Bacteria in urine in pregnancy

The general urinalysis is a standard common test, which begins the diagnosis of pregnant women. This analysis will indicate the presence of malfunctions in the urinary system, will help to assess the state of water-electrolyte balance. Unfortunately, not always the results of such a study can please - for example, if the indicators do not correspond to the norm. What can be suspected if bacteria in the urine in pregnancy are determined? Is it worth worrying, and what measures to take?

What does it mean to have bacteria in urine in pregnancy?

The composition of the urinary fluid should be sterile - free of germs and other infectious agents. If bacteria are found in pregnancy, this condition is considered dangerous because of the high probability of spreading the infection through the urinary system.

Most often the analysis reveals Escherichia coli, streptococci and staphylococci, Klebsiella, enterococcus - that is, bacteria living in the intestinal cavity or on the covering tissues of the body. However, we repeat, in a healthy person, such bacteria in the urine should be absent. [1]

The norm of bacteria in urine during pregnancy

In the normal state of health of a pregnant woman, the urinary fluid is always sterile - that is, it does not contain any bacteria or other infectious agents. If, however, a certain amount of bacteria is found in the urine, this condition is called bacteriuria. Microbes are able to get into the urinary fluid from the vagina, or from the urinary ducts. The affiliation of such flora can be both pathogenic and opportunistic.

If the doctor detects the presence of bacteria, his task becomes to determine where exactly "hides" the focus of infection, in order to further neutralize it.

It is customary to distinguish between two varieties of bacteriuria:

• Asymptomatic bacteriuria, in which there are no clinical signs other than the detection of bacteria in the pregnant woman's urine;
• Bacteriuria with an appropriate clinical picture of pathology.

False bacteriuria is also distinguished. It is said if 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 should be taken again, after a thorough genital toilet.

Bacteriuria is recognized as error-free if more than 100,000 bacteria are detected in one milliliter of urine or more than¹⁰⁵ bacteria in one milliliter. In this case, it is mandatory to take the test twice to rule out an error.

Causes of the bacteria in the urine during pregnancy

Pregnancy is a condition that in itself is a risk factor for bacteria in the urine, as the anatomy and functionality of many organs in the body change. For example, the renal calyxes and pelvis expand, the function of the urinary sphincter becomes more difficult. Even latent 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:

• through the lymphogenic route - for example, if the infection exists near the urinary organs or kidneys;
• The ascending route, when bacteria enter the urinary system through the urethral canal - e.g. Catheter placement, cystoscopy;
• through the hematogenous route - that is, with blood flow from other inflamed organs;
• downward pathway, when the main focus of infection is in the renal organs.

Depending on what other changes are present in the urinalysis results, such diseases associated with bacteriuria can be suspected:

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

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

Risk factors

Bacteria in urine in pregnancy can be detected by certain disposing factors:

• increase in the size of the uterus, compression of nearby structures - including kidney organs, ureters;
• difficulty defecating, slow bowel motility;
• impaired ureteral tone;
• weakened immune defenses;
• slow urinary outflow;
• changes in the renal pelvis and ureters;
• an increase in the pH of the urine.

Pathogenesis

Most often, the mechanism of the appearance of bacteria in the urine in pregnancy is associated with the upward spread of pathogens through the urinary system. Very rarely such a spread occurs by 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 urethral sphincter. With a weak immune response, complete elimination of bacteria is not carried out, and their content becomes such that an inflammatory process occurs (or the latent course of bacteriuria begins). [3]

Acceleration of bacterial development occurs as a result of the physiologic increase in urine pH during pregnancy, as well as the possible presence of sugar in the urine.

Symptoms of the bacteria in the urine during pregnancy

The presence of bacteria in the urine during pregnancy is not always manifested by any symptoms. Quite often bacteriuria is hidden and is detected only during diagnosis. In this case, women themselves may feel well and do not present any health complaints. However, this does not mean that there is no problem: it exists and worsens, and symptoms may appear a little later.

In some cases, pathology originates even before the onset of pregnancy, just a woman begins to take tests after registration. As a result, the doctor has to diagnose many diseases in the process of carrying the baby: among the most common pathologies are chronic pyelonephritis, urolithiasis.

The first signs of the presence of bacteria in the urine are usually subdued and not characterized by a pronounced intensity. These symptoms may include:

• Cutting, burning sensations during or at the end of the urinary act (e.g. Cystitis);
• soreness in the lower abdomen, with possible irradiation to the left or right side;
• Episodic urinary incontinence, impaired urination;
• A slight or significant increase in temperature readings;
• general deterioration of well-being, feeling of fatigue and weakness;
• turbidity of urinary fluid, change of color shades, appearance of flakes and mucus.

Urinalysis allows you to determine the presence and number of bacteria in the urinary tract. This can be pathogenic, non-pathogenic and opportunistic microorganisms, and neither the first, second and third microbes should not be normal in the urine.

What can urinalysis tell? Usually, the technique of sector seeding is used for the study: biological fluid is placed on a special nutrient medium, after which the number of bacterial cells in 1 ml of urine is estimated. Recall, it is considered normal if no bacterial growth is detected in the material. [4]

• If the results of the analysis show single bacteria in the urine in pregnancy +, it means that their number does not exceed^{103 CFU / ml} . Such bacterial growth does not in all cases cause an inflammatory reaction and can occur covertly.
• Bacteria in the urine in pregnancy ++ correspond to a microbial cell count of¹⁰⁴ CFU/mL. This result may be considered by the doctor as doubtful, so it is advisable to take the urine test again.
• Bacteria in the urine in pregnancy +++ correspond to a microbial cell count of¹⁰⁵ CFU/mL. As a rule, this number of bacteria always causes the development of inflammation.

A lot of bacteria in the urine in pregnancy indicates the presence of an inflammatory reaction in the kidneys, or in the urinary tract. The doctor assesses the degree of pathogenicity of the detected bacteria: he takes into account both clinical data and the patient's complaints. [5]

If there are both leukocytes and bacteria in the urine in pregnancy, it is a clear indication of the presence of an inflammatory process in the urinary tract. The presence of more than five leukocytes in the field of vision 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 in pregnancy is an unfavorable sign that indicates various diseases and pathological conditions, such as:

• glomerulonephropathy;
• glomerulonephritis;
• amyloidosis;
• pre-eclampsia;
• infectious diseases.

The exact diagnosis is established by the doctor only after all the required diagnostic procedures have been performed.

In large quantities of bacteria and mucus in the urine in pregnancy - this is also a sign of pathology. The causes of such a malfunction can become:

• urinary tract infections;
• urinary fluid stasis.

If there is little mucus, but bacteria are found in significant quantities, it makes sense to retest: it is possible that the fluid was collected incorrectly, and bacteria got into the material from external skin and mucous membranes.

Complications and consequences

Even if bacteria in the urine during pregnancy are not detected in any way, their presence can seriously complicate the process. According to statistics, in about 30% of cases, hidden bacteriuria in pregnant women transforms into acute gestational pyelonephritis, and increased local and total production of prostaglandins - endometrial activators - can cause premature labor. [6]

With the appearance of bacteria in the urine increases the risk of gestosis, anemia. Fetoplacental insufficiency, intrauterine oxygen deficiency, fetal developmental disorders, and infectious complications (e.g., postpartum endometritis or chorioamnionitis) are common.

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

What are the dangers of bacteria in urine in pregnancy?

Since the urinary system is in close proximity to the reproductive organs, there is a danger of spreading infection to the uterus and fetus. Especially dangerous is intrauterine infection, the development of inflammatory reactions. Among other possible dangers, the following complications stand out:

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

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

Diagnostics of the bacteria in the urine during pregnancy

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

Further diagnostic plan most often includes laboratory tests:

• general urinalysis, which is repeated with the examination of the middle portion, to exclude the accidental introduction of bacteria into the urinary fluid;
• urine culture for microflora - it is performed twice, with an interval of at least a day;
• Photocolorimetric screening, or TTC test helps detect high concentrations of bacteria in urinary fluid over a 4-hour period.

Instrumental diagnostics in the form of renal ultrasound, renal vascular ultrasound, as well as radiography and endoscopic methods are prescribed only in diagnostically difficult 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 diagnosis is carried out with inflammatory urogenital diseases. To assess the functional capacity of the kidneys as an addition, the method of urine collection according to Nechiporenko, a number of renal tests, clinical blood analysis and blood biochemistry are used.

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

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

Treatment of the bacteria in the urine during pregnancy

Detection of bacteria in the urine during pregnancy is a reason to prescribe treatment, even if there are no complaints and symptoms.

The doctor decides which method of therapy to choose, based not only on the results of the test for sensitivity of bacteria to antibiotics, but also on the well-being of the woman, the term of pregnancy. It is also necessary to carefully weigh the likely benefits for the patient and the degree of harm to the fetus.

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

At the end of the treatment - after about 1-2 weeks - the urine test is repeated. If all is well and no bacteria are detected in the urine, further prophylactic use of certain medications, such as Kanefron or Aflazine, is possible.

Medications

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

Monural	The drug is based on fosfomycin. It is taken in the evening, on an empty stomach and empty bladder, having previously dissolved granules in 100 ml of water. Reception - single, so it is rarely accompanied by side effects. Sometimes diarrhea may occur.
Amoxiclav	A drug combining amoxicillin and clavulanic acid. It is taken three times a day, in individually set dosages. The duration of therapy is determined by the doctor. Possible side effects: dysbacteriosis, candidiasis, headache, diarrhea.
Augmentin	A preparation of amoxicillin and clavulanic acid. The dosage is determined by the doctor on an individual basis. Possible side effects: candidiasis, allergies, dyspepsia.
Cystone	A herbal preparation that improves the condition of the urinary system. Tablets are taken orally 2 pcs. Three times a day. The duration of therapy is determined by the doctor. Side effects: allergic rashes, digestive disorders, lumbar pain.
Phytolysin	A plant preparation, which is available in the form of paste for preparation of suspension. Take the drug three times a day, after meals, 1 tsp. Of paste in 100 ml of water. Duration of treatment - from 2 weeks to one month. Possible side effects: allergic reaction, dizziness, photosensitization, diarrhea.

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

Canefron for bacteria in urine in pregnancy

One of the safest medicines recommended to improve the work of the urinary tract in pregnancy is Kanefron. This is a herbal remedy that does not have teratogenic effects, but has a number of useful properties:

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

The composition of the drug is represented by the plants goldenseal, lubistock and rosemary.

In pharmacies, Kanefron can be purchased in the form of drops or tablets, but with bacteria in the urine in pregnancy it is better to opt for a tablet preparation, since the drops contain a certain proportion of ethyl alcohol.

Kanefron is allowed for use at any term of pregnancy, and even during breastfeeding. The duration of treatment is usually at least two weeks: tablets are taken one piece in the morning and evening, regardless of the time of meals. The tablet is washed down with a sufficient volume of liquid and swallowed without chewing. As a rule, the medicine is well perceived by the body, and only in rare cases an allergic reaction may 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, when bacteria appear in the urine during pregnancy, self-treatment (even with vitamins) should not be started, because it can lead to the most unfavorable consequences. The best vitamin remedies for pregnant women are those prescribed by a doctor. Vitamins, like other medicines, are selected individually, based on the results of diagnosis and medical examination.

In pregnancy, the best vitamin complex is considered a complete and varied diet. And only when there is a real lack of vitamins, the doctor may insist on additional intake of certain preparations. It may be about such vitamin components:

• vitamin D combined with calcium;
• Vitamin A (strictly under the control of a doctor to avoid overdose);
• Vitamin E (one of the most powerful antioxidants);
• Vitamin K (supports kidney function);
• B-group vitamins (improve metabolic processes);
• ascorbic acid (contributes to the inhibition of the inflammatory response).

Perhaps the doctor will opt for a single vitamin, or prescribe a full vitamin and mineral complex, created specifically for pregnant women - for example, it may be Vitrum Prenatal, Elevit pronatal, Complivit Trimestrum or Complivit Mama, Pregnavit or Multitabs perinatal.

Physiotherapy treatment

Physiotherapy for the appearance of bacteria in the urine in pregnancy is rarely used - mainly in the chronic form of urological pathology. It is possible to use magneto or electrophoresis, inductothermia, EHF 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 phytotherapy, and physical procedures are postponed to the postpartum period.

Folk treatment

You can supplement the main treatment with folk remedies - of course, with the doctor's consent. 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 glasses of cranberry or blueberry juice every day (you can replace the juice with morsels). These drinks will prevent the accumulation and reduce the viability of bacteria in the urinary system.
• Eat 1 tbsp of natural coconut oil daily, or drink a glass of coconut milk, which has antimicrobial properties against many bacteria.
• Add asparagus to your meals - this plant is great for clearing the urinary ducts.
• Drink natural apple cider vinegar - 2 tbsp. Per day, with water.
• Add celery, pineapple, and basil to your meals. The right food ingredients can help keep your urinary system healthy.

Herbal treatment

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

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

In addition to the above, in the pharmacy you can buy the so-called "kidney tea", as well as tea Nephrofit: these herbal preparations enhance the effect of antibacterial medications, and also help to cope with the inflammatory response sooner.

Homeopathy

Homeopathic medicines are relatively safe and effective in 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 remedies, it is necessary to make sure that the woman is not allergic to the drug. If there is no such allergy, it is allowed to use homeopathy.

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

The following homeopathic remedies may be recommended when bacteria appear in the urine during pregnancy:

• Berberis homaccord - 10 drops three times a day, can be prolonged;
• Populus compositum - 10 drops three times a day, and at exacerbation hourly;
• Renel - one tablet three times a day (chewed in the mouth);
• Uroregulan - 5-7 pellets up to five times a day 20 minutes before meals.

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

Prevention

• A woman should drink adequate amounts of fluids daily, excluding soups, dairy products and juices.
• It is optimal to choose purified drinking water or rosehip infusion for drinking.
• From the diet it is better to exclude or severely limit pickles, hot sauces, fried and fatty foods, sugar. You should not "prescribe" yourself calcium preparations, because it can cause increased kidney stone formation.
• It is preferable to consume plant-based non-heavy foods, porridge.
• Foods for dishes are better boiled, steamed or baked.
• It is important for a pregnant woman to spend enough time in the fresh air. Moderate physical activity, yoga and breathing exercises are encouraged.
• Urinalysis in pregnancy should be taken regularly to keep the condition of the urinary tract under control.

Forecast

If the doctor detects bacteria in the urine in pregnancy, then ignoring such an indicator is in no way inadmissible. It is necessary to take action, and the sooner it happens, the better. The effectiveness of the prescribed drug therapy is defined as 80-90%. That is, in the vast majority of cases, treatment leads to the elimination of this malfunction. According to statistics, in about 75% of cases, timely therapy can prevent the development of pyelonephritis of pregnant women, and in 8% of cases - to prevent prematurity in the baby. Given these indicators, it is safe to talk about a positive prognosis of bacteriuria, provided timely medical intervention.