Key references discussed in the episode:
Key take-home messages from the episode:
- Urinary symptoms are common in pregnancy. These can be due to physiological changes as well as having pathological causes.
- Empirical antibiotics should be started for all pregnant women with urinary symptoms or asymptomatic bacteriuria.
- A mid-stream specimen of urine should be sent, but empirical antibiotics should be started while waiting for the result.
- First-line treatment is usually with a 7-day course of nitrofurantoin, but nitrofurantoin should not be prescribed at term.
- Pyelonephritis is more common in pregnancy and is associated with pre-term labour and low birth weight infants.
- We should be discussing with secondary care if there is a catheter-associated urinary tract infection, atypical bacteria (including group B streptococcus), or an underlying structural or functional abnormality or co-morbidity that would increase the risk of complications. We should also be referring if there is any suspicion of malignancy or renal failure or in the presence of red flags.
- Red flags include severe pain, a tender uterus or uterine contractions, vomiting, fever, or signs of sepsis, dehydration or pyelonephritis.