Why are white blood cells in the urine increased during pregnancy?

Leukocytes in the urine during pregnancy - this increase in the level of white blood cells above the norm, which can be caused by different reasons. More often a significant increase in the level of leukocytes is two or more times caused by the inflammatory process of the urinary or genital tract. But there can be a normal deviation of the level of leukocytes under certain conditions. Therefore, you need to know such "anxiety symptoms" in time to prevent the development of complications of pregnancy and childbirth.

Causes of the leukocyturia in pregnancy

To know the reasons for the increase in the level of leukocytes, it is necessary to understand the role of these cells in the body and what are the standards of these indicators. Leukocytes are blood cells that have a white color and different shapes, depending on their type. These cells perform the role of protective forces, so the increase of these cells in the blood indicates the activation of immunity. The structure of leukocytes allows them to penetrate the cells and tissues of the body, which facilitates the realization of their function in any place. Under normal conditions, leukocytes get through the renal filter only in the form of single cells, which does not indicate an inflammatory change. The norm of immune cells in the urine of a pregnant woman may be higher than that of other women. This is due to the fact that during pregnancy and the increase in the uterus, the urinary tract changes its position. Therefore, because of the physiological compression of the urinary tract, leukocytes can accumulate there, which are excreted in the urine. The normative values of inflammatory cells in the urine are 0-4 cells in the field of vision. In pregnancy, this indicator can reach 6 cells in the field of vision, but if the figure is much larger, then you should start a checkup or, at least, consult a doctor.

The level of leukocytes in the analysis of urine is very important and if it is 4-6-10, then we can say that this is a permissible level, but it is necessary to retake. This amount does not indicate a disease, and the reason for this increase can only be that the woman has passed the analysis not according to the rules or in the unclean capacity. Therefore, you need to repeat the analysis, observing all the rules of hygiene. To submit the analysis of urine it is necessary necessarily in the morning, after careful hygienic procedures. It is very important that the container is clean - therefore it is better to buy a glass for analysis in the pharmacy. This will eliminate all possible subjective reasons for increasing the level of leukocytes.

If the level of leukocytes in the primary analysis exceeds the norm by three or more times, then it should be thought that this is a symptom of inflammation. The process can be localized in the kidneys, bladder, ureters, and genitals.

One of the reasons for the increase in leukocytes is pyelonephritis. This disease, which is characterized by inflammation of the calyxal and pelvic system of the kidney and the formation of an inflammatory secretion. This is accompanied by the expansion of the system, accumulation of secretion and migration of leukocytes to the site of inflammation, as the main immune cells. Therefore, in addition to clinical manifestations of pyelonephritis, leukocytes are excreted in the urine because of their large number in the focus of infection. Also, one of the reasons for the allocation of leukocytes in the urine can be chronic pyelonephritis. Then the release of leukocytes is permanent, and this can be the only symptom that is determined laboratory.

Another cause for the symptomatology of leukocyturia is acute cystitis. This inflammation of the bladder, which is caused by pathogenic bacteria and is also accompanied by active migration of leukocytes. Symptomatic development of cystitis is very rapid and is characterized by the appearance of leukocytes at the beginning of the disease, which is due to the proximity of the bladder. The pathogenesis of the development of inflammatory diseases in pregnancy is associated with a significant compression of organs with an enlarged uterus. This contributes to the active development of the inflammatory process.

The cause of an increase in white blood cells in the urine may be inflammation of the genitals. Acute vulvovaginitis is an inflammation of the vagina, which often develops in pregnant women against a background of decreased immune status. The disease is characterized by an increase in the number of leukocytes, as well as other clinical manifestations.

[1], [2], [3]

Risk factors

Based on possible causes of pathology, it is necessary to identify the risk factors that must be taken into account in the diagnosis and planning of pregnancy. Women with chronic pyelonephritis have an immediate risk of exacerbating this pathology during pregnancy. Also at risk are women who often have cystitis, who have reduced immunity and resistance.

[4], [5]

Symptoms of the leukocyturia in pregnancy

Clinical signs of pathologies that cause an increase in white blood cells in the urine can develop even before the changes in the analysis. Therefore, you need to pay attention to the symptoms that are before this. The situation may be reversed, and leukocyturia may be the first and only symptom of the disease.

Acute pyelonephritis is more common in the third trimester of pregnancy, when an increase in the uterus and an increased synthesis of progesterone stimulates a violation of the anatomical structure of the urinary tract. Therefore, acute pyelonephritis in a pregnant woman is called gestational, and has a secondary obstructive character. Against the background of a violation of the normal outflow of urine conditions are favorable for the development of pathogenic microorganisms. The first signs of pyelonephritis can manifest as a significant increase in body temperature. More often it happens at night, when a woman feels a headache, poor general health and the temperature rises above the low-grade figures. There is also a pain in the lower back or just below the back. The pain is not permanent, but it is pronounced and causes acute sensations. This may be accompanied by impaired urination - pain or discomfort, frequent urge to urinate, cloudy urine. These are the main symptoms of pyelonephritis, the appearance of which should make the doctor consult.

Chronic pyelonephritis during pregnancy can worsen, then all the symptoms that are characteristic of acute pyelonephritis appear. But sometimes the chronic process may not exacerbate, then there are no objective symptoms other than changes in the analyzes. Therefore, it is so important to conduct follow-up care for pregnant women with chronic pyelonephritis.

Acute cystitis is characterized by rapid development of symptoms after hypothermia. By the evening there are symptoms of discomfort and a pulling sensation in the lower abdomen above the pubis. At the same time frequent urge to urinate and pain and pain during this - the characteristic symptoms of cystitis. The body temperature does not increase and is a distinctive feature of cystitis and pyelonephritis.

Acute vulvitis or vulvovaginitis is accompanied by an inflammatory process directly in the vagina. Therefore, the main symptom of the disease is purulent or turbid discharge from the vagina, as well as sensations of itching, burning in the vagina. And the appearance of any discharge may be a manifestation of local inflammatory processes of the genital organs.

Leukocyturia may not be the only manifestation. Leukocytes and bacteria in the urine during pregnancy mainly indicate exactly the acute inflammatory process - pyelonephritis or cystitis. Bacteria can be the direct pathogens of infection.

If leukocytes and erythrocytes are found, then this can be a serious symptom of acute renal pathology with nephron damage. Glomerulonephritis - inflammation of the kidneys with glomerular lesions, which is accompanied by the appearance in the urine of the harvested erythrocytes due to the violation of renal filtration. The disease develops gradually and can be manifested by increased blood pressure, swelling, intoxication syndrome. If the red blood cells are fresh, then this may be a symptom of kidney damage, injuries, or urolithiasis. Therefore, it is important to conduct complex differential diagnosis when leukocyturia and erythrocyturia appear.

Protein and white blood cells in the urine during pregnancy can be a symptom of a serious late gestosis. Late gestosis develops in the third trimester of pregnancy and the first clinical manifestations can begin with swelling of the legs. Further symptoms of increased blood pressure and symptoms on the part of the fetus can be added. Such a pathology - pre - eclampsia, is caused by a massive release of protein, a change in oncotic blood pressure and the corresponding symptoms.

Many reasons for the appearance of leukocytes in the urine of expectant mothers indicate that it is necessary to conduct a thorough diagnosis, especially for expectant mothers.

Complications and consequences

The consequences of leukocyturia can be very serious if the cause is acute pyelonephritis. In pregnant women, the inflammatory process in the kidneys with untimely diagnosis can cause acute anuria or the formation of an abscess of the kidney. Complications that can develop against a background of intense inflammation are the infection of the fetus and the possible development of intrauterine infections and congenital malformations.

If white blood cells appear on the background of pre-eclampsia in a pregnant woman, the complications can be very serious in the form of arterial hypertension and the development of eclampsia. This can be accompanied by cramps, which also carries a potential threat to the fetus.

[6]

Diagnostics of the leukocyturia in pregnancy

If the level of white blood cells in the urine of a pregnant woman reaches 4 to 10 in the field of vision, then it is definitely early to talk about the diagnosis, but it is necessary to conduct a repeated urine test. If the result is the same or higher, then you need to carefully examine the woman and conduct a thorough differential diagnosis. If the repeated result is within the limits of the norm, then the changes were due to incorrect technique of the analysis.

A pregnant woman gives tests during pregnancy regularly for the purpose of determining the disease in time before the onset of symptoms. The analysis of urine is included in the list of mandatory tests, and is carried out once a month in the first trimester, twice a month - in the second trimester and every week in the third trimester. If the changes are found in a woman with a planned urinalysis and no objective symptoms, then in this case, you need to start the diagnosis from a history and examination of the systems. It is necessary to clarify the woman about the presence of chronic diseases, kidney diseases. It is important to ask about previous pregnancies and about the presence of late or early gestosis. Then you need to examine the woman, sometimes you can see swelling of the legs or swelling under the eyes, which may lead to the idea of kidney pathology. If a woman had a fever, then you need to check the symptom Pasternatsky, which is positive in the case of acute pyelonephritis. After an objective examination, additional diagnostic methods should be performed to clarify the pathology and eliminate the threat to life for the baby.

Analyzes should exclude a pathological condition, or identify a foci of infection when an inflammation is suspected. A general blood test helps to eliminate the inflammatory process, otherwise, there will be leukocytosis and a shift of the formula to the left with acute pyelonephritis or exacerbation of the chronic. A general urine test helps to establish the function of the kidneys and urinary tract. Any increase in leukocytes may indicate inflammation and possible cystitis or pyelonephritis. In the case of cystitis, the changes will only be in the urinalysis, and the blood test will be normal. If a woman has pyelonephritis, then there will be changes in blood and urine. Urine analysis, in addition to leukocyturia, may have minor proteinuria, epithelium, and bacteria. If, in addition to leukocytes, massive proteinuria is determined, then one can think of pre-eclampsia, which is very serious in terms of possible complications.

Instrumental diagnostics must be carried out in order to avoid acute conditions. Ultrasound can accurately determine the condition of the fetus, the localization of the fetal egg and you can accurately exclude a particular condition. Acute pyelonephritis can be accurately diagnosed with the help of ultrasound - the expansion of the cup-and-pelvic system is an objective symptom of inflammation. The presence of stones in the pelvis region can also be diagnosed with accuracy and the establishment of urolithiasis. If there is a suspicion of pre-eclampsia, it is necessary to monitor blood pressure. Other methods of instrumental research can be used for the purpose of differential diagnosis. If necessary, then conduct a Doppler study to study the blood circulation of the fetus and examine its response to mum's disease.

[7], [8]

Differential diagnosis

Differential diagnosis of leukocyturia should be carried out to exclude an acute condition that threatens with serious complications of pregnancy. For example, preeclampsia can quickly become a convulsive syndrome. Therefore, it is necessary to examine a woman and differentiate the transient increase in leukocytes in the urine with gestosis. It is also necessary to exclude the exacerbation of chronic pyelonephritis and acute pyelonephritis, since the approaches to treatment differ.

Treatment of the leukocyturia in pregnancy

Treatment is used with the obligatory consideration of the etiologic factor and only after a thorough examination. It is necessary to take into account the potential harm to the child in any treatment of a woman. If the cause is gestational acute pyelonephritis, then use complex treatment with mandatory hospitalization in the hospital. In pregnant women, pyelonephritis has a secondary nature because the uterus contracts the ureters, so an obligatory element of treatment is stenting with restoration of the outflow of urine. Then you need to prescribe an antibiotic that can be given to pregnant women. Such authorized antibacterial agents include unprotected aminopenicillins and cephalosporins.

1. Ampicillin is an antibiotic from a group of unprotected penicillins that have activity against gram-positive and some gram-negative microorganisms that play a key role in the development of pyelonephritis. The drug is active against E. Coli, hemophilic rod, Klebsiella, Shigella, Salmonella, Proteus. The action of the drug is carried out due to the violation of the cell wall and its easy lysis, which leads to the death of the parasitic microorganism. The drug has no teratogenic effect, but is able to penetrate with milk in a small amount. The method of application of the drug for acute pyelonephritis is parenteral, which accelerates the effect and action of the substance in the focus of infection. Dosage of the drug - 0.5 grams four times a day. Side effects can be frequent in the form of allergic manifestations, as well as effects on the nervous system.
2. Ceppodoxime is a beta-lactam antibiotic of the third generation, especially effective in the action on aerobic flora. The drug has a bactericidal effect on possible pathogens of chronic and acute infection, therefore it can also be used for cystitis. Dosage of the drug - 200 milligrams twice a day, at least ten days. Side effects are possible as allergic and dyspeptic.  
3. Kanefron is a complex herbal preparation that is very effective in treating acute and chronic diseases of the urinary system. Its composition includes herbs zlatotysyachnika, rosemary, as well as vitamins, so the drug is completely safe for the child. Treatment can be carried out with acute cystitis or with frequent episodes. The medicine should be drunk with a sufficient amount of fluid and monitor the arterial pressure of the pregnant woman. Method of use in tablets or drops. Dosage - two tablets three times a day. Side effects are rare - a drop in blood pressure, headache, dizziness, nausea, allergic reactions.
4. Amazestine is a plant drug that has an antibacterial, anti-inflammatory and diuretic effect, which allows the use of the drug for the treatment of urinary tract infections. The composition of the medicine includes a dry extract from the leaves of bear's ears. The way of using the drug in the form of tablets, without chewing and washing down with a sufficient amount of water. Dosage is two tablets three times a day, the treatment should be no more than one week. Side effects are not common, allergic manifestations are possible.

Vitamins can be used by a future mother throughout pregnancy, or in case of an acute illness - after recovery. Many vitamins normalize the state of the immune system of a woman after a disease, and also strengthen the wall of blood vessels, which improves blood flow in the kidney. Therefore, you can recommend taking complex vitamin preparations during the recovery period.

Physiotherapeutic treatment can be used for cystitis, but in the absence of contraindications. It is necessary to take into account the condition of the fetus and at early stages to take any procedures only on the recommendation of the doctor and the absence of an acute inflammatory process.

Surgical treatment of pathologies that are accompanied by the appearance of white blood cells in urine can be used only in the presence of complications against this background. Sometimes, with urolithiasis and acute anuria, it is necessary to carry out an operative intervention to apply the nephrostomy. With a running purulent process, there may be a need for surgical removal of purulent foci.

Alternative therapies

Alternative treatment is very effective together with the elimination of the inflammatory process with antibacterial therapy. The main effect of alternative methods is the use of drugs that have a diuretic and antiseptic effect, which speeds up the excretion of pathogenic microorganisms.

1. Birch juice has many microelements and phytoncides that promote the elimination of metabolic products and relieves inflammation in the kidney area. For the therapeutic effect, it is recommended to take fresh birch sap over a glass in the morning - this will improve blood circulation after a night's sleep.
2. Chamomile tea with cranberries is an excellent remedy for the treatment of urinary tract pathologies, as tea leaves and cranberries have not only anti-inflammatory, but also spasmolytic effect, which improves the outflow of urine. You need to drink tea at least twice a day.
3. Flax is a remedy that actively cleanses the kidneys and promotes the regeneration of the cells of the urinary tract epithelium. For cleansing infusion it is necessary to take thirty grams of flax seeds, pour boiling water and insist for two hours. Then the solution should be diluted in a ratio of one to one with warm water. Medicinal infusion should be drunk on a tablespoon five times, at least three days.

Herbal treatment is very effective in the pathology of the kidneys and bladder, but it is necessary to exclude gestosis in a woman, since additional water load can greatly damage and lead to complications. In any case, the intake of medicinal teas should be done carefully, controlling the condition of the pregnant woman and possible swelling.

1. Leaves bearberry are an excellent tool in the treatment of kidney pathology. To make a brew, you need to pour 30 grams of herb bearberry into cold water and insist for three days. Then, before use, drain the broth and boil, only after that you can take twenty grams in the morning and in the evening.
2. Very useful kidney collection from berries of cowberry, chamomile, currant leaves and corn stigmas. This tea has a diuretic and anti-inflammatory effect. You need to take 50 grams of all the ingredients, make tea from two liters of water and drink in small sips throughout the day. The course of treatment is four weeks while monitoring the total amount of fluid that is output.
3. Infusion of cornflowers, lovers and St. John's wort is known for its beneficial effect on the condition of the urinary tract, so you can use this remedy for urolithiasis and an outflow of urine of a spasmodic nature. Infusion can be done by boiling the leaves of herbs in hot water for ten minutes, and then after it has cooled to take on the pile of solution twice a day.
4. Cowberry and strawberries are plants that reduce the inflammatory process in the bladder, the renal pelvis and reduce the tone of the ureters, which improves the dynamics of urine in a pregnant woman and thus accelerates recovery. The medicine is also used in women with chronic pyelonephritis in the form of infusion for the prevention of exacerbations. For tea, you need to take 30 grams of grass and berries of both bushes, pour hot water and insist for ten minutes. Then, before use, drain the broth and take twenty grams in the morning and evening.
5. Herbal collection of leaves of mother-and-stepmother, chamomile and cornflower is very effective in acute pyelonephritis as an antiseptic. For therapeutic tea you need to take twenty grams of each herb, pour into a thermos and pour hot water, leaving for the night. You need to drink fifty grams of tea in a warm form.

Homeopathy can also be used, especially in women at risk before the onset of symptoms.

1. Baptisia is a homeopathic remedy of plant origin, which is effective in the treatment of inflammatory pathology of the kidneys and chronic inflammatory process of the bladder. The preparation has very strong antiseptic properties and is used as a tincture. Dosage - three drops every day. The course of treatment can begin immediately after the appearance of complaints, and before birth you can stop taking the drug. Side effects may manifest as impaired intestinal function.
2. Aconite - a plant that is used to treat renal pathology in the sixth breeding. The drug is especially effective in the treatment of women of strong temperament, with a rapid pulse and palpitations. The way of application of the drug enteral and the dosage starts with one pellet every three hours on the first day, then you need to take two pellets every six hours the next day, and from the third day, four grains twice a day. The prophylactic dose can be started in a half dose of medication from the first trimester of pregnancy. Side effects can be on the first day of admission as an increase in the pulling pain in the lower abdomen, which occurs after several hours.
3. Solidoga is a homeopathic medicine that is used to treat kidney pathology, which is accompanied by severe leukocyturia and a prolonged temperature reaction. The medicine is dosed four drops in the morning and in the evening, the method of application - you need to dissolve drops in a lot of water. Side effects can occur at a high dose - there is dizziness, headache, general weakness.
4. Apis is an agent for the treatment of pyelonephritis in the first trimester with ascending infection and kidneys, and the bladder. Issued in the form of drops and used in the dosage of three drops for one dose. Method of application - the solution should be diluted with boiled water and drink after eating. The course of treatment - two drops twice a day. Side effects are rare, allergic skin reactions are possible.
5. Capsisum is the most effective remedy for an acute inflammatory process in the kidneys in late pregnancy. This homeopathic medicine acts in the third dilution precisely on the dynamics of the inflammatory reaction and its rapid resolution. Issued in the form of drops and used in the dosage of three drops for one dose. Method of application - the solution should be diluted with boiled water and drink after eating. The course of treatment - two drops twice a day, and then a month later you can increase the dose to three drops, as the duration of pregnancy increases. Side effects are rare.

Alternative and homeopathic treatments can only be used after consultation with the doctor.

[9], [10], [11], [12]

Prevention

Prevention of any diseases for a future mother is very important, especially if the woman takes preventive measures at the planning stage of pregnancy. For women with chronic pyelonephritis should be carefully monitored and, if necessary, treated, because the likelihood of exacerbations is very high. The same applies to women at risk.

[13], [14], [15]

Forecast

The prognosis for recovery even in acute inflammatory processes is favorable, provided there is adequate and timely treatment. The prognosis for normal birth and the birth of a healthy child is also favorable, as the pathology of the kidneys is easily corrected without harm to the baby.

Leukocytes in the urine during pregnancy - it often indicates an acute pyelonephritis or cystitis, but it is necessary to take into account other manifestations. It is necessary to exclude the late gestosis, if the white blood cells are determined together with the protein, since this is the most threatening condition in pregnancy. In any case, in order to avoid taking antibacterial drugs during pregnancy, it is necessary to prevent pathology in women at risk.

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