This is infection of the urethra, bladder, ureter and the kidney. It is more common in pregnancy due to physiological changes that cause dilatation of the urinary system and relative stasis of urine. Glycosuria and ammo aciduria in pregnancy also encourages bacterial growth. UTI can lead to abortion, premature labour, low birth weight and intrauterine growth retardation.

ASYMPTOMATIC BACTERIURIA

Clinical Features

This condition occurs when there are 100,000 or more bacteria per millilitre of urine without any symptoms. It occurs in 2-10% of all pregnant women. If left untreated pyelonephritis will develop in 25-30%.

Investigations

• Urinalysis

• Urine C&S.

Management

• Oral antibiotic therapy, oral amoxycillin 500 mg TDS OR nitrofurantoin 100 mg QDS OR nalidixic unit 500 mg QDS OR erythromycin 500 mg TDS. All for 10 to 14 days.

URETHRITIS AND CYSTITIS

Clinical Features

Dysuria. Frequency. Urgency. Hesitancy. Suprapubic pain. False labour.

Investigations

• Urine specimen for microscopy, C&S.

Management

• Advice on adequate hydration

• Oral antibiotic therapy as above

• Pain relief using hyoscine butylbromide 20 mg TDS or paracetamol 1 gm TDS for five days.

PYELONEPHRITIS

Clinical Features

Fever. Vomiting. Renal angle tenderness, particularly on the right. Rarely premature labour.

Investigations

• Urine culture will usually grow E. Coli or K. enterobacteria.

Management

• Admit immediately

• Hydration using intravenous fluids

• Antibiotic therapy as above until the patient responds. Then continue orally for 10 days. If patient is vomiting ampicillin 500 mg IM QDS then change to oral therapy for 10 days.

Recurrence cases are high and may indicate resistant organism, urologic abnormalities (e.g. polycystic kidneys), renal calculi, ureteric obstruction or perinephric abscess. Ultrasound if available may be helpful. However, X-ray examinations may be done after the puerperium.