Relevance. The term “urinary tract infection” refers to an inflammatory process localized in various parts of the urinary system. Allocate an infection of the lower (cystitis, urethritis, asymptomatic bacteriuria) and upper urinary tract (pyelonephritis, abscess and kidney carbuncle, pyelonephritis) [1, p.7].
The prevalence of asymptomatic bacteriuria in the population of pregnant women is on average 6%. Acute cystitis and acute pyelonephritis are somewhat less common – in 1-2.5%. However, 20-40% of pregnant women with asymptomatic bacteriuria develop acute pyelonephritis in the II and III trimesters [2, p. 123]. These figures indicate that the prevalence of urinary tract infections in the population of pregnant women is extremely high. Thus, the relevance of our study is based on the high incidence of urinary tract infections in pregnant women and various complications of pregnancy caused by them [3, p.272]. Urinary tract infections can cause a number of serious complications of pregnancy and childbirth: anemia, hypertension, premature birth, premature rupture of amniotic fluid, low birth weight (<2500 g), which, in turn, leads to an increase in perinatal mortality in 3 times [4, p. 134].
Therefore, the main goal of this study is to identify the causes of asymptomatic bacteriuria, cystitis, pyelonephritis and formulate recommendations for their prevention.
Materials and methods. Currently, 40 case histories of pregnant women with concomitant urinary tract infections have been studied. A retrospective and prospective analysis of clinical, laboratory and instrumental examination of pregnant women was carried out.
The inclusion criteria for patients in the study were: one pregnancy at a gestational age of 22 to 37 weeks, a confirmed diagnosis of asymptomatic bacteriuria, and urinary tract infection. Exclusion criteria: multiple pregnancy, extragenital pathology in a decompensated pregnant woman, diagnosed fetal malformations.
Results of the study. In the course of the study, it was found that in 47% of patients there is an increased content of protein in the urine (0.099-0.165 g/l) at a rate of 0-0.033 g/l. Possible reasons: with diseases of the kidneys and urinary system, nephropathy of pregnant women, fever, leptospirosis, severe heart failure, anemia, hemorrhagic vasculitis, diabetes mellitus, proteinuria appears, that is, increased excretion of protein in the urine. There are also physiological causes of proteinuria: increased muscle activity and the consumption of large amounts of protein foods. Increased presence of renal cells (32%), flat (61%), transitional (7%) epithelium. Possible causes: epithelial cells line the urinary tract and appear in the urine during inflammatory processes in the mucous membrane. The renal epithelium is above normal. Possible causes: epithelial cells line the urinary tract and appear in the urine during inflammatory processes in the mucous membrane.
In the blood of 37%, an increase in the level of leukocytes was observed: 11 thousand/μl at a rate of 4-9 thousand/μl. Possible reasons: an increase in the content of leukocytes in the urine (leukocyturia) is observed in inflammatory diseases of the kidneys and urinary tract, less often in tuberculosis and renal amyloidosis, acute and chronic glomerulonephritis.
Also, 42% of pregnant women have an increase in the number of segmented leukocytes: 67-68 thousand/μl, while the norm is 55-65 thousand/μl. The current indicators are evidence of a localized inflammatory process occurring in the body of a pregnant woman, affecting the organs of the urinary tract. A detailed study of the anatomical and physiological features of the structure of the female body made it possible to identify a number of factors in the occurrence of a high prevalence of urinary tract infection in pregnant women: a short wide urethra, its proximity to the natural reservoirs of infection (vagina, anus), mechanical compression of the ureters by the uterus, decreased urinary tract tone, glucosuria, immunosuppression, change in urine pH.
For the treatment of urinary tract infections in pregnant women, antibiotic therapy is used, based on the use of the following drugs: Amoxicillin / clavulanate; Cefuroxime sodium; Ceftriaxone; Cefotaxime. The greatest efficiency in the treatment of pyelonephritis is achieved by the drug “Nolitsin”, in the treatment of cystitis – by the drug “Nitroxoline”, in the treatment of asymptomatic bacteriuria – by the drug “Ceftriaxone”.
The main criteria for the treatment of urinary tract infection in pregnant women include the following: only those drugs are prescribed that are guaranteed to be safe and meet the bioavailability criteria; when choosing drugs, it is necessary to take into account the trimester of pregnancy; the whole process of treatment should take place under regular and strict medical supervision, including screening tests of blood and urine.
Conclusions. Prevention of urinary tract infections is indicated for pregnant women who have had two or more episodes of cystitis or one episode of pyelonephritis. In accordance with current concepts, suppressive therapy should be carried out immediately after the end of the course of treatment for upper urinary tract infections or recurrence of lower urinary tract infections. An auxiliary means of treatment and especially prevention of urinary tract infections in pregnant women are uroantiseptic herbal preparations. In turn, conscientious observance of the rules of personal hygiene constitutes most of the preventive measures aimed at preventing the development of urinary tract infections in pregnant women.
References
- National Vital Statistics Reports, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES. – 2018. – Vol. 61. – № 1.
- Maia S. Neto S. Preterm birth of twins // 21st European Congress of Obstetric and Gynaecology Antwerpen Belgium / 5 to 8 May 2016, 123.
- Flores-Mireles A.L., Walker J.N., Caparon M. Urinary tract infections: epidemiology, mechanisms of infection and treatment options // Nature Reviews. Microbiology. – 2019. – Vol. 13 (5). – P. 269–284.
- Salvatore S., Cattoni E., Siesto G. Urinary tract infections in women // European Journal of Obstetrics, Gynecology, and Reproductive Biology. – 2018. – Vol. 156 (2). –P. 131–136.
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