Bacteria in urine during pregnancy: causes of abnormalities, symptoms and treatment

Bacteriuria is a pathological condition characterized by the excretion of bacteria in the urine. If their number reaches 105 in 1 ml of liquid, this indicates the presence of microbial flora in the organs of the urinary system. Bacteria in the urine during pregnancy is a sign of infection of the kidneys, bladder or urinary tract. For diagnosis, urine culture and photocolorimetric TTX test are used. Treatment of women during pregnancy is carried out with low-toxic antibiotics and herbal uroseptics.

Types of bacteriuria

In 80% of cases, bacteriuria is provoked by microorganisms that always inhabit the distal (end) section of the urethra. In 2/3 of women, the microbial flora is represented by:

Proteus;
enterobacter;
pyogenic streptococcus;
saprophytic staphylococcus;
klebsiella;
coli;
Citrobacter.

Most often, bacteriuria occurs in women during pregnancy, which is associated with a natural decrease in immune defense, changes in the chemical composition of urine, or its stagnation in the urinary organs.

There are 2 forms:

True. Accompanied by changes in the functioning of the urinary system, as indicated by characteristic symptoms - urinary disorders, fever.
False (asymptomatic). It is detected only in the laboratory during a general urine test.

Asymptomatic bacteriuria during pregnancy occurs 3 times more often. It affects women suffering from nephrolithiasis, bacterial vaginosis, and diabetes mellitus.

Most often, bacteria in urine are detected in the 2nd and 3rd trimesters of pregnancy. As the fetus enlarges, the urinary ducts are compressed or displaced, which leads to impaired urodynamics and stagnation of urine in the bladder and kidneys.

Pathways for microorganisms to enter urine

In half of the cases, bacteriuria in pregnant women is the result of an insufficient immune response to the proliferation of opportunistic bacteria. Normally, the kidneys and bladder are sterile. Representatives of normal microflora inhabit only the end section of the urethra. But if the pH of the urine changes or the body’s immunity decreases, they begin to multiply and colonize other parts of the urinary system.

The main ways bacteria enter urine are:

Rising. Microorganisms enter the bladder and kidneys from the urethra.
Descending. The infection enters the urethra from the kidneys, ureters and bladder. This route of infection is possible with relapses of urological diseases - ureteritis, cystitis, pyelitis, pyelonephritis.
Hematogenous. Bacteria enter the urine from distant foci of infection through the bloodstream. Therefore, bacteriuria is more often found in pregnant women who have had acute respiratory viral infections, tonsillitis, or bacterial rhinitis.
Lymphogenic. The infection enters the urinary system through lymphatic vessels from distant foci of inflammation.

Bacteria usually enter the urinary organs through a relaxed urethral sphincter. Due to decreased immunity during pregnancy, classic inflammation in the end section of the urethra does not occur. Therefore, microorganisms almost freely enter the bladder, ureters and kidneys.

Where do bacteria come from in urine during pregnancy?

Bacteria can appear in urine in two ways: ascending and descending. With a descending route of infection, bacteria enter the bladder from the upper organs, in particular the affected kidneys and ureters. With ascending bacteriuria, microorganisms end up in the bladder from the underlying parts of the human genitourinary system (this can be the urethra, vagina, external genitalia, etc.).

In addition, bacteriuria can be triggered by certain external interventions (catheterization of the bladder, cystoscopy, etc.), as well as the presence of foci of infection in nearby organs (for example, in the intestines).

Causes of bacteriuria in pregnant women

To find out why bacteriuria appeared, you need to undergo a comprehensive examination by a urologist. The presence of bacteria in the urine during pregnancy indicates poor health of the genitourinary system.

Microbial flora provokes complications that negatively affect the body of the expectant mother and fetus.

Cystitis

Very often, bacteriuria during pregnancy occurs against the background of cystitis - inflammation of the bladder. In 86% of women, the pathology is provoked by Escherichia coli. Possible pathogens include Klebsiella, enterococcus, and streptococcus. In some women, bacteria in urine are the result of sexually transmitted infections:

ureaplasmosis;
candidiasis;
gonorrhea;
chlamydia.

The proliferation of microbial flora in the urine is provoked by hypothermia, dysbacteriosis, metabolic disorders, and hypovitaminosis.

Urethritis

Inflammation of the urethra is a common cause of an increase in the number of bacteria in the urine. In 82% of cases, a pregnant woman is diagnosed with secondary urethritis, provoked by:

genitourinary infections;
urinary catheterization;
vitamin and mineral deficiency;
urolithiasis;
unbalanced diet.

With urethritis, opportunistic and pathogenic bacteria are found in the urine - chlamydia, E. coli, gonococci, Proteus.

Pyelonephritis

Gestational pyelonephritis is an infectious inflammation of the kidneys, predominantly of a bacterial nature. Occurs in 7-10% of women in the 2nd and 3rd trimesters of pregnancy. The disease is provoked by opportunistic bacteria that colonize the urethral area.

With bacterial pyelonephritis, the concentration of microbes in the urine exceeds 105 per 1 ml. In half of the cases, kidney inflammation occurs against the background of gynecological diseases - bacterial vaginosis, vulvitis, endocervicitis.

During pregnancy, changes occur in the female body that lead to stagnation of urine. An increase in pressure in the urinary system leads to dilation of the renal pelvis. As a result, conditions are created that are favorable for the growth of bacteria.

Other reasons

Bacteria in urine during pregnancy can be detected as a result of many negative factors. The appearance of microbial flora in the urinary system is facilitated by:

physical inactivity;
secondary immunodeficiencies;
pelvic organ injuries;
decreased urinary tone;
gestational diabetes;
ENT infections;
lack of personal hygiene;
wearing tight underwear;
varicose veins;
congenital anomalies of the urinary organs.

Women suffering from pyelitis, vesicoureteral reflux, urolithiasis, and diabetes are susceptible to bacteriuria.

Bacteriuria, cystitis and pyelonephritis during pregnancy

The human urinary system consists of two kidneys that filter blood plasma and remove part of the fluid and some substances dissolved in it into urine, two ureters that conduct urine from the kidneys to the bladder, a bladder that serves as a reservoir for urine, and the urethra through which urine is excreted from the body.

During pregnancy, several changes occur in the urinary system that increase the risk of urinary tract infection. The acidity of the urine changes, the urine becomes more alkaline (its pH increases), and this creates a more favorable environment for the development of bacteria, the passage of urine slows down and conditions arise for reflux (reverse reflux) of urine, due to which bacteria can be transported with urine from the underlying sections to the overlying ones , to the renal pelvis. In addition, changes in the immune system that also reduce the body's ability to fight infection.

Thus, we see that pregnant women are more predisposed to developing urinary tract infections than their non-pregnant peers.

Asymptomatic bacteriuria

Asymptomatic bacteriuria is the presence of bacteria in the urine in the absence of signs of inflammation.

Normally, our urine is sterile, and bacteria, even if they pass from the rectum to the bladder through the urethra, are washed out in the urine stream during the next urination. During pregnancy, very comfortable conditions are created for bacteria, and they can linger in the bladder, multiply, attach to the walls of the urinary tract, causing inflammation, and even spread into the renal pelvis.

If a general urine test during pregnancy reveals bacteria and, in particular, nitrites, a product of the decomposition of urea in urine by bacteria living in it, a urine culture is required to determine the pathogen, its quantity (titer) and the antibiotics to which it is sensitive.

About thirty percent, that is, one in three pregnant women, with asymptomatic bacteriuria without treatment during the same pregnancy develops gestational (pregnancy-related) pyelonephritis. Therefore, asymptomatic bacteriuria during pregnancy always requires treatment. All urinary tract infections during pregnancy are treated with antibacterial drugs.

Drugs are selected that are compatible with pregnancy and are sufficiently safe for the fetus so that they can be used at this time. The sensitivity of the pathogen to the antibiotic is also taken into account. Herbal medicines should not be used to treat urinary tract infections during pregnancy.

Cystitis

Cystitis (inflammation of the bladder wall) during pregnancy usually manifests itself in a more erased form than outside it, very severe pain is less likely to occur, and cystitis is less often hemorrhagic - that is, blood is less often found in the urine. Cystitis can also serve as the first step to the subsequent development of pyelonephritis, therefore cystitis during pregnancy also requires treatment with antibacterial drugs; herbal medicine should not be used in this case.

Gestational pyelonephritis

Gestational pyelonephritis, in which the inflammatory process is localized in the pelvis of the kidney or both kidneys, is a rather serious disease that can lead to miscarriage, stillbirth, and even threaten the life of the pregnant woman herself. It can be suspected if there is an increase in temperature and pain in the lower back. In case of gestational pyelonephritis, the pregnant woman must be hospitalized in the urology department for short periods and in the maternity hospital at a multidisciplinary hospital with the obligatory presence of a urology department. Treatment is also carried out with antibiotics. If a clot of pus formed in the pelvis blocks the ureter and interferes with the outflow of urine, a special stent is installed in the ureter, restoring the patency of the ureter and saving the kidney from hydronephrotic transformation (stretching of the kidney with urine that does not flow out, followed by death of part of the kidney tissue). The stent may remain in place until delivery.

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Main symptoms of bacteria in urine

Clinical manifestations of bacteriuria depend on the cause of bacterial proliferation and the location of inflammation. The presence of microbes in urine is indicated by:

frequent urge to go to the toilet;
cloudy urine;
burning when urinating;
discomfort in the suprapubic region;
lower back pain;
mucous discharge from the urethra;
urinating in small amounts.

Bacterial waste products provoke intoxication. Therefore, true bacteriuria during pregnancy is accompanied by:

muscle weakness;
drowsiness;
lack of appetite;
body aches;
increased temperature;
excessive sweating;
nausea;
headaches.

Asymptomatic bacteriuria in pregnant women does not manifest itself in any way and is detected only in the laboratory.

To prevent complications during pregnancy, all women should undergo a general urine test once every 2-3 months. The presence of bacteria in the liquid indicates an infectious lesion of the urinary system.

Diagnostics

Bacteria in the urine is a nonspecific symptom that accompanies many urological diseases. To determine the cause of the pathological condition, you need to undergo a comprehensive examination with laboratory tests.

Express test

To detect pathogenic bacteria in urine, diagnostic strips are often used - paper or plastic strips with a reagent.

To identify microbes, indicators with Griess reagent are used. When pathogenic bacteria are present in the urine, nitrates are converted to nitrites, causing the strip to change color. If microorganisms are found in the fluid, the woman should consult a doctor for further examination.

Urine culture

Urine culture is a bacteriological study that determines:

number of microbes per 1 ml of liquid;
type of bacteria;
sensitivity of microorganisms to antibiotics.

The study is carried out by inoculating biomaterial on different nutrient media. To test for bacteriuria, urine is collected in a sterile container, which is delivered to the laboratory within 30-60 minutes. If necessary, urine is stored in the refrigerator at temperatures up to 4°C, but not longer than 24 hours.

Additional diagnostic methods

If pathogenic bacteria are found in the urine, additional research will be required:

General urinalysis (UCA). Based on the results, the density of the liquid and the presence of foreign inclusions in it - protein, ketone bodies, leukocytes - are assessed.
Blood chemistry. Elevated levels of creatinine and nitrogenous substances indicate kidney dysfunction.
TTX test. Using a screening method, an increased concentration of bacteria in a portion of urine is detected. The accuracy of the test using triphenyltetrazolium chloride is at least 90%.

Due to decreased immunity during pregnancy, it is undesirable to conduct instrumental examinations of the urinary tract - cystoscopy, urinary catheterization.
If necessary, hardware examination methods are prescribed - ultrasound of the urinary tract, ultrasound examination of the renal vessels, CT scan of the kidneys.

Normal urine levels

After the examination, the doctor compares the test results with normal urine values:

pH level – 5.0-8.0;
protein – no more than 0.14 g/l;
red blood cells - up to 2-3 pieces in the field of view;
leukocytes – no more than 5 in the field of view;
urobilinogen – less than 34 mmol/l;
ketone bodies – no more than 1 mmol/l;
bilirubin – absent;
bacteria – up to 104 per 1 ml.

Normal urine is straw-colored. There is no foam, purulent or bloody inclusions. Deviation of laboratory parameters from normal values is a reason for further examination and treatment. The main goal of therapy is to restore the pH of urine plus the destruction of microbial flora in the urinary system.

The importance of taking a urine test during pregnancy

In 2/3 of women, bacteriuria does not manifest itself in any way. But even with a slight increase in the number of bacteria in urine, the course of pregnancy becomes more complicated. Delayed treatment leads to:

gestational pyelonephritis;
anemia of pregnant women;
postpartum endometritis.

Microbial flora in the urinary system during pregnancy provokes the production of inflammatory mediators in the body. They increase the contractile activity of the myometrium (the muscular layer of the uterus), which increases the risk of spontaneous abortion or miscarriage.

How to treat bacteriuria during pregnancy

The presence of pathogenic bacteria in the urine is a serious reason for complex treatment. In uncomplicated pregnancy, therapy is carried out on an outpatient basis under the supervision of a urologist and obstetrician-gynecologist.

Medicinal treatments

Treatment of asymptomatic bacteriuria is carried out with low-toxic antibiotics:

Cefuroxime;
Ampicillin;
Ospamox;
Cefaclor;
V-mox;
Ceftriaxone.

At the beginning of pregnancy, 2-3 generation cephalosporins and beta-lactam penicillins are prescribed.

In the 2nd trimester of pregnancy, synthetic nitrofurans are indicated - Solafur, Furagin, Furadonin. To disinfect the urinary tract, uroseptics are used - Urolesan, Canephron, Uroprofit.

Folk remedies

Self-treatment of bacteriuria during pregnancy is dangerous due to complications. Some herbs are strictly prohibited for pregnant women. Therefore, folk remedies are used only on the recommendation of a urologist.

To destroy pathogenic bacteria in urine, decoctions are used based on:

bearberry;
peppermint;
pharmaceutical chamomile;
juniper;
birch buds.

The course of treatment is from 2 to 4 weeks.

Diet and drinking regime

During pregnancy, foods that alkalize urine and irritate the urinary tract mucosa are excluded from the diet:

strong coffee;
carbonated drinks;
spices;
marinades;
semi-finished products;
greenery;
onion.

To create unfavorable conditions for the growth of bacteria, they consume more products that shift the pH of urine to the acidic side - fruit drinks, fermented milk products, chicken eggs.

Pregnancy and UTI - urologist’s tactics

In the structure of extragenital pathology of pregnant women, one of the leading places is occupied by diseases of the urinary system, the frequency of which reaches 10-12%. Kidney diseases have a negative impact on the outcome and course of pregnancy, childbirth and the postpartum period.

In the population of non-pregnant women of reproductive age, the incidence of urinary tract infections (UTIs) is 2-5%. In pregnant women, UTIs are a common complication, reaching, according to some data, 18%.

Developing against the background of pregnancy-specific anatomical and physiological changes in the urinary system, the inflammatory process is accompanied by disturbances in urodynamics and hemodynamic changes in the urinary tract. As is known, circulatory disorders in the kidneys are one of the leading pathogenetic links in a serious complication of pregnancy - gestosis. In this regard, prevention of UTIs during pregnancy is of particular importance in the prevention of preeclampsia.

Changes in the urinary system in pregnant women that increase the risk of developing UTIs:

an increase in the volume of the kidneys (except for the volume of the pelvis);
dilatation of the collecting apparatus;
an increase in the diameter of the ureter, mainly in the upper and middle third, often on the right;
lengthening of the ureter, acquiring a tortuous shape;
hypertrophy of the muscle fibers of the ureter in the lower third;
decreased peristalsis, changes in the tone and mobility of the ureteral muscles;
increased muscle tone and ureteral capacity;
tendency to incomplete emptying of the bladder;
development of vesicourethral reflux
changes in the chemical composition of urine, alkalization of urine;
increased renal blood flow and glomerular filtration rate;
increased excretion of calcium and uric acid.

Factors leading to these transformations include hormonal changes (increased synthesis of estrogen, progesterone, prostaglandin on E2), and, at a later date, also impaired urine outflow due to an enlarged uterus. The high prevalence of urinary tract infections in pregnant women is also explained by the following factors: mechanical compression of the ureters by the uterus; glucosuria; immunosuppression; changes in urine pH, etc.

Changes that occur during pregnancy may reverse within 3-4 months of the postpartum period.

Pregnancy in women with renal pathology is often complicated by anemia (35-70%), gestosis (up to 40%), premature termination of pregnancy at various times (15-20%), placental insufficiency (25-30%), chronic intrauterine fetal hypoxia ( 30-40%), intrauterine growth retardation (12-15%) and a number of other serious conditions.

There are 3 main nosological forms of UTI in pregnant women: asymptomatic bacteriuria, acute cystitis and pyelonephritis. The spectrum of microorganisms that cause UTIs in pregnant women is practically no different from the spectrum of pathogens that cause UTIs in non-pregnant women: Escherichia coli causes 80-90% of all infections. UTIs can also be caused by other gram-negative bacteria, such as Proteus mirabilis and Klebsiella pneumoniae.

Asymptomatic bacteriuria is persistent bacterial colonization of the urinary tract without obvious clinical manifestations. The diagnosis is established upon receipt of two consecutive positive bacteriological cultures of urine with the same pathogen (with a break of 1-2 weeks). Single cultures can give a false positive result in almost half of the cases. The quantitative criterion for severe bacteriuria is the detection of more than 105 uropathogens of the same species in 1 ml of urine. Without treatment, asymptomatic bacteriuria can lead to the development of clinical manifestations of UTI.
Acute cystitis.
Pyelonephritis (uncomplicated, complicated).

The choice of antibiotic for gestational UTI is carried out mainly empirically; it should be based on local data on the sensitivity of uropathogens. Typically, 5-7-day courses of treatment are prescribed, but some authors recommend a short-term course of therapy of 1-3 days, as for acute cystitis. The drugs of choice for short-course treatment of UTIs in pregnant women may be fosfomycin trometamol (3 g, 1 dose) or 2nd-3rd generation oral cephalosporins (cefixime, 400 mg). Treatment with amoxicillin, cephalexin or nitrofurantoin is generally recommended. Control urine cultures should be obtained 1-4 weeks after treatment and at least 1 more test before delivery.

In recent years, a combination drug of plant origin, Canephron N (Bionorica, Germany), has become widely used in medical practice. There is serious work concerning the use of the drug in pregnant women for the prevention and treatment of UTIs. The drug was studied at the following institutions.

FSBI "Research Institute of Urology" of the Ministry of Health of Russia - prof. T.S. Perepanova, Ph.D. PL. Khazan.
FSBI "Scientific Center for Obstetrics, Gynecology and Perinatology" of the Federal Agency for High-Tech Medical Care - prof. N.V. Ordzhonikidze.
RMAPO, Moscow - prof. L.A. Sinyakova.
SPbMAPO, St. Petersburg - prof. S.N. Kalinina, prof. O.L. Tiktinsky.
Scientific Center for Children's Health of the Russian Academy of Medical Sciences.
First Moscow State Medical University named after. THEM. Sechenov.
Department of Obstetrics and Gynecology, Petrozavodsk State University.
Institute of Pediatrics, Obstetrics and Gynecology of the Academy of Medical Sciences of Ukraine - prof. IN AND. Bear.
Dnepropetrovsk State Medical Academy - prof. V.A. Potapov.

And this is not the entire list of respected urological clinics and departments where the effectiveness and safety of the drug Canephron N was studied.

All scientists noted that the use of Canephron N was accompanied by subjective and objective improvement in the condition of pregnant women of all groups compared to patients who did not receive this drug.

During treatment in pregnant women suffering from cystitis, when the drug Canephron N was included in complex therapy, a more pronounced decrease in dysuric symptoms was observed. A significant decrease in the frequency of reinfection was also noted.

In pregnant women with gestational pyelonephritis and exacerbation of chronic pyelonephritis, a significant increase in the effectiveness of therapy while taking the drug was confirmed: there was a faster improvement in well-being, pain and dysuric symptoms disappeared. The results of urine tests normalized faster. In addition, the number of relapses and repeated exacerbations has significantly decreased.

There was no evidence of poor tolerability of the drug.

We must not forget that there are drugs that are strictly contraindicated during pregnancy:

fluoroquinolones - cause the development of arthropathy in the fetus (norfloxacin, ciprofloxacin, ofloxacin);
oxolinic acid and pipemidic acid (pimidel, palin, uropimide) - increase the risk of fetotoxic effects;
nitroxoline (5-NOK) - in the first trimester may be accompanied by embryotoxic effects. There is evidence of a possible toxic effect on the fetal liver when using the drug at the end of pregnancy;
tetracyclines increase the incidence of defects in the formation of the skeleton in the fetus and tooth enamel, cause yellow-brown staining of teeth in children under one year of age;
chloramphenicol - the risk of toxic effects on the liver, the development of leukopenia in the fetus, as well as the occurrence of cardiovascular failure in newborns.

In the treatment of acute and exacerbations of chronic pyelonephritis in pregnant women in the presence of hyperthermia and dilatation of the upper urinary tract, it is recommended to install a ureteral catheter stent before the onset of labor.

Rules for ureteral stenting in pregnant women:

dynamic observation by a urologist throughout pregnancy!;
covered stents for 4-6 months;
stenting should end with the installation of a urethral catheter;
timely change of stents;
frequent urination after catheter removal;
ultrasonic control once a month;
delivery against the background of a drained urinary tract;
removal of the stent 4-6 weeks after birth.

In particularly severe cases, it is necessary to determine indications for termination of pregnancy, regardless of the period. These indications are:

progressive renal failure, established on the basis of a creatinine value of more than 265 µmol/l and/or glomerular filtration rate below 30 ml/min;
increasing severity of hypertension, especially its malignant forms.

Currently, infectious diseases of the genitourinary system in women are characterized by polyetiology, a blurred clinical picture, a high frequency of mixed infections and a tendency to recur, which requires an integrated approach to diagnosis and treatment. The prescription of drugs must be regulated by standards. In 2012, National Russian recommendations “Antimicrobial therapy and prevention of infections of the kidneys, urinary tract and male genital organs” were published. In accordance with this document, herbal preparations can be used both as additional therapy in pregnant women with UTIs, and for the purpose of preventing relapses of infection.

The material was prepared by V. Shaderkina , urologist.

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How bacteria in urine affects pregnancy

Bacteriuria has a negative effect on the fetus and the body of the expectant mother. Pathogenic bacteria increase the content of toxins in the blood, which leads to poisoning and metabolic disorders. Untimely destruction of microbes is dangerous:

fetoplacental insufficiency;
oxygen starvation of the fetus;
late toxicosis;
increased maternal blood pressure;
infection of the birth canal.

In 10% of cases, uroinfections provoke chorioamnionitis - an infectious lesion of the fetal fluid and membranes. Mortality rates in newborns with bacteriuria during pregnancy increase by 2.5 times.

Prevention

Primary prevention is aimed at eliminating factors that provoke the growth of bacteria in the urine. To prevent bacteriuria during pregnancy, you should:

treat kidney and ureter diseases in a timely manner;
be examined by a urologist once every 3 months;
eat a balanced diet;
take vitamins;
Take OAM once a quarter.

Women with chronic pyelonephritis should regularly undergo ultrasound of the kidneys and have their urine tested. To reduce the risk of bacterial growth in the urinary organs, consumption of berry fruit drinks is recommended. Preventive treatment with herbal uroseptics is carried out as prescribed by a doctor. Compliance with preventive measures prevents complicated pregnancy and congenital diseases in the child.

What is the threat of bacteria in urine during pregnancy?

Any infection in the body of the expectant mother can have a detrimental effect on the health of her baby. When bacteria penetrate the fetus, intrauterine infection develops, which can lead to many complications during the normal course of pregnancy. Fortunately, this is extremely rare today, but it is still better to do a urine test for bacteria in a timely manner.

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