Ep 34 – Urinary symptoms during pregnancy

In this episode, Dr Kate Chesterman discusses the case of Lauren, a 32-year-old lady who is 30 weeks pregnant. Lauren presents with dysuria and increased frequency. Kate talks us through the current guidance on urinary symptoms in pregnancy and considers who to investigate, when to treat and what to treat with. She highlights physiological changes in pregnancy, important obstetric and non-obstetric causes for urinary symptoms as well as relevant red flags.

Key references discussed in the episode:

• Bhatia M, et al. BMJ. 2020;370:m2248. doi: 10.1136/bmj.m2248.
• Clinical Knowledge Summary. Urinary tract infection (lower) – women. 2021.
• Urinary tract infection (lower): antimicrobial prescribing. NG109. 2018.

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.