Urinary tract infections (UTI) during pregnancy constitute one of the important problems in obstetrics, urology and nephrology, which is associated with their high frequency, specific approaches to diagnosis and treatment, as well as a high risk of developing various urological, obstetric and neonatal complications.
Asymptomatic bacteriuria (AS) is a common variant of UTI during pregnancy, observed in 2-10% of pregnant women and in the vast majority of cases it is BD acquired before conception. Risk factors for BD in pregnant women include low socioeconomic status, age, sexual activity, repeat pregnancies, anatomical and functional changes in MS, diabetes mellitus, and a history of recurrent UTIs.
During gestation, 40% of pregnant women with untreated BD develop clinical manifestations of UTI and, first of all, symptoms of acute pyelonephritis. Successful treatment and elimination of BD during pregnancy significantly reduces the incidence of pyelonephritis and improves the prognosis for both the mother and the fetus.
Along with an increased incidence of pyelonephritis, bacteriuria during gestation may represent a risk factor for the development of other adverse maternal and fetal effects, such as anemia, hypertension, spontaneous abortion, preterm birth, intrauterine growth restriction, and perinatal mortality.
Cystitis during pregnancy occurs in 0.3-1.3% of cases, often becomes recurrent and can be complicated by acute pyelonephritis. Acute pyelonephritis and exacerbation of chronic pyelonephritis in pregnant women occur with a frequency of 1-4%, usually in the second and third trimesters.
The main etiological factor for UTI during gestation is E.coli (85-90%). Less commonly, UTIs are caused by Proteus mirabilis, Klebsiella spp., Enterobacter spp. and etc.
The pathophysiology of UTI during pregnancy is determined by hormonal and anatomical and physiological changes in the MS, as well as chemical changes in the composition of urine. These factors determine the tendency of IMS to persist and recur, as well as resistance to antibiotic therapy.
To treat UTIs during pregnancy, penicillins, cephalosporins of I-IV generations, aminoglycosides, macrolides, nitrofurantoin, fosfomycin and some other antibiotics are used. The choice of drug depends on the clinical form of UTI and the duration of pregnancy.
A single prescription of antibiotics can be used for newly diagnosed BD. In case of ineffectiveness or relapses, longer treatment is carried out. Acute pyelonephritis is treated parenterally with aminopenicillins, cephalosporins, aminoglycosides for at least 2-3 days, followed by switching to oral antibiotics.
Thus, UTIs during pregnancy represent an important problem due to the high risk of complications for the mother and fetus. Timely diagnosis and adequate antibiotic therapy can significantly improve the prognosis for both.