Reasons for the appearance of red blood cells in the urine of pregnant women, risks to the fetus

Red blood cells in urine in pregnant women

indicate a number of pathologies in the body and require immediate examination. Do not forget that red blood cells saturate our blood with oxygen and feed cells. During pregnancy, red blood cells are responsible not only for the health of the mother, but also of the child.

Red cells contain hemoglobin. In many ways, the general condition of the expectant mother and the growth of the embryo depend on it. If red blood cells leave the bloodstream and end up in the urine, this indicates a possible abnormal pregnancy.

The norm of red blood cells in the blood

The norm of red blood cells during pregnancy is (3.5-5.6) * 1012 cells/l.

When referring for a general blood test, the doctor is interested in 3 parameters of erythrocyte indices:

1. Red blood cell distribution width. It is calculated by dividing the hematocrit value (the volume of blood per red blood cells in 1 mm³) by the total number of red blood cells. Its norm in the female body from 18 to 45 years is 81-100 fl. An increased value may indicate macrocytic anemia, and a decreased value may indicate microcytic anemia. The index also indicates a violation of water and electrolyte balance.
2. Average hemoglobin content in a red blood cell. It shows the concentration in the cell. The norm is 26-34 pg.
3. Average concentration of iron-containing protein in an erythrocyte. Shows its number relative to the size of the red blood cell. The norm is 31-36 g/dl. A low value indicates the same as low red blood cell volume, while an increased value indicates congenital diseases.

During pregnancy, changes occur in the number of blood cells due to the fact that the baby's system joins the mother's circulatory system. These changes can have a negative impact on the fetus. With an increased content of red blood cells, the plasma will thicken and slow down its movement, which is why oxidized oxygen will reach the baby. The norm of hematocrit (erythrocyte content) is from 36 to 42%. At levels above 45%, dilution therapy is urgently required.

An increase in blood volume leads to the fact that red blood cells are lower during pregnancy at first, then the value increases. The norm in the 1st trimester is 4.2-5.4 million, in the 2nd trimester - 3.5-4.8 million, in the 3rd trimester - 3.7-5.0 million per 1 μl.

The erythrocyte sedimentation rate during pregnancy can increase and decrease. A decrease in ESR in the first 6 months is taken as the norm. Then, towards childbirth, there is an increase to 45 mm/h.

The norm of red blood cells in the urine of a pregnant woman

Sometimes red blood cells are detected in the urine of a pregnant girl - here deviations from the norm should alert the doctor.

To detect red blood cells in urine, a general clinical urine test is performed. Microscopy is used to reveal cellular composition. For different periods of pregnancy there are definitely different normal levels of red blood cells in the urine. These indicators can be seen in the table:

Detection of 4 red blood cells in the urine during pregnancy is the norm, but this is a borderline number, after which their number must be constantly monitored to identify pathology and timely therapy.

Also, to test urine for the presence of red blood cells, a test is used that involves testing the liquid with a semi-automatic analyzer. The normal level of red blood cells in urine according to this analysis is as follows:

Reference values

The normal concentration of red blood cells in pregnant women does not exceed one cell in the field of view under a microscope

If red blood cells in the urine are elevated, doctors first make sure the data is accurate. A woman should have no more than one red blood cell excreted in her urine, and a man should have up to three. In the second trimester of pregnancy, the content of red blood cells should not change, even against the background of an increase in blood flow to provide the growing fetus with the necessary nutrition and oxygen. In the third trimester, the risk of developing preeclampsia, a severe complication of pregnancy characterized by the presence of edema, protein in the urine and hypertension, increases due to iron deficiency anemia.

Normally, the urine of pregnant women should not contain red blood cells. Even a slight increase should alert clinicians. They will definitely prescribe a repeat or clarifying study. The norm is characterized by a complete absence of red blood cells, therefore, if one cell is detected in the field of view, an additional analysis is performed.

Red blood cells often increase against the background of complicated leukocytosis, proteinuria (with protein in the urine). In many cases, doctors diagnose nephrourological diseases of an infectious and non-inflammatory nature, gestosis, and secondary arterial hypertension.

Types of hematuria

There are 2 types of hematuria:

• microhematuria is characterized by a small content of cells in the urine, which are detected only by laboratory tests;
• macrohematuria is characterized by a high content of red blood cells, which cause redness of the urine.

Doctors also distinguish types of hematuria due to the appearance of:

• extrarenal - if it did not arise due to diseases of the urinary system and injuries;
• renal – caused by kidney disease;
• postrenal - arose due to pathology of the ureters, urethra, and bladder.

Hematuria is divided according to the degree of development:

• terminal, if red blood cells are contained in the last portion of biological fluid;
• initial, if contained in the first portion;
• total, if all the urine has a scarlet tint.

By identifying the type of hematuria, the doctor can roughly determine the part of the urinary tract in which the bleeding occurs.

Frequently asked questions to the doctor

Importance of Red Blood Cells

Good afternoon. Explain why red blood cells and their absence in urine are so important? These are blood cells, shouldn't they be in the body?

Hello. Red blood cells are the largest group of blood cells, 1 ml of blood contains about 5 million red blood cells, they are necessary for transporting oxygen and nutrients to the cells, and in urine, as we know, there are no cells, because it is a liquid that the body secretes. The presence of blood cells in the urine occurs due to various disorders and is not the norm.

What uterine bleeding can be confused with hematuria

When a woman notices bloody inclusions in her urine, she cannot independently distinguish between uterine bleeding and hematuria. This is very important for making a correct diagnosis and timely treatment. Therefore, if you find traces of blood, you should immediately consult a doctor.

At the beginning of pregnancy, bleeding from the uterus means:

• threat of interruption or a process that has already begun;
• ectopic pregnancy.

At this moment, the girl most often only guesses about pregnancy and experiences acute pain. You can save your child only if you immediately consult a doctor.

Bleeding also occurs when placental abruption or uterine rupture occurs. Therefore, the presence of blood cells in urine requires a thorough examination, which is necessary to maintain the health of the mother and child.

Symptoms and possible complications

If the color of urine and its transparency do not change during pregnancy, a woman needs to pay attention to alarming symptoms:

• frequent urination, accompanied by a burning sensation, pain in the lower abdomen may indicate a urinary tract infection;
• heaviness or discomfort in the lumbar region, an increase in body temperature in the evening to 38°C and above are characteristic of kidney diseases.

Specific symptoms indicating that there are increased red blood cells in the urine are not clearly expressed, so a pregnant woman needs to pay attention to her general condition, poor appetite, weakness, and blood pressure levels. You cannot avoid scheduled tests and contacting a gynecologist, since hematuria is fraught with negative consequences:

• chronic renal pathologies, urinary retention in the body, edema;
• malignant tumors increase in size during pregnancy and can metastasize;
• even minor bleeding of the placenta affects the fetus - hypoxia occurs, and pregnancy can be terminated.

During this period, a woman is required to pay close attention to her health.

You cannot self-medicate or limit yourself to traditional medicine. Only timely diagnosis and qualified treatment will allow you to bear a healthy child.

Causes

It is important to find out in time about the presence of red blood cells in the urine during pregnancy and the reason for their appearance. First of all, the doctor must exclude serious pathologies. But the expectant mother should not worry, because blood cells in urine may appear due to improper urine collection or other harmless reasons.

Physiological

The study can reveal hematuria due to changes in blood circulation and impaired renal filtration. If the number of red blood cells in the urine during pregnancy is increased for this reason, then there is no danger to the health of the mother and child.

Lifestyle

An increase in the level of red blood cells in the urine may be due to external factors:

• severe overheating, including visiting saunas and taking a hot bath;
• drinking large amounts of alcohol;
• great physical activity;
• stress.

External factors can also include injuries to the kidneys, ureters or bladder.

Pregnancy status

This cause of hematuria is associated with changes in hormonal levels and the growth of the uterus. It enlarges and begins to put pressure on the bladder and ureters, causing urine to stagnate, circulation to be impaired, and red blood cells to leak into the urine. In this case, even if the red blood cells in the urine of a pregnant woman are elevated, the kidneys and bladder are normal.

Pathologies

Most often, hematuria appears due to infections and inflammation of various organs.

An increase in the number of red blood cells in urine can cause inflammatory processes in the genitourinary system. During pregnancy, a girl may experience worsening cystitis or pyelonephritis. Also, red blood cells may appear in the urine due to urolithiasis, as a result of damage to the mucous membrane by sand and stones. These diseases are accompanied by pain.

Scarlet-colored urine can be a symptom of cancer and indicates a malignant formation in the body. Diagnosis is complicated by the late onset of discomfort and pain.

Also, red blood cells during pregnancy can enter the urine due to compression of the renal vein, necrotizing papillitis, diabetes mellitus, hypertension, anemia, thrombosis or vascular aneurysm.

The appearance of a large number of red blood cells in urine can mean a variety of pathologies; the exact cause can only be determined through research and diagnosis.

Stabilization methods

Of course, if we are talking about the physiological causes of hematuria, then it is impossible to select stabilization methods in this case. You just have to wait until the pregnancy is resolved by childbirth, and the red blood cells in the urine will disappear on their own.

If the cause of hematuria is the presence of various pathologies in the pregnant woman that provoke the appearance of red blood cells in the urine, then in this case, stabilization methods should be aimed primarily at eliminating the causes of the appearance of red blood cells.

Taking into account the indications, the following are used:

• antibacterial therapy;
• strict diet;
• taking anti-inflammatory drugs;
• taking diuretics;
• Limiting fluid intake to minimize stress on the kidneys.

We should not forget that only a doctor can prescribe adequate treatment.

Did you know? In the 17th century, urine baths became fashionable in France. Their fans sincerely believed that such bathing could restore youth to the skin, make it beautiful and elastic.

How to recognize the disease: symptoms

Microhematuria is difficult to determine by any signs, because it often occurs without symptoms. Therefore, pregnant girls need to give urine samples every month. A timely examination will facilitate early diagnosis of the disease and facilitate therapy.

Women with hematuria may experience the following symptoms:

• poor appetite;
• nausea;
• vomit;
• weakness;
• headache;
• lack of weight gain during pregnancy.

Painful and uncomfortable sensations during urination can mean inflammation of the kidneys and genitourinary system. Often with these diseases, pain is felt on one side of the lower back.

What do urine tests say for erythrocyturia?

The presence of red blood cells in urine can be correctly explained using the Nechiporenko study. According to the results, an excess of cylinders means kidney damage, and an increased number of leukocytes and red blood cells means diseases of the ureters, renal pelvis and ureter.

To make a diagnosis, it is necessary to determine the type of red blood cells detected. Fresh red blood cells can appear when the renal barrier is destroyed, the mucosa is damaged, stones in the kidneys, bladder or ureters, or decaying tumors of these organs.

The presence of leached red blood cells in the urine indicates kidney disease or prolonged bleeding from the mucous membranes of the urinary tract.

Diagnosis of a pregnant woman when red blood cells appear in the analysis

If hematuria is suspected, a urine test is performed. If it confirms a large number of red blood cells in the urine, then you will need to visit a gynecologist. The doctor will examine the cervix with a gynecological speculum, examine the mucous membrane under magnification, and also prescribe:

• urine examination for the content of leukocytes, red blood cells and casts;
• bacteriological culture and laboratory smear examination;
• Ultrasound of the kidneys.

The results will help to find out the exact cause of the appearance of red blood cells in the urine and prescribe the correct therapy.

Risk to the fetus

Physiological hematuria is not associated with risks to the fetus. Just like most diseases of the genitourinary system, which can be treated during pregnancy with drugs that are safe for the woman and the fetus. The danger for the unborn child is uterine bleeding, when bloody discharge through the reproductive canals flows into urine during urination.

We suggest you read: Can brown discharge occur during pregnancy?

Significantly aggravates the risks to the fetus caused by the appearance of a significant number of red blood cells in the urine and an increase in red blood cells in the blood in pregnant women. Treatment in such cases should be comprehensive and immediate.

Treatment

Regardless of the period of pregnancy and the cause of hematuria, urgent treatment is required. The main goal of therapy is to eliminate the pathology that causes red blood cells to appear in urine.

First, diagnostics and laboratory tests are carried out, then a therapy method is selected, and medications are prescribed. You should not self-medicate, as it can lead to undesirable consequences and fetal loss.

During therapy during pregnancy, a small list of medications is allowed. Most of them can be used only in later stages. For infectious diseases, antibacterial drugs are prescribed.

For infection inside the kidneys, antibiotics that do not penetrate the placenta are prescribed, such as Oxacillin, Amoxiclav, Erythromycin, Cefazolin. The use of corticosteroids, immunomodulators and painkillers is prohibited. Antipyretic drugs can only be prescribed after 37 weeks.

To improve the effectiveness of treatment, the expectant mother needs to eat right, avoid heavy physical activity, and sleep well. It is useful to be in the fresh air, not to be nervous or tense.

After the 3rd month, it is recommended to regularly take the knee-elbow position to restore blood circulation to the pelvic organs.

Prevention

You can reduce the risk of hematuria by following the recommendations:

• to live an active lifestyle;
• eat less salt;
• do not smoke or drink alcohol;
• drink enough water per day;
• use high-quality intimate hygiene products;
• don't get too cold.

Hematuria in pregnant women is diagnosed quite often, but in most cases it is not dangerous for the mother and child. But it can also indicate serious pathologies, so it is necessary to undergo all studies for timely detection and treatment.