
• Urine tests during pregnancy should be taken regularly to monitor the condition of the urinary tract.

Forecast

If a doctor detects bacteria in the urine during pregnancy, then ignoring such an indicator is absolutely unacceptable. Measures must be taken, and the sooner this happens, the better. The effectiveness of the prescribed drug therapy is determined as 80-90%. That is, in the vast majority of cases, treatment leads to the elimination of this problem. According to statistics, in about 75% of cases, timely therapy can prevent the development of pyelonephritis in pregnant women, and in 8% of cases, it can prevent prematurity in the baby. Given these indicators, we can confidently speak about a positive prognosis for bacteriuria, provided that medical intervention is timely.