‘’ASSESSMENT OF MATERNAL OUTCOMES SECONDARY TO SYMPTOMATIC URINARY TRACT INFECTION IN PREGNANCY’’

Main Article Content

Dr. Garima Kejriwal
Dr. Kirti Singh
Dr Rupali Singh

Keywords

urinary tract infection, preterm delivery, premature rupture of membrane, post-partum sepsis

Abstract

Background- The prevalence of bacteriuria is the same in pregnant and non-pregnant women. Pregnant women are at the risk of recurrent bacteriuria. Without treatment, 30 to 40% of these pregnant women will develop symptomatic UTI. Urinary tract infection (UTI) is a widely prevalent problem in developing countries like India. This leads to adverse maternal and fetal outcomes, which could have been avoided by preventing the urinary tract infection. Despite increase in hospital-based ante-natal checkups and more deliveries in hospital than at home which has significantly reduced maternal and fetal morbidity and mortality, maternal and fetal deaths due to complications from urinary tract infection still occur which should ideally be prevented.


Aim - ‘‘Assessment of maternal outcomes secondary to symptomatic urinary tract infection in pregnancy’’.


Methods and materials: This is a prospective cohort study which was done in the department of pediatrics Medicine and    Obstetrics and Gynecology at Mahatma Gandhi Memorial Medical college and associated hospital Indore from January 2021 to January 2023. Pregnant women who were booked in my hospital for their antenatal care were included in the study. Pregnant women  with symptomatic urinary tract infection with significant growth in urinary culture were taken as cases and others were taken as controls. Maternal outcomes were assessed at delivery. Comparison of quantitative variables were done using independent t- test or Wilcoxon rank sum test. Comparison of categorical variables were done using Fisher’s Exact test. All significant variables were analysed using logistic regression.


Results and conclusion- In our study preterm premature rupture of membranes was more among the case  than controls with OR of 2.697 which was statistically significant (95% CI- 1.423- 5.11, p=0.001) Preterm delivery and post-partum sepsis were also statistically significant with OR of 3.162 and 3.972 respectively. Primigravida, multifetal pregnancy, low maternal education, past history of catheterization, urinary tract infection, and anemia were statistically significant risk factors for the development of urinary tract infection.

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References

1. Smaill FM, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. In: The Cochrane Library [Internet]. John Wiley & Sons, Ltd; 2015 [cited 2018 Jul 23]. Available from: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD000490.pub3/full
2. Patterson TF, Andriole VT. DETECTION, SIGNIFICANCE, AND THERAPY OF BACTERIURIA IN PREGNANCY: Update in the Managed Health Care Era. Infect Dis Clin North Am. 1997 Sep 1;11(3):593–608.
3. Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM. Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults. Clin Infect Dis. 2005 Mar 1;40(5):643–54.
4. Nicolle LE. Asymptomatic bacteriuria. Infect Dis Clin North Am. 2003 Jun;17(2):367–94.
5. Harris RE, Gilstrap LC. Cystitis during pregnancy: a distinct clinical entity. Obstet Gynecol. 1981 May;57(5):578–80.
6. Wing DA, Fassett MJ, Getahun D. Acute pyelonephritis in pregnancy: an 18-year retrospective analysis. Am J Obstet Gynecol. 2014 Mar;210(3):219.e1-219.e6.
7. Sabharwal ER. Antibiotic Susceptibility Patterns of Uropathogens in Obstetric Patients. North Am J Med Sci. 2012 Jul;4(7):316–9.
8. Rizvi M, Khan F, Shukla I, Malik A, Shaheen. Rising Prevalence of Antimicrobial Resistance in Urinary Tract Infections During Pregnancy: Necessity for Exploring Newer Treatment Options. J Lab Physicians. 2011 Dec;3(2):98.
9. Kant S, Lohiya A, Kapil A, Gupta SK. Urinary tract infection among pregnant women at a secondary level hospital in Northern India. Indian J Public Health. 2017 Jun;61(2):118–23.
10. Emiru T, Beyene G, Tsegaye W, Melaku S. Associated risk factors of urinary tract infection among pregnant women at Felege Hiwot Referral Hospital, Bahir Dar, North West Ethiopia. BMC Res Notes. 2013 Jul 25;6:292.
11. McMahon MJ, Ananth CV, Liston RM. Gestational diabetes mellitus. Risk factors, obstetric complications and infant outcomes. J Reprod Med. 1998 Apr;43(4):372–8.
12. Glaser AP, Schaeffer AJ. Urinary Tract Infection and Bacteriuria in Pregnancy. Urol Clin North Am. 2015 Nov;42(4):547–60.
13. Kass EH. Bacteriuria and pyelonephritis of pregnancy. Arch Intern Med. 1960 Feb;105:194–8.
14. Sweet RL. Bacteriuria and pyelonephritis during pregnancy. Semin Perinatol. 1977 Jan;1(1):25–40.
15. Petersson C, Hedges S, Stenqvist K, Sandberg T, Connell H, Svanborg C. Suppressed antibody and interleukin-6 responses to acute pyelonephritis in pregnancy. Kidney Int. 1994 Feb;45(2):571–7.
16. Hill JB, Sheffield JS, McIntire DD, Wendel GD. Acute pyelonephritis in pregnancy. Obstet Gynecol. 2005 Jan;105(1):18–23.
17. Schito GC, Naber KG, Botto H, Palou J, Mazzei T, Gualco L, et al. The ARESC study: an international survey on the antimicrobial resistance of pathogens involved in uncomplicated urinary tract infections. Int J Antimicrob Agents. 2009 Nov;34(5):407–13.
18. Gilstrap LC, Ramin SM. Urinary tract infections during pregnancy. Obstet Gynecol Clin North Am. 2001 Sep;28(3):581–91.
19. Schneeberger C, van den Heuvel ER, Erwich JJHM, Stolk RP, Visser CE, Geerlings SE. Contamination rates of three urine-sampling methods to assess bacteriuria in pregnant women. Obstet Gynecol. 2013 Feb;121(2 Pt 1):299–305.
20. Jayalakshmi J, Jayaram VS. Evaluation of various screening tests to detect asymptomatic bacteriuria in pregnant women. Indian J Pathol Microbiol. 2008 Sep;51(3):379–81.
21. Jain S, Pandya J, Mehta S, Jain A, Kikani K, Pandya M. Evaluation of asymptomatic bacteriuria in antenatal women at C. U. Shah Medical College and Hospital, Surendranagar, Gujarat. Int J Med Sci Public Health. 2013;2(4):1021.
22. Primigravida | definition of primigravida by Medical dictionary [Internet]. [cited 2018 Oct 16]. Available from: https://medical-dictionary.thefreedictionary.com/primigravida
23. multigravida. In: The Free Dictionary [Internet]. [cited 2018 Oct 16]. Available from: https://medical- dictionary.thefreedictionary.com/multigravida
24. Definition of Grand multipara [Internet]. [cited 2018 Oct 16]. Available from: https://www.medicinenet.com/script/main/art.asp?articlekey=9750
25. Lampinen R, Vehviläinen-Julkunen K, Kankkunen P. A Review of Pregnancy in Women Over 35 Years of Age. Open Nurs J. 2009 Aug 6;3:33–8.
26. Williams Obstetrics, 25e | AccessObGyn | McGraw-Hill Medical [Internet]. [cited 2018 Oct 16]. Available from: https://obgyn.mhmedical.com/book.aspx?bookid=1918
27. Shaikh Z, Pathak R. Revised Kuppuswamy and B G Prasad socio-economic scales for 2016. Int J Community Med Public Health. 2017 Mar 28;4(4):997.
28. Ananth CV, Lavery JA, Vintzileos AM, Skupski DW, Varner M, Saade G, et al. Severe placental abruption: clinical definition and associations with maternal complications. Am J Obstet Gynecol. 2016 Feb;214(2):272.e1-272.e9.
29. Hypertensive Disorders | Williams Obstetrics, 24e | AccessMedicine | McGraw-Hill Medical [Internet]. [cited 2018 Oct 14]. Available from: https://accessmedicine.mhmedical.com/content.aspx?bookid=1057§ionid=59789184&jumpsec tionID=59795621
30. American College of Obstetricians and Gynecologists, American College of Obstetricians and Gynecologists, editors. Hypertension in pregnancy. Washington, DC: American College of Obstetricians and Gynecologists; 2013. 89 p.
31. Simhan HN, Canavan TP. Preterm premature rupture of membranes: diagnosis, evaluation and management strategies. BJOG Int J Obstet Gynaecol. 2005 Mar;112 Suppl 1:32–7.
32. Tita ATN, Andrews WW. Diagnosis and Management of Clinical Chorioamnionitis. Clin Perinatol. 2010 Jun;37(2):339–54.
33. Colgan R, Williams M, Johnson JR. Diagnosis and treatment of acute pyelonephritis in women. Am Fam Physician. 2011 Sep 1;84(5):519–26.
34. pb017.pdf [Internet]. [cited 2018 Oct 15]. Available from: http://www.goforitcourse.com/uploads/1/7/2/5/17251206/pb017.pdf
35. Cesarean Birth - ACOG [Internet]. [cited 2018 Oct 15]. Available from: https://www.acog.org/Patients/FAQs/Cesarean-Birth
36. Peleg D, Kennedy CM, Hunter SK. Intrauterine growth restriction: identification and management. Am Fam Physician. 1998 Aug;58(2):453–60, 466–7.
37. Preterm birth [Internet]. [cited 2018 Oct 15]. Available from: http://www.who.int/news-room/fact- sheets/detail/preterm-birth
38. WHO | International Classification of Diseases, 11th Revision (ICD-11) [Internet]. WHO. [cited 2018 Oct 15]. Available from: http://www.who.int/classifications/icd/en/
39. who definitions.pdf.
40. Pediatrix Pearls [Internet]. [cited 2018 Oct 15]. Available from: https://www.pediatrix.com/body_university.cfm?id=2648&action=detail&ref=5
41. Mazor-Dray E, Levy A, Schlaeffer F, Sheiner E. Maternal urinary tract infection: is it independently associated with adverse pregnancy outcome? J Matern Fetal Neonatal Med. 2009 Jan;22(2):124–8.
42. Johnston CL, Johnston MJ, Corke A, Davies MC. A likely urinary tract infection in a pregnant woman. BMJ. 2017 Apr 27;j1777.
43. Kenny LC, Lavender T, McNamee R, O’Neill SM, Mills T, Khashan AS. Advanced Maternal Age and Adverse Pregnancy Outcome: Evidence from a Large Contemporary Cohort. PLoS ONE [Internet]. 2013 Feb 20 [cited 2018 Oct 8];8(2). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3577849/
44. Chen X-K, Wen SW, Fleming N, Demissie K, Rhoads GG, Walker M. Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. Int J Epidemiol. 2007 Apr;36(2):368–73.
45. Dotters-Katz SK, Patel E, Grotegut CA, Heine RP. Acute Infectious Morbidity in Multiple Gestation [Internet]. Infectious Diseases in Obstetrics and Gynecology. 2015 [cited 2018 Oct 8]. Available from: https://www.hindawi.com/journals/idog/2015/173261/
46. Vijayaraghavan K, Brahmam GN, Nair KM, Akbar D, Rao NP. Evaluation of national nutritional anemia prophylaxis programme. Indian J Pediatr. 1990 Apr;57(2):183–90.
47. Knowledge on urinary Tract Infection among Primigravida Women. - ScopeMed.org - Deposit for Medical Articles [Internet]. [cited 2018 Oct 17]. Available from: http://www.scopemed.org/?mno=204009
48. Muttai PC. THE IMPACT OF EDUCATION ON ADVERSE PREGNANCY OUTCOMES IN KENYA. :52.
49. Schieve LA, Handler A, Hershow R, Persky V, Davis F. Urinary tract infection during pregnancy: its association with maternal morbidity and perinatal outcome. Am J Public Health. 1994 Mar;84(3):405–10.