Management and Prevention of Urinary Tract Infection in Pregnancy

Urinary tract infection (UTI) is a common problem in pregnancy. The spectrum of these infections ranges from lower urinary tract disease (asymptomatic bacteriuria, acute cystitis) to upper urinary tract disease (acute pyelonephritis). Morphological and physiological changes in the genitourinary tract during pregnancy increase the risk of acquiring UTI. Adverse effects of UTI in pregnancy include preterm labor, intrauterine growth retardation, chorioamnionitis, and stillbirth, resulting in a higher neonatal mortality rate. Consequently, screening for asymptomaticbacteriuria (ASB) is a routine examination in antenatal care. The ideal test for diagnosing UTIand ASB is urine culture, but it is expensive, not practical, and the result is not immediate. Nitrite test in urine dipstick is a quick and inexpensive test and can be used for screening UTI in pregnancy. If possible, a positive nitrite test should be followed by a urine culture. In facilitieswhere doing culture is impossible, nitrite tests could be used to diagnose UTI in pregnancy. AllUTI in pregnancy, including asymptomatic bacteriuria must be treated adequately. The selectionof an appropriate antimicrobial agent to treat urinary tract infection in pregnancy is limited by the safety of the drug to the mother and the fetus. Amoxicillin and ceftriaxone can be safely used to treat UTI throughout pregnancy. Nitrofurantoin can only be used for UTI treatment in the first and second trimester of pregnancy, while cotrimoxazole can only be used in the second trimester of pregnancy.