Asymptomatic bacteriuria found in 4 – 7 % of pregnant women.
This may progress to pyelonephritis in 20 – 40 %.
- Severe lower tract or upper tract infections may precipitate worse foetal outcomes including premature labour and decreased birth weight.
Therefore asymptomatic bacteriuria should be screened for and treated in pregnancy.
Pyelonephritis should be treated as an inpatient with intravenous antibiotics and should probably have upper tract imaging to assess for obstruction.
Recurrent UTIs – consider prophylaxis through pregnancy – low dose Keflex or TMP.
Safe antibiotics are:
- Penicillins, cephalosporins, piptaz (?augmentin may incr risk of NEC)
Safe with caveats are:
- Trimethoprim – avoid in first trimester due to potential for NTD (folate inhibitor)
- Nitrofurantoin – avoid in third trimester – potential haemolytic anaemia
- Gentamicin – widely used, theoretical risk of ototoxicity and nephrotoxicity
Do not use:
- Fluoroquinolones – arthropathy and joint/tendon development
- Tetracyclines – doxycycline etc (bone/tooth development)