During pregnancy, women’s health is seriously tested: in addition to drastic hormonal changes, the body of the expectant mother is undergoing a global restructuring with a shift of internal organs due to the growing uterus, the redistribution of resources, which should now be enough for two. Therefore, it is not surprising that for 9 long months, women are “in the position” of many chronic illnesses, and, in addition, there are deviations in the work of internal organs, for which, it would seem, there are no prerequisites. Asymptomatic Bacteriuria is one of the fairly common companions of pregnancy, which may be asymptomatic or may be accompanied by certain discomfort. Where does atypical microflora appear in the urine of a pregnant woman, what threatens such a rejection of the expectant mother and her baby and how to recognize bacteriuria, if it is asymptomatic? Knowing the answers to these questions, you will be able to identify the disease in time and take appropriate measures to eliminate it!
If during pregnancy, the kidneys cope with the functions assigned to them, and the urinogenital system works without “failures”, the urine released from the body is devoid of any microflora, that is, sterile. However, with the slightest deviation in the functionality of the internal organs of the excretory system, all sorts of pathogenic and conditionally pathogenic bacteria can appear in it, the presence of which can be confirmed at least by a twofold analysis. If each of the analyzed portions contains at least 100 thousand bacteria of the same type in each milliliter of physiological fluid, the doctor diagnoses true bacteriuria.
Bacteriuria during pregnancy can occur in two forms:
- an asymptomatic disease that does not manifest itself, except for deviations in the test results;
- bacteriuria with characteristic symptoms, which may cause pain in the lower abdomen, burning during urination, pulling back pain, slight fever, etc.
Despite the fact that asymptomatic bacteriuria does not cause any discomfort to the expectant mother, this form of the disease is more insidious than symptomatic, since it is unrealistic to suspect the appearance of pathology. Therefore, during pregnancy, patients have to pass a general urine test before each admission – only in this way can one not miss the appearance of the first signs of illness and take timely measures.
Where in the urine can bacteria appear?
Bacteriuria, especially asymptomatic, is far from uncommon during pregnancy. According to statistics, such a deviation is detected on average in 6-11% of pregnant women at different times. In some cases, bacteriuria may precede conception, but not detected until a certain point: while the body copes with the load, the immunity manages to keep under control the quantity and localization of pathogenic microflora, but at the slightest failure the illness begins to manifest itself, first in analyzes and then symptomatically.
Usually in urine tests during pregnancy appear:
This microflora is not foreign to the body – normally these pathogens are present in the digestive tract (in particular, in the intestine), as well as on the skin and mucous membranes. However, their urine should not be – this indicates a specific pathology.
In itself, bacteriuria during pregnancy is not so dangerous and quite easily curable, but in some cases, this condition is not a specific disease, but a symptom of a more serious disorder. Thus, microorganisms can appear against the background of infectious processes in the urinary system, chronic pyelonephritis, kidney stones, expansion of the ureters, or vesicoureteral reflux.
Factors provoking asymptomatic bacteriuria in pregnant women
In some cases, bacteriuria appears by itself, without any other pathology. Especially often this condition occurs against the background of physiological changes characteristic of the pregnancy period. For the emergence of microorganisms during gestation, there are several predisposing nuances:
- Changes in the urinary organs. Against the background of pregnancy, the sphincter of the bladder is usually disturbed, the renal calyx and pelvis are dilated, and the ureter tone is reduced. Such an anatomical feature can provoke the introduction of infection into the excretory organs and, as a result, the appearance of asymptomatic bacteriuria.
- Active growth of the uterus. A sharp increase in the uterus causes a displacement of all the internal organs of the abdominal cavity, but the greatest pressure falls on the kidneys and the bladder. All this can not affect the performance of the excretory system, causing various violations, including bacteriuria.
- Digestive disorders. Frequent constipation due to dislocation of the colon and less active peristalsis is another reason for changing the composition of urine.
- Hormonal changes. The high level of progesterone in the body, characteristic of the normal course of pregnancy, reduces the tone of the ureters, as a result of which bacteria of different origin can appear in the urine.
- The composition of urine. During pregnancy, urine pH becomes higher, it appears a higher percentage of estrogen. Such an environment is more favorable for microbial growth, so the number of pathogenic microorganisms increases exponentially.
- Immunity problems. While carrying a baby, the effectiveness of the immune system decreases for many reasons, so it becomes more difficult for the body to resist pathogenic micro flora.
- Stasis urine. Low levels of bladder tone provoke stagnant processes in which a part of the fluid is not released during urination. This allows microbes to actively multiply and develop, causing asymptomatic bacteriuria.
Is it dangerous to change the microflora for the mother and the fetus?
By itself, bacteriuria has no direct effect on the fetus, but during pregnancy, it can provoke many unpleasant consequences. Since the excretory system is adjacent to the genital, pathogenic bacteria can spread to the walls of the uterus, affect the fetal membranes and, accordingly, the child in the womb. This condition significantly increases the risks:
- development of intrauterine infection,
- premature rupture of the fetal membranes and, as a result, labor,
- birth of low birth weight infants weighing less than 2.5 kg.
That is why obstetricians and gynecologists are trying to track the dynamics of the analyzes of pregnant women in order to promptly begin adequate therapy for asymptomatic bacteriuria and help the woman communicate a healthy baby.
How to confirm the diagnosis?
It is rather difficult to diagnose asymptomatic bacteriuria since it does not manifest itself. Suspected pathology can only be detected in the urine of leukocytes or a high number of microorganisms (more than 10 5 per 1 ml).
Important! Even if bacteria appeared in one of the analyzes, this does not mean that there are pathologies in the pregnant woman’s body – perhaps a specific portion was selected incorrectly. Therefore, to confirm the diagnosis, a minimum of 2 repeated analyzes with an interval of no more than 24 hours is required – only in this case, it can be a question of making a specific diagnosis.
If there is suspicion of a pregnant woman, a special screening test with TTX reagent is performed, which, in the presence of bacteriuria, gives a positive result. To clarify the clinical form of the disease and the degree of its development requires a more comprehensive examination, which usually includes the following activities:
- general and biochemical blood tests will reveal the presence of infectious processes occurring in asymptomatic form;
- biochemical analysis of urine and the study of daily diuresis by Nechiporenko will demonstrate how well the excretory system copes with the functions assigned to it;
- the bacteriological urine culture will confirm the presence of asymptomatic bacteriuria and help assess the sensitivity of microorganisms to antibiotic therapy;
- ultrasound of the kidneys will help to demonstrate the anatomical features and the likely changes in the structure of organs during pregnancy;
- Dopplerometry of the excretory system will assess the blood supply to the urogenital system.
Important! Bacteriological culture should be repeated twice with an interval of 3-7 days. If the quantitative content of bacteria and their sensitivity to antibiotics are identical in both samples, the result can be considered correct.
Treatment of asymptomatic bacteriuria
If atypical microflora in the composition of urine is detected, treatment should be started immediately, as this will prevent unpleasant consequences for both the woman and her unborn child. The adequate method that is safe during pregnancy can only be determined by the attending physician based on the results of clinical studies and the presence of complications, but in most cases, it is impossible to avoid antibiotic therapy — antibiotics are the most effective and effective measure to eliminate asymptomatic bacteriuria.
Before treating pathology, it is necessary to wait for the results of bacteriological seeding, which will tell you which specific type of antibiotics the bacteria are sensitive to. And only after that, the attending physician can choose the safest remedy for the elimination of bacteriuria, which will not adversely affect the fetus and at the same time guarantees the effectiveness of therapy. In addition, adjuvant treatment with herbal preparations and diuretic preparations, which have a positive effect on the kidneys and may be combined with prescribed medications, may be required.
Important! It is not necessary to prescribe yourself renal herbal teas and other folk remedies for the treatment of asymptomatic bacteriuria – during pregnancy any, even the safest-looking remedy, can have a negative effect on the body. Everything that you accept must be coordinated with a specialist!
In addition, clinical recommendations include a sparing salt-free diet and an optimal drinking regimen with a focus on healthy types of liquids (cranberry or lingonberry fruit drinks, clean drinking water, dogrose decoction, etc.). This approach will allow you to get rid of asymptomatic bacteriuria during pregnancy quickly and without consequences!