Bacteria in urine during pregnancy

A general urinalysis is a standard, common study from which diagnostics in pregnant women begin. Such an analysis will indicate the presence of problems with the urinary system, will help assess the state of water and electrolyte balance. Unfortunately, the results of such a study may not always please - for example, if the indicators do not correspond to the norm. What can be suspected if bacteria are detected in the urine during pregnancy? Should I be concerned and what steps should I take?

What does bacteria in urine mean during pregnancy?

The composition of the urinary fluid must be sterile - free of microbes and other infectious agents. If bacteria are found during pregnancy, then this condition is considered dangerous due to the high probability of infection spreading through the urinary system.

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

The rate of bacteria in the 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 one or another amount of bacteria is found in the urine, then this condition is called bacteriuria. Microbes can enter the urinary fluid from the vagina or from the urinary tract. The belonging of such flora can be both pathogenic and conditionally pathogenic.

If the doctor detects the presence of bacteria, then his task becomes to determine exactly where the focus of infection is “hiding” in order to neutralize it in the future.

It is customary to separate two types of bacteriuria:

• asymptomatic bacteriuria, in which there are no other clinical signs, except for the determination of bacteria in the urine of a pregnant woman;
• bacteriuria with the corresponding clinical picture of pathology.

False bacteriuria is also isolated. They talk about it 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 must be retaken, after a thorough toilet of the genitals.

Bacteriuria is recognized as unmistakable if more than 100 thousand bacteria are detected in one milliliter of urine, or more than 10 ⁵  bacteria per milliliter. In this case, it is necessary to pass the analysis twice, in order to exclude errors.

Causes of the bacteria in urine during pregnancy

Pregnancy is a condition that in itself serves as a risk factor for the appearance of bacteria in the urine, since the anatomical characteristics and functionality of many organs change in the body. For example, the renal calyces and pelvis expand, the function of the urinary sphincter becomes difficult. At the same time, even latent bacteriuria, without any clinical symptoms, can eventually reveal itself as acute pyelonephritis.

Bacteria can end up in the urine of a pregnant woman in several ways:

• along the lymphogenous pathway - for example, if the infection exists near the urinary organs or kidneys;
• along the ascending path, when bacteria enter the urinary system through the urethral canal - for example, when placing a catheter, during cystoscopy;
• along the hematogenous pathway - that is, with blood flow from other inflamed organs;
• on a descending path, when the main focus of infection is in the renal organs.

Depending on what other changes are present according to the results of the urinalysis, the following diseases associated with bacteriuria can be suspected:

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

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

Risk factors

Bacteria in the urine during pregnancy can be detected under the influence of certain disposing factors:

• an increase in the size of the uterus, squeezing adjacent structures - including the renal organs, ureters;
• difficulty with defecation, slow intestinal motility;
• deterioration of the tone of the ureters;
• weakening of the immune defense;
• slow outflow of urinary fluid;
• changes in the renal pelvis and ureters;
• increase in urine pH.

Pathogenesis

Most often, the mechanism of the appearance of bacteria in the urine during pregnancy is associated with the upward spread of pathogenic microorganisms through the urinary system. Very rarely, such spread occurs according to the hematogenous type - through the bloodstream. As a rule, bacteria that inhabit the mucous tissues of the periurethral region pass into the urinary tract through a poorly fitting urinary 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 a latent course of bacteriuria begins). [3]

The acceleration of bacterial development occurs under the influence of the physiological increase in urine pH during pregnancy, as well as the possible presence of sugar in the urine.

Symptoms of the bacteria in urine during pregnancy

The presence of bacteria in the urine during pregnancy is not always manifested by any symptoms. Quite often, bacteriuria is latent and is detected only during diagnostics. At the same time, women themselves can feel good and not make any health complaints. However, this does not mean that there is no problem: it exists and gets worse, and symptoms may appear a little later.

In some cases, the pathology arises 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 already in the process of bearing a baby: among the most common pathologies are chronic pyelonephritis, urolithiasis.

The first signs of the presence of bacteria in the urine are usually smoothed out and do not differ in pronounced intensity. These may be the following symptoms:

• cutting, burning sensations during or at the end of the act of urination (for example, with cystitis);
• pain 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;
• general deterioration of well-being, feeling of fatigue and weakness;
• turbidity of the urinary fluid, a change in color shades, the appearance of flakes and mucus.

Urinalysis allows you to determine the presence and number of bacteria in the urinary tract. These can be pathogenic, non-pathogenic and conditionally pathogenic microorganisms, and neither the first, nor the second, nor the third microbes should normally be in the urine.

What can a urine test reveal? Usually, the technique of sector crops is used for research: the biological fluid is placed on a special nutrient medium, after which the number of bacterial cells in 1 ml of urine is estimated. Recall that it is considered the norm if bacterial growth is not detected in the material. [4]

• If, according to the results of the analysis, single bacteria are found in the urine during pregnancy +, this means that their number does not exceed 10 ³  CFU / ml. Such bacterial growth does not in all cases cause an inflammatory reaction and may be hidden.
• Bacteria in urine during pregnancy ++ corresponds to the number of microbial cells of 10 ⁴  cfu/ml. This result can be regarded by the doctor as doubtful, so it is advisable to take a urine test again.
• Bacteria in the urine during pregnancy +++ correspond to the number of microbial cells of 10 ⁵  cfu/ml. As a rule, such a number of bacteria always causes the development of inflammation.

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

If leukocytes and bacteria are simultaneously present in the urine during pregnancy, then this clearly indicates the presence of an inflammatory process in the urinary tract. The presence of more than five leukocytes in the field of view indicates the development of the body's immune response to the penetration of the 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 the urine during pregnancy is an unfavorable sign that indicates various diseases and pathological conditions, for example, such:

• glomerulonephropathy;
• glomerulonephritis;
• amyloidosis;
• preeclampsia;
• infectious diseases.

An accurate diagnosis is established by the doctor only after all the required diaonotic procedures have been carried out.

In large numbers, bacteria and mucus in the urine during pregnancy is also a sign of pathology. The reasons for this problem can be:

• urinary tract infections;
• congestion of urinary fluid.

If there is little mucus, and bacteria are found in a significant amount, then it makes sense to retake the analysis: perhaps the liquid was collected incorrectly, and the bacteria got into the material from the outer skin and mucous membranes.

Complications and consequences

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

With the appearance of bacteria in the urine, the risk of developing preeclampsia, anemia increases. Fetoplacental insufficiency, intrauterine oxygen deficiency, fetal developmental disorders, infectious complications (for example, postpartum endometritis or chorioamnionitis) often occur.

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

Why are bacteria in urine dangerous during pregnancy?

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

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

In order to prevent an unfavorable development of events, the gynecologist regularly prescribes a urine test to a pregnant woman. This is a necessary measure for the timely detection of various problems - in particular, the appearance of bacteria in the urine. Timely prescribed treatment will help prevent further development of the infection and convey a healthy pregnancy.

Diagnostics of the bacteria in urine during pregnancy

If bacteria are found in the urine of a pregnant woman, the doctor should 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 indicators of laboratory and instrumental studies. Symptoms such as vaginal discharge, pain syndrome, burning sensation and itching should be especially alert - all these signs indicate the presence of an infectious-inflammatory process.

Further diagnostic plan most often includes laboratory tests:

• a general urine test, which is repeated with a study of the middle portion, in order to exclude accidental entry of bacteria into the urinary fluid;
• sowing urine for microflora - it is performed twice, with an interval of at least a day;
• photocolorimetric screening, or TTX test, helps to determine the high concentration of bacteria in the urinary fluid for 4 hours.

Instrumental diagnostics in the form of ultrasound examination of the kidneys, ultrasound of the vessels of the kidneys, as well as radiography and endoscopic methods are prescribed only in diagnostically difficult situations, given 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 genitourinary diseases. To assess the functional ability of the kidneys, as a supplement, the Nechiporenko urine collection method, a number of kidney samples, a clinical blood test and blood biochemistry are used.

Latent bacteriuria should be differentiated from a false form, as well as from cystitis, pyelonephritis, urethritis.

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

Treatment of the bacteria in urine during pregnancy

The detection of bacteria in the urine during pregnancy is the basis for prescribing treatment, even if there are no complaints and symptoms.

Which of the methods of therapy to choose, the doctor decides, based not only on the results of the test for the sensitivity of bacteria to antibiotics, but also on the well-being of the woman, the duration of pregnancy. The likely benefit to the patient and the degree of harm to the fetus should also be carefully weighed.

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 during the gestation period. These drugs include Kanefron, kidney tea, Cyston, Phytolysin: they are prescribed in combination with uroseptic and antibacterial agents - for example, with Monural, antibiotics of the penicillin or cephalosporin series (they are allowed to be used in the II-III trimester). [9]

At the end of treatment - after about 1-2 weeks - the urine test is repeated. If everything is in order, and bacteria in the urine are not detected, then further prophylactic use of individual drugs is possible - for example, Kanefron or Aflazin.

Medications

• Antibiotic therapy is most often represented by Monural: a single dose of this drug helps to eliminate bacteria that accumulate in the urinary tract. This antibiotic is safe and effective, it is easy to use. [10]
• Monotherapy with antibiotics can also be represented by semi-synthetic β-lactam penicillins, II-III generation cephalosporin drugs. In addition to the third trimester, the use of synthetic nitrofuran agents is prohibited, since they can cause a hemolytic disease in a child.

Monural	Fosfomycin based drug. Take in the evening, on an empty stomach and an empty bladder, after dissolving the granules in 100 ml of water. Reception is a one-time, therefore, it is rarely accompanied by side effects. Sometimes diarrhea may occur.
Amoxiclav	A drug that combines amoxicillin and clavulanic acid. Take 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	Amoxicillin and clavulanic acid. The dosage is determined by the doctor individually. Possible side effects: candidiasis, allergies, dyspepsia.
Cystone	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	Herbal preparation, which is available in the form of a paste for the preparation of a suspension. Take the drug three times a day, after meals, 1 tsp. Paste in 100 ml of water. The duration of treatment is from 2 weeks to one month. Possible side effects: allergic reaction, dizziness, photosensitivity, diarrhea.

Antibiotics are allowed to be used no earlier than from the 14-16th week of pregnancy, since during the first trimester the fetus actively forms organs and systems, and the unborn child does not have placental protection at this time. As a rule, antibiotics are used in the shortest possible course - no more than three or five days. For treatment, extremely safe drugs are selected that do not cause harm during pregnancy.

Kanefron with bacteria in the urine during pregnancy

One of the safest medicines recommended to improve the functioning of the urinary tract during pregnancy is Kanefron. This is a herbal remedy that does not have a teratogenic effect, but exhibits a number of useful properties:

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

The composition of the drug is represented by plants centaury, lovage and rosemary.

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

Kanefron is approved for use at any stage of pregnancy, and even during breastfeeding. The duration of treatment is usually at least two weeks: tablets are taken one at a time in the morning and evening, regardless of the meal time. The tablet is washed down with a sufficient volume of liquid and swallowed without chewing. As a rule, the drug is well received by the body, and only in rare cases can an allergic reaction occur. This point must 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-medication (even with vitamins) cannot be started, because this can lead to the most adverse consequences. The best vitamin remedies for pregnant women are those that the doctor will prescribe. Vitamins, like other medicines, are selected individually, based on the results of diagnosis and medical examination.

During pregnancy, the best vitamin complex is a complete and varied diet. And only with a real lack of vitamins, the doctor can insist on additional intake of certain drugs. We can talk about such vitamin components:

• vitamin D in combination with calcium;
• vitamin A (strictly under medical supervision 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 inhibition of the development of the inflammatory reaction).

Perhaps the doctor will opt for any one vitamin, or immediately prescribe a complete vitamin-mineral complex created specifically for pregnant women - for example, it can be Vitrum prenatal, Elevit pronatal, Complivit Trimestrum or Complivit Mom, Pregnavit or Multitabs perinatal.

Physiotherapy treatment

Physiotherapy with the appearance of bacteria in the urine during pregnancy is used extremely rarely - mainly in the chronic form of urological pathology. It is possible to use magneto or electrophoresis, inductothermy, EHF-therapy, ultrasound and laser treatment. However, the need for such procedures is carefully weighed on a case-by-case basis. Most often, the doctor decides on the use of medication and herbal medicine, and physiotherapy is transferred to the postpartum period.

Alternative Treatment

You can supplement the main treatment with alternative means - of course, with the consent of the doctor. When bacteria appear in the urine during pregnancy, it is recommended to pay attention to such simple recipes:

• Try to drink at least a couple of glasses of cranberry or blueberry juice every day (you can replace the juice with fruit drink). These drinks will prevent the accumulation and reduce the viability of bacteria in the urinary system.
• Eat 1 tbsp daily. L. Natural coconut oil, or drink a glass of coconut milk, which has antimicrobial activity against many bacteria.
• Add asparagus to your food - this plant perfectly cleanses the urinary tract.
• Drink natural apple cider vinegar - 2 tbsp. L. Per day with water.
• Add celery, pineapple, basil to dishes. The right food ingredients will help support a healthy urinary system.

Herbal treatment

You can consult with your doctor about the use of herbal medicines, because many plants are famous for their pronounced activity against pathogenic bacteria. Of course, not all herbs are allowed for pregnant women, but some of them may 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 Nefrofit tea: these herbal preparations enhance the effect of antibacterial medicines, and also help to quickly cope with the inflammatory reaction.

Homeopathy

Homeopathic medicines are relatively safe and effective during pregnancy. Why is such security relative? The fact is that the only possible side property of such medicines is an allergic reaction. Therefore, before using homeopathic remedies, you need to make sure that the woman is not allergic to the drug. If there is no such allergy, then homeopathy is allowed.

Homeopathic remedies are not designed 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.

If bacteria appear in the urine during pregnancy, the following homeopathic remedies can be recommended:

• Berberis homaccord - 10 drops three times a day, for a long time;
• Populus compositum - 10 drops three times a day, and in case of exacerbation hourly;
• Renel - one tablet three times a day (dissolve in the mouth);
• Uroregulan - 5-7 granules up to five times a day 20 minutes before meals.

The use of homeopathic medicines should not replace the medical treatment prescribed by the doctor. However, it is able to successfully supplement it, as it goes well with taking other medicines.

Prevention

• Every day a woman should drink sufficient volumes of fluid, excluding soups, dairy products and juices.
• It is optimal for drinking to choose purified drinking water or rosehip infusion.
• It is better to exclude or severely limit pickles, spicy sauces, fried and fatty foods, and sugar from the diet. You can’t “prescribe” yourself drugs with calcium, as this can cause increased stone formation in the kidneys.
• It is preferable to use vegetable light food, cereals.
• Products for dishes are best boiled, steamed or baked.
• Sufficient stay of a pregnant woman in the fresh air is important. Moderate physical activity, yoga, breathing exercises are welcome.
• Urinalysis during pregnancy should be taken regularly to keep the condition of the urinary tract under control.

Forecast

If the doctor detects bacteria in the urine during pregnancy, then it is by no means unacceptable to ignore such an indicator. Action must be taken, and the sooner this 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 problem. According to statistics, in about 75% of cases, timely therapy can prevent the development of pyelonephritis in pregnant women, and in 8% of cases, prevent prematurity in a baby. Given these indicators, we can confidently talk about a positive prognosis of bacteriuria, subject to timely medical intervention.