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SYMPTOMATIC URINARY TRACT INFECTIONS DURING PREGNANCY
Subudhi K B, Behera Susanta Kumar, Subudhi Monalisha, Das Sudhansu Kumar,Jena
Soubhagya Kumar
Department of Obstetrics and Gynecology, MKCG Medical College, Berhampur, Orissa
ABSTRACT
Objectives: to find out the obstetric outcome symptomatic urinary tract infections in pregnancies
and type of organisms responsible for symptomatic UTI and response to treatment in those
patients. Materials & Methods: Patients with symptoms (n=100) subjected urine culture and
sensitivity and colony count. The antibiotic which is relatively safe during pregnancy, depending
upon sensitivity is implicated for that particular patient. If she is not found to be cure of
symptoms or bacteriological cure after a course of antibiotic, repeat urine culture done and
according to sensitivity repeat course of antibiotic given. Results: Common age group affected is
21-30 yrs (83%), primigravida (66%) of ‘O’ group(77%) and low SES(53%). Most of them
presented with frequency of micturition, dysuria (81%) in 3 rd trimester (60%). Among all women
66% are terminated in 28-37 wks, vaginally (82.7%) and most common organism isolated is E
coli (69%).63% women delivered babies within 2-2.5 kg, preterm contraction (22%), and
neonatal asphyxia (27%), Breast complications (15%), LBW (80%), Prematurity (60%).
Conclusion: Symptomatic urinary tract infections in pregnancy should be diagnosed and treated
early.
INTRODUCTION
During pregnancy UTI is as high as 8% out of which 20% to 40% are symptomatic.
Recurrence of UTI in subsequent pregnancy is about 4-5% and same is risk of pyelonephritis. 1,2
A significant bacteriuria is the major risk factor for developing symptomatic urinary tract
infection during pregnancy leading to hypertension, preeclampsia, LBW, fetal wastage and

2. prematurity. UTI in pregnancy can take the forms of asymptomatic bacteriuria, acute
uncomplicated cystitis, urethritis, pyelonephritis.3 The organisms responsible for producing UTI
in pregnancy can be of following types:(a) Gram Negative : E.Coli in 80% of Cases, Proteus
Mirabilis, Klebsiella, (b) Gram Positive : Mycoplasma, Group-B Streptococus, Staphylococus
areus.4 Urinary tract infections are common in pregnancy due to increase susceptibility to certain
organisms, ureteral dilatation during pregnancy causing stasis of urine in the urinary tract leading
to more chance of infections. Most of the pregnant women develop glycosuria during pregnancy
which favours bacterial growth.5
MATERIAL AND METHOD
The present study was conducted in the Department of Obstetrics and Gynecology,
MKCG Medical College, Berhampur, Orissa from October 2008 to November 2010. Patients
with symptoms (n=100) subjected for history taking and meticulous clinical examination
followed by urine culture and sensitivity and colony count. The organism isolated and the
sensitivity of antibiotic is taken into account. The safe antibiotic during pregnancy, depending
upon sensitivity is implicated for that particular patient in a standard regimen and response is
observed. She is subjected for urine culture and sensitivity within one week of completion of
antibiotic course. If the pregnant women is cured of the infection as evidenced by both clinical
and bacteriological evidence, she is advised the methods of prevention of UTI during pregnancy.
If she is not found to be cure of symptoms or bacteriological cure after a course of antibiotic,
repeat urine culture done and according to sensitivity repeat course of antibiotic given. Within
one week of completion of second course of antibiotic she is evaluated for cure, both

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symptomatic and bacteriological. If she is not being cured she is subjected for reculture and
retreatment.
RESULTS AND DISCUSSION
It is most common in age group of 21-30 yrs (83%) of age and 66% in primigravida,
77% in ‘O’ blood group, presented in 3-7 days in 76% and in low SES (53%). Maximum, 87%
presented with frequency of urination which is almost in agreement with that of Nkudic et al,
frequency in 80% of cases.6 It is highest in 3rd trimester of pregnancy accounting to 60%, similar
to the study conducted by Lee M et al of highest in 3 rd trimester of about 54% cases.7 Most of the
pregnancies, 66% are terminated in 28-37 wks, similar to the study of Winberg J et al reporting
28-37 weeks is 77%8.E coli is isolated in majority (69%), followed by S. areus (18%),
Pseudomonas(4%), Klebsiella(3%), Candida albicans(2%),Proteus(2%), similar result by
Rahman MA et al revealing E Coli(75%) and Staphylococcus(15%). 9 85% are not presented in
labor, among which 63% are without preterm contraction, majority and 37% with preterm
contraction. It is similar to Kass EH et al revealing, majority (70%) of without preterm
contraction.10 Here 9% cases were presented in labor. Majority, 92% of cases are having colony
count > 105 CFU per ml, 6% of 102 to 104 CFU per ml and 2% of cases have less than 10 2
CFU/ml or no growth found over 48 hrs of incubation. It is not coinciding to the study of
Onifade AK, et al revealing 98% of > 105 CFU/ml and 2% of < 105 CFU/ml.11
Table-I : Antepartum complications
Sl No Ante Partum Complications No of Cases %
1 Anemia (< 7 gm %) 4 4
2 13 13
Leaking of Membrane

4. 3 22 22
Preterm Contraction
4 IUD 2 2
5 Multiple Pregnancy 1 1
Majority, 63% of pregnant women delivered low birth weight of 2-2.5 kg and 17% of
cases in < 2.0 kg implicating UTI as a significant contributor for this outcome. In this study 20%
cases are resulted out as > 2.5 kg, concurrent to the study done by Laura A et al reflecting 68% of
2-2.5 kg where as < 2 kg in 22% cases and > 2.5 Kg in 20% cases.12
Table-II : Intrapartum complications Table-III : Postpartum complications
Sl Intra Partum No of Sl Post Partum No of
% %
No Complication Cases No Complication Cases
1 Fetal Distress 4 4 1 PPH 2 2
Neonatal
2 27 27 2 Puerperal Pyrexia 6 6
Asphyxia
Breast
3 PPH 4 4 3 15 15
Complications
4 Eclampsia 1 1 4 Pyelonephritis 1 1
Instrumental
5 8 8 5 Anemia (< 7 gm %) 6 6
Delivery
Non Progress of Chronic
6 1 1 6 1 1
Labor Hypertension
Table-IV : Fetal complications Table-V : Sensitivity of antimicrobials
Fetal No of E. Klebsi Pseudo
% Agent Proteus Candia
Complications Case Coli ella monas
Abortion 2 2 Nitrofurantoin MS WS R WS NA
Prematurity 66 66 Amoxicillin MS SS R SS NA

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Low Birth Cefuroxime MS SS MS WS NA
80 80
Weight
IUGR 17 17 Amox+Clav SS SS SS SS NA
Fluconazole NA NA NA NA SS
IUD 3 3
Pip+Tazo SS SS SS SS NA
Among fetal complications, low birth weight is the most common (80%), followed by
prematurity (66%) (Table-IV). Similar study conducted by Brumfitt et al showed low birth
weight (75%) and prematurity (62%) as 2nd most common complication.15. Most of the cases,
62.3% are of appropriate for gestational age (AGA), 37.7% of cases are small for gestational age
(SGA) and no case of large for gestational age (LGA) is detected. It is similar to Fihn SD et al
revealing 57% of SGA, 40% of AGA and 3% of LGA. 13The commonest ante partum
complication detected in this study is preterm contraction (22%) which is similar to study of
Naeye RL et al (Table-I). Neonatal asphyxia (27%) is highest, followed by fetal distress (4%)
indicating increased incidence of intra partum complications. (Table-II). The postpartum
complication is highest as breast complications (15%), followed by puerperal pyrexia (6%). It is
not similar to the study of Naeye RL et al which revealed that commonest postpartum
complication as puerperal pyrexia (21%) (Table-III).14Most common mode of delivery is vaginal
(82.7%), followed by LSCS (17.3%). Almost Similar study was conducted by Patton JP, et al
16
revealing most common mode of delivery as vaginal in 75% of cases & LSCS in 25% of cases.
Pre labor rupture of membrane is highest (47%) which is not similar with that of Valiquette et al
revealing PROM > 24 hrs accounting for 15% of cases.17
E Coli is strongly sensitive (SS) to Amoxicillin+Clavulinic acid &
Piperacillin+Tazobactum. Klebsiella is strongly sensitive (SS) to Amoxicillin, Cefuroxime,

6. Amoxicillin+Clavulunic acid and Piperacillin+Tazobactm Proteus species is strongly sensitive
(SS) to Amoxicillin, Amoxicillin+Clavulunic acid and Piperacillin+Tazobactam. Pseudomonas is
strongly sensitive (SS) to Amoxicillin+Clavulunic acid and Piperacillin+Tazobactum. All the
Candida species is strongly sensitive (SS) to Fluconazole (table-VI). It is similar to that of M R
Khatoon et al except that E Coli is strongly sensitive to Cefuroxime. Pseudomonas is weakly
sensitive to amoxicillin.
CONCLUSION
So any evidence of symptomatic urinary tract infection during pregnancy should be
diagnosed as early as possible by urine culture and to be treated judiciously to prevent and
improve maternal and perinatal outcome of every pregnancy.
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1:807-22.
2) Foxman : Epidemiology of Urinary tract infections, Incidence; Am J Med 2002;113:5S-
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2004:32-24
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