Urinary tract infections in pregnant women are divided into three groups:
• bacteriuria - the presence of bacteria in the urinary tract;
• infections of the lower parts of the urinary tract (cystitis, urethritis);
• infection of the upper urinary tract (pyelonephritis).
Women suffer from pyelonephritis 5 times more often than men, and fall ill in their reproductive years. Why? Part of the fault is the anatomical features of the female body: the presence of a short and wide urethra opening on the threshold of the vagina (ie greater accessibility for infection). In addition, during the second phase of the menstrual cycle and throughout the gestation period, physiological changes occur in the urine excretory system of women, which also reduces the resistance to infections.
It was found that the risk of developing a urinary tract infection is higher in women:
• firstly given birth at the age of 28-30 years;
• multi-breeders;
• those who had had these diseases before;
• patients with diabetes mellitus;
• having anatomical abnormalities or functional disorders of the urinary tract.
As you know, a huge load is imposed on the kidneys during pregnancy - their functioning takes place with great strain. They have to remove from the body the products of decay and exchange not only of the woman herself, but also of her growing baby. However, without looking at it, physiological pregnancy itself does not cause any changes in the kidneys and they cope with the work. In the last months of pregnancy in urine, there may be traces of protein - this is the first signal about the possible occurrence of gestosis.
Asymptomatic bacteriuria
It is detected with the help of urine analysis in 2-7% of pregnant women, although it is not clinically manifested (hence the term "asymptomatic"). Diagnosis means that there is persistent bacterial colonization in the urinary tract. Despite the absence of a clinical picture, asymptomatic bacteriuria during pregnancy quite often (in 20-30% of cases) provokes the development of cystitis and pyelonephritis and requires specific treatment.
Acute cystitis
This type of infection of the urinary tract during pregnancy is not difficult to detect in the typical manifestations of acute inflammation: rapid, painful urination. In the popular literature now print a lot of various advice on how to cope with this disaster. To extinguish the inflammatory process, of course, you can. But this can not be done, especially pregnant! An untreated acute cystitis easily passes into a chronic form. In addition, as with asymptomatic bacteriuria, with cystitis, it is possible to climb infection to the kidneys and develop pyelonephritis.
Acute pyelonephritis
In infectious-induced focal destructive inflammation, the interstitial tissue of the kidneys and the bowl-and-pelvic system are affected. A very serious complication of pregnancy (during this period the disease is called gestational pyelonephritis). It can progress up to the development of urosepsis and lead to premature birth.
It occurs in more than 12% of pregnant women (often in the first-pregnant). In this case, there is an adverse effect on the course of pregnancy itself and directly on the child - often accompanied by gestosis, causes spontaneous abortion, development of fetal hypotrophy, chronic placental insufficiency.
Causes and pathogens
The determining role in the development of urinary tract infection in pregnant women is played by two groups of factors - anatomical and hormonal. Starting with the 7th week, a physiological hydroureter is formed - an expansion of the calyx and pelvic system and ureter. Thus, the body tries to adapt to the increase in the circulating fluid. The volume of the ureter can reach 200 ml, which contributes to the violation of the outflow of urine, its retention in the ureter, i.е. favorable conditions for the emergence of bacteriuria.
The uterus gradually increases in volume, changing the position of the bladder due to its deformation and squeezing. The anatomically close location of the ureter and the vagina, as well as the relative gluco-zuria (sugar in the urine) available in pregnant women, facilitates the easier infection of urine and the spread of infection by the ascending route. Elevated levels of estrogen causes a decrease in the peristalsis of the ureter, which may contribute to a violation of urinary outflow.
All these changes during pregnancy can begin on a period of 8 weeks and reach its climax in 18-20 weeks, retaining its signs for another 2-3 weeks after childbirth. By the beginning of the second half of pregnancy, a violation of the passage of urine can occur due to compression of the ureters with an enlarged and shifted right uterus. Squeezing the ureter can also produce a varicose dilated, thicker and shorter right ovarian vein. These facts explain the predominant occurrence of right-sided pyelonephritis.
The leading causative agent of urinary tract infection in both pregnant and nonpregnant women is E. coli (80-90% of cases), but there may be other Gram-negative bacteria such as Proteus and Klebsiella. Gram-positive bacteria are much less common. In women during pregnancy, the inflammatory process in the kidneys can be caused by fungi of the genus Candida. A significant role in the occurrence of pyelonephritis is also played by mycoplasma, ureaplasma, trichomonads, and in 20% of the patients microbial associations are detected.
Endotoxins of Escherichia coli caused sclerosis of the renal pelvis, a capsule of the kidney and pericardial tissue is affected. Infection caused by the prostate is characterized by a recurring course, stone formation and a lower content of white blood cells in the urine due to their destruction by enzymes of microorganisms. The course of gestational pyelonephritis caused by gram-negative flora is most severe, with bacterial shock and septicemia.
How is pyelonephritis manifested?
The clinical pathway of the disease is directly influenced by the path of infection. If this is a hematogenous pathway (with a blood flow), the most common symptoms of the disease go. If this is a urogenital way (through the urine), then the local symptoms will prevail. The manifestation of acute pyelonephritis usually occurs a few days after exacerbations of chronic tonsillitis or the identification of other focal infections (furunculosis, mastitis, etc.). That's why the disease can not be diagnosed right away. There is a sudden increase in temperature, chills, followed by profuse sweating, headache, severe pain in the lower back, more often on the right. Typical cases are characterized by a triad of symptoms: chills, dysuric phenomena, pain in the lumbar region. The pains tend to increase, with each new rise in temperature, we can talk about the appearance of new purulent formations in the kidneys. Disturbed by nausea, vomiting, aches all over the body. Expressed tachycardia, dyspnea. With a decrease in blood pressure, bacterial shock may even develop.
Treatment of acute pyelonephritis
It is always complex, long (4-8 weeks), individual. When prescribing drug therapy should take into account the timing of pregnancy, the severity and duration of the disease, the analysis of the functional state of the kidneys and liver, the individual tolerability of drugs and the possibility of their transition into milk. In the acute stage of the disease, bed rest is at least 4-6 days. When the fever has passed, the use of an active regimen is recommended in order to improve the outflow of urine.
The use of positional therapy: 2-3 times a day, knee-elbow position for 4-5 minutes; sleep only on the side, on the opposite side of the diseased kidney. A special diet with salt restriction is not required. If there is no edema, drink plenty, up to 2 liters per day. Recommended cranberry juice, kidney tea, infusions of parsley, horsetail, cowberry - plant diuretics and antiseptics. There are ready-made herbal medicines (especially kanefron), which in obstetrical practice are of great value in the treatment of pyelonephritis and other infections of the urinary tract.
Recently, the herbal preparation kanefron of the German company "Bionorica AG" has been actively used, possessing a whole complex of actions. Among them - antiseptic, anti-inflammatory, spasmolytic, antibacterial, diuretic. Kanefron is used to treat gestational pyelonephritis in early pregnancy. With its help, the exacerbation of chronic pyelonephritis, the treatment of urolithiasis, the prevention of complications of pregnancy, which entail a violation of the functional state of the kidneys. Kanefron is suitable during the period of antibiotic cancellation during the treatment of resistant infections of the urinary tract and for prolonged use after initial treatment with antibiotics. There were no side effects of the drug.
Consequences of the transferred infections
During pregnancy and the process of delivery itself, women who suffer from pyelonephritis have some characteristics. 6% of women with chronic pyelonephritis undergo late miscarriages, 25% have a risk of premature birth, 44-80% have late toxicosis of pregnant women. Pregnancy and fetal development depend to a large extent on the severity of renal dysfunction, the severity of the infection process.
Born children often have a number of signs of infection obtained in utero. So the pathology of the kidneys in the mother is inherent in influencing kidney development in the child (insufficiently mature renal tissue, urinary system dysembryogenesis). Fetal fetal hypoxia, hypotrophy, is often encountered, and careful monitoring of the fetus is necessary.
In the postpartum period, 22-33% of women who underwent gestational pyelonephritis develop purulent-septic diseases. On the 4th, 12th and 14th days after the birth, pyelonephritis can become worse. In 20% of cases after delivery, the renal function may remain reduced.
About prevention and urinary tract infections in pregnancy
1. Preparing for pregnancy. Careful, scrupulous, especially if in the past a woman had episodes of urinary tract infections. The doctor will tell you which exams you need to pass to both spouses before conceiving a child.
2. Early sanation of all foci of infection in the body.
3. A pregnant woman should register with a woman's clinic as early as possible and during the entire pregnancy period follow all the recommendations of her doctor, take tests in time and take other tests. To be protected from colds!