Infections of the genitourinary organs during pregnancy. Urinary tract infections in pregnant women: causes, diagnosis, treatment

The most common inflammatory diseases of the urinary system include asymptomatic bacteriuria (detection of a significant amount of bacteria in the urine), cystitis (inflammation of the mucous membrane Bladder) and pyelonephritis - an infectious and inflammatory process accompanied by damage to the kidney tissue and pelvicalyceal system.

Asymptomatic bacteriuria

The diagnosis of “asymptomatic bacteriuria” is established when 100,000 microbial cells are detected in 1 milliliter of urine and there are no symptoms of infection urinary tract. Pregnant women with asymptomatic bacteriuria should be carefully examined to identify hidden forms of urinary system disease. First of all apply laboratory methods research - blood and urine tests. Pathological changes observed in a quantitative study of urine sediment (urine analysis using the Nechiporenko method), as well as in studies of the excretory and filtration capacity of the kidneys (urine analysis according to Zemnitsky, Reberg). Kidney ultrasound has become an integral part of the diagnostic package. On the background asymptomatic bacteriuria Acute pyelonephritis develops in approximately 30%-40% of cases, so such pregnant women need to undergo timely preventive treatment. The effectiveness of treatment is monitored by culture of urine for flora: the urine is placed on a special nutrient medium and it is observed whether colonies of microorganisms grow on the nutrient medium.

Cystitis in pregnant women

Cystitis accompanies a variety of pathological conditions urinary tract and genitals. It may be the first manifestation of pyelonephritis or other urological diseases.

Acute cystitis is characterized by decreased ability to work, weakness, fever up to 37.5°C and local symptoms that allow one to suspect and, in many cases, make an accurate diagnosis. These include: painful urination (pain at the end of urination), pain in the suprapubic region, increasing with palpation and filling of the bladder, frequent urination (every 30 - 60 minutes).

The diagnosis must be confirmed by laboratory data: in case of illness, a urine test reveals leukocyturia (the presence large quantity leukocytes), bacteriuria (presence of bacteria). Pathological changes can also be observed in blood tests. Acute cystitis lasts 7-10 days; if it drags on, the doctor will prescribe an examination necessary to exclude inflammatory damage to the kidneys. Cystitis is treated with tableted antibacterial agents (semi-synthetic penicillins, cephalosporins) for 5-7 days. Timely recognition and treatment of asymptomatic bacteriuria and cystitis during pregnancy leads to a significant reduction in the risk of acute pyelonephritis and its immediate consequences for both the mother and the fetus (most often this is the threat of miscarriage or premature birth).

There are three degrees of risk of pregnancy and childbirth in women with pyelonephritis:

I degree - uncomplicated course of pyelonephritis that occurred during pregnancy;

II degree - chronic pyelonephritis, developing before pregnancy;

III degree - pyelonephritis, occurring with arterial hypertension (increased blood pressure), pyelonephritis of a single kidney.

The most severe complications occur with risk degree III, so women with pyelonephritis should be observed not only by an obstetrician-gynecologist, but by a general practitioner and a nephrologist. The outcome of pregnancy and childbirth depends not only on the degree of risk, but also on the duration of the disease, the degree of kidney damage and the general condition of the mother’s body.

Pyelonephritis in pregnant women

Pyelonephritis that occurs for the first time during pregnancy is called “gestational pyelonephritis” or “pyelonephritis of pregnant women.” It occurs in 6-7% of expectant mothers, more often in the second half of pregnancy. Pyelonephritis existing before pregnancy can worsen against its background or occur in a chronic and erased form. Women with pyelonephritis are at high risk for pregnancy complications such as miscarriage, preeclampsia2, intrauterine infection and malnutrition (stunted growth) of the fetus. The most dangerous complication is acute renal failure - a condition in which the kidneys completely or partially stop functioning.

Predisposing factors for the development of acute gestational pyelonephritis and exacerbation of chronic pyelonephritis during pregnancy are changes in the urinary system. Namely: urinary disturbances (caused by an increase in the size of the uterus), changes in hormonal and immune status, as well as the presence of recurrent (aggravated) cystitis before pregnancy, malformations of the kidneys and urinary tract (doubling of the kidney, ureter), urolithiasis, diabetes mellitus, etc. d.

To assess the clinical picture of an infectious kidney disease, and especially to select a treatment method, identifying the pathogen is of great importance. The close anatomical proximity of the urethra, vagina, rectum, and a decrease in antimicrobial immunity during pregnancy contribute to the colonization of the entrance to the urethra by bacteria from the intestines. A short urethra and close location of the bladder, impaired movement of urine along the urinary tract contribute to the upward spread of infection. This, apparently, explains the significant predominance of E. coli and other microbes that live in the intestines among the causative agents of urinary system diseases, which take first place during pregnancy. In addition, yeast-like fungi of the genus Candida (thrush), mycoplasma and ureaplasma are often found in the urine of pregnant women. The infection can also spread hematogenously (through the blood) from the source of inflammation - pharyngeal tonsils, teeth, genitals, gall bladder.

Most often, acute pyelonephritis occurs at 22-28 weeks of pregnancy (as well as at certain stages of pregnancy: 12-15 weeks, 32-34 weeks, 39-40 weeks) or on the 2-5th day of the postpartum period (these periods are associated with the characteristics of hormonal levels and an increase in the functional load on the kidneys, in later stages - with a deterioration in the outflow of urine).

During the acute period of the disease, pregnant women complain of a sudden deterioration in health, weakness, headache, increased body temperature (38-40°C), chills, lower back pain, dysuric disorders - frequent urination, pain when urinating. We must remember that against the background of the underlying disease, signs of a threatening and incipient miscarriage or premature birth (due to the presence of an infectious process) may appear.

Pyelonephritis can begin early and initially be latent (in this case, the symptoms of the disease are not pronounced), therefore, to identify it, the entire range of diagnostic tests should be used with mandatory urine culture in all pregnant women.

Diagnosis of pyelonephritis is based on the above clinical signs, supported by laboratory data. Important have research average portions of morning urine and counting the number of formed elements in the urine sediment (leukocytes, erythrocytes, various casts - a kind of casts of the renal tubules and epithelial cells). Nechiporenko’s methods are used to calculate the ratio of leukocytes and erythrocytes (normally in a pregnant woman the ratio of leukocytes to erythrocytes is 2:1, i.e. 1 milliliter of urine contains 4000 leukocytes and 2000 erythrocytes) and Zemnitsky to determine relative density and disturbances in the ratio of daytime and nighttime diuresis. All pregnant women with kidney pathology undergo a urine culture to identify microflora and determine its sensitivity to antibiotics, a general and biochemical blood test, as well as an ultrasound examination of the kidneys to identify the condition of the pyelocaliceal system. If pyelonephritis is suspected, the pregnant woman is hospitalized in the antenatal department of the maternity hospital, and long-term treatment is recommended (at least 4 - 6 weeks).

Treatment of pyelonephritis in pregnant women is carried out according to general principles therapy of the inflammatory process. The first stage of complex treatment consists of positional therapy. This is the position of the pregnant woman on the side opposite to the localization of pyelonephritis (on the “healthy” side), which promotes better urine outflow and speeds up recovery. The same purpose is served by the knee-elbow position, which a woman should periodically take for 10-15 minutes several times a day.

Antibacterial drugs are prescribed depending on the type of pathogen and its sensitivity to antibiotics. In this case, preference is given to drugs that do not have a pronounced negative effect on the condition of the fetus (very important) - semisynthetic penicillins, cephalosporins. To enhance the effect of therapy, antibiotics are combined with uroantiseptics (5-NOK, FURAGIN, NEVIGRA-MON).

An important point in the treatment of pyelonephritis is to improve the outflow of urine. For this, antispasmodics and herbal diuretics are prescribed, which can be ready-made forms Buy it at the pharmacy or prepare it yourself. The treatment regimen also includes vitamin complexes. If there are symptoms of intoxication (fever, weakness, weakness), infusion detoxification therapy is carried out (various solutions are administered intravenously - GEMODEZ, REOPO-LIGLUKIN, ALBUMIN).

In chronic pyelonephritis, without exacerbation, there is dull pain in the lower back, urine contains a small amount of protein, slightly increased number of leukocytes. During pregnancy, the disease can worsen - sometimes twice or three times. With each exacerbation, the woman should be hospitalized. Treatment of exacerbation of chronic pyelonephritis is not much different from therapy for acute disease. During pregnancy, an appropriate diet is recommended with limited consumption of spicy, salty foods, drinking plenty of fluids, vitamin therapy, herbal uroseptics, and antibacterial drugs.

I would like to especially note that in parallel with the treatment of pyelonephritis, it is necessary to carry out complex therapy aimed at maintaining pregnancy and improving the condition of the fetus. Delivery is carried out through the natural birth canal, since C-section in conditions of an infected organism is extremely undesirable and is performed according to strictly obstetric indications.

It is worth mentioning the prevention of pyelonephritis. Due to the fact that 30-40% of pregnant women with asymptomatic bacteriuria develop an acute urinary tract infection, timely detection and treatment of bacteriuria is necessary.

And in conclusion, I would like to draw your attention to two main points regarding the postpartum period. Children born to mothers with pyelonephritis constitute a risk group for the development of purulent-septic diseases; and as for mothers, as a rule, after gestational pyelonephritis, kidney function is restored in most women.

We heal with herbs

It is known that medicinal plants have diuretic, antibacterial and anti-inflammatory effects. In the phase of active inflammation with pyelonephritis, the following collection can be recommended: sage (leaves) - 1 dessert spoon, bearberry (leaves) - 2 teaspoons, horsetail (herb) - 1 teaspoon, chamomile (flowers) - 2 teaspoons. All these herbs must be mixed and infused for 30 minutes in 400 milliliters of boiled water, then be sure to strain. The infusion should be taken hot, 100 milliliters 3 times a day before meals, in courses of 2 months with two-week breaks. During the period of remission, collections of medicinal plants with a pronounced effect on the regeneration process can be recommended. For example: dandelion (root) - 1 teaspoon, birch (buds) - 1 teaspoon, chamomile (flowers) - 1 teaspoon, nettle (leaves) - 1 teaspoon, lingonberry (leaves) - 2 teaspoons. Mix everything, leave for 30 minutes in 350 milliliters of boiling water, strain. It is recommended to drink the infusion hot, 100 milliliters 3 times a day, half an hour before meals for 2 months with a two-week break.

The kidneys can be divided into two parts - the medulla (the part where urine is formed) and the collecting system, which removes urine. With pyelonephritis, the latter is affected.

Preeclampsia is a complication of the second half of pregnancy, in which spasm of the blood vessels of the mother and fetus occurs, and both the pregnant woman and the baby suffer. More often, gestosis is manifested by increased blood pressure, the appearance of protein in the urine and edema.

The main prerequisites for the emergence inflammatory diseases of the urinary system are: short urethra; proximity of the rectum and genital tract, which are high degree colonized by various microorganisms; physiological changes urinary system during pregnancy under the influence of hormonal influences (dilatation of the urinary tract, hypotension of the pyelocaliceal system).

Based on localization, inflammatory diseases of the urinary system are divided into infections of the upper sections (pyelonephritis, abscess and carbuncle of the kidney, apostematous pyelonephritis) and infections of the lower sections of the urinary tract (cystitis, urethritis). In addition, asymptomatic bacteriuria is isolated. According to the nature of the course, uncomplicated and complicated inflammatory diseases of the urinary system are distinguished. Uncomplicated infections occur in the absence of structural changes in the kidneys, obstruction of the urinary tract, and in the absence of serious concomitant diseases(for example, diabetes, etc.).

In most cases of inflammatory diseases of the urinary system, microorganisms from the perianal area penetrate the urethra, bladder, and then through the ureters into the kidneys. Urinary infection during pregnancy can manifest as asymptomatic bacteriuria, acute cystitis and/or acute pyelonephritis (exacerbation of chronic pyelonephritis).

Asymptomatic bacteriuria

The incidence of asymptomatic bacteriuria among pregnant women varies from 2 to 9% or more (average about 6%) depending on their socioeconomic status. Asymptomatic bacteriuria, despite the absence clinical manifestations, can lead to premature birth, anemia, gestosis, malnutrition of the newborn and intrauterine death fetus Asymptomatic bacteriuria most often develops between 9 and 17 weeks of pregnancy.

Main The causative agent of asymptomatic bacteriuria is Escherichia coli. The diagnostic criterion confirming the presence of asymptomatic bacteriuria is the growth (105 CFU/ml) of the same microorganism in two cultures of an average portion of urine taken with an interval of 3-7 days (at least 24 hours). If asymptomatic bacteriuria is confirmed in a pregnant woman, antibacterial treatment is necessary, starting from the second trimester of pregnancy. When choosing an antimicrobial drug, its safety for the fetus should be taken into account. Treatment is carried out only on the basis of the attending physician’s prescriptions and under his supervision. Self-medication poses a health hazard.

Acute cystitis

Acute cystitis (inflammation of the mucous membrane of the bladder) is the most common type of inflammatory diseases of the urinary system in women. Among pregnant women, acute cystitis develops in 1-3% of women, most often in the first trimester, when the uterus is still in the pelvis and puts pressure on the bladder. Clinically, cystitis is manifested by frequent and painful urination, pain or discomfort in the bladder area, urge, and the appearance of blood in the urine. Symptoms such as malaise, weakness, low-grade fever. For diagnosis, the detection of leukocyturia (pyuria), hematuria, and bacteriuria is important.

The main causative agent is Escherichia coli, which responds well to short courses of antimicrobial therapy. It must be remembered that frequent urge to urinate, discomfort in the suprapubic region, and a “weak bladder” may be caused by pregnancy itself and are not indications for therapy. Antibacterial drugs should be prescribed only if bacteriuria, hematuria and/or leukocyturia are detected.

Acute pyelonephritis

Acute pyelonephritis in pregnant women (or exacerbation of chronic pyelonephritis) is infectious inflammatory disease kidney. Pyelonephritis ranks first in the structure of extragenital pathology in pregnant and postpartum women, its frequency reaches 10% and higher. Most often (about 80%), pyelonephritis occurs at the end of the second trimester (22-28 weeks) of pregnancy. After childbirth, the risk of developing pyelonephritis remains high for another 2 - 3 weeks (usually on the 4th, 6th, 12th days of the postpartum period), while the expansion of the upper urinary tract and the risk of postpartum inflammatory diseases persist. Postpartum pyelonephritis is, as a rule, an exacerbation of a chronic process that existed before pregnancy, or a continuation of a disease that began during pregnancy. About 10% of women who have had acute pyelonephritis in pregnancy subsequently suffer from chronic pyelonephritis. In turn, 20-30% of women who have had acute pyelonephritis in the past may experience an exacerbation of the process during pregnancy, especially in the later stages. Gestational pyelonephritis can have an adverse effect on the course of pregnancy and the condition of the fetus, which is due to the high frequency of gestosis, characterized by early onset and severe course, spontaneous abortion in different deadlines and premature birth, which occurs in 15-20% of pregnant women with this pathology. A frequent consequence of gestational pyelonephritis is malnutrition and retention syndrome intrauterine development fetus, detected in 12-15% of newborns. In addition, 35-42% of women who have had gestational pyelonephritis develop iron deficiency anemia. Factors that contribute to the development of acute pyelonephritis in pregnant women include asymptomatic bacteriuria, malformations of the kidneys and urinary tract, kidney and ureteral stones, vesicoureteral reflux in cystitis, inflammatory diseases of the female genital organs, metabolic disorders, neurogenic bladder. The risk of urinary infection is also increased by chronic kidney diseases in women: chronic glomerulonephritis, polycystic kidney disease, spongy kidney, interstitial nephritis, and other kidney diseases. The most significant causative agents of gestational pyelonephritis are: Escherichia coli, Klebsiella and Proteus, Pseudomonas aeruginosa. Group B streptococci, enterococci, and staphylococci are relatively less common.

Clinically acute pyelonephritis in pregnant women is usually begins with acute cystitis(frequent and painful urination, pain in the bladder, terminal hematuria). After 2-5 days (especially without treatment), fever with chills and sweats, pain in the lumbar region, and symptoms of intoxication ( headache, sometimes vomiting, nausea), leukocyturia (pyuria), bacteriuria, flakes, cloudy urine. Proteinuria (protein in the urine) is usually mild. Possible hematuria (presence of blood elements in the urine). In severe cases, there is a moderate decrease in hemoglobin and protein levels in the blood. In severe cases of pyelonephritis, signs of renal dysfunction may be observed. In 3-5% of cases of acute pyelonephritis, acute renal failure may develop.

Treatment of gestational pyelonephritis should be carried out taking into account the duration of pregnancy (trimester), begin after restoration of normal urine passage, identification of the pathogen, taking into account its sensitivity to drugs, urine reaction and renal dysfunction. For the treatment of pyelonephritis in pregnant women, the following are used: antibacterial drugs (antibiotics, uroantiseptics), positional therapy, catheterization of the ureters, including a stent catheter, surgery (kidney decapsulation, opening of purulent foci, nephrostomy, nephrectomy), detoxification therapy, physiotherapy. Throughout pregnancy, treatment with tetracycline and chloramphenicol antibiotics, as well as biseptol, long-acting sulfonamides, furazolidone, fluoroquinolones, streptomycin is strictly contraindicated due to the risk of adverse effects on the fetus (bone skeleton, hematopoietic organs, vestibular apparatus and hearing organ, nephrotoxicity). Antibacterial therapy for pregnant women with acute pyelonephritis (exacerbation of chronic pyelonephritis) should be carried out in a hospital and begin with intravenous or intramuscular administration of drugs, followed by transition to oral administration. The total duration of treatment is at least 14 days. With the development of acute pyelonephritis, if the patient's condition is severe and there is a threat to life, treatment begins immediately after taking urine for culture with broad-spectrum drugs that are effective against the most common pathogens of pyelonephritis. The effectiveness of the drugs can be assessed within 48 hours from the start of therapy. In less severe conditions, it makes sense to delay the prescription of antimicrobial drugs until data on the sensitivity of the pathogen to certain antibiotics is obtained.

Acute and aggravated pyelonephritis are not indications for termination of pregnancy if the course of the disease is uncomplicated and there is no severe arterial hypertension. If renal function is impaired, a severe form of gestosis occurs, which is difficult to treat, the pregnancy is terminated. Prevention of gestational pyelonephritis is aimed at identifying early signs disease and prevention of its exacerbations. Throughout pregnancy, dynamic monitoring with urine examination (cytological, bacteriological if indicated) is necessary at least once every 14 days, early detection of urodynamic disorders, and timely administration of the necessary therapy.

Acute renal failure

Acute renal failure (ARF) is a life-threatening complication of pregnancy. Pregnant women account for 15-20% of all cases of acute renal failure, which, as a rule, complicates the second half of pregnancy or the postpartum period. AKI is a sharp decrease in kidney function, accompanied in 80% of cases by a decrease in urine production of less than 400 ml/day. The incidence of AKI currently does not exceed 1 in 20,000 births. More than half of cases of acute renal failure in pregnant women, in addition to septic abortion, are associated with the development of severe forms of gestosis (nephropathy of pregnancy), with obstetric bleeding (premature placental abruption, hypotonic uterine bleeding). In 3-5% of cases, acute renal failure is caused by gestational pyelonephritis, in 15-20% - by intrauterine fetal death, amniotic fluid embolism and other causes. AKI usually develops in women with the development of vascular spasm and a decrease in blood volume, which leads to impaired renal circulation.

During the treatment of acute renal failure in pregnant women it is necessary to exclude the presence of hidden uterine bleeding, which is a trigger or provoking factor for acute renal failure, correct hemodynamic disturbances and resolve the issue of indications for immediate delivery. If the gestational age is sufficient (over 30-34 weeks), rapid delivery is recommended, which eliminates growth retardation or intrauterine death of the fetus and improves the mother's further prognosis. In case of prerenal acute renal failure, it is necessary, first of all, to eliminate hypovolemia - to restore the intravascular volume of fluid by infusion of saline, plasma, large-molecular dextrans, albumin; correct water and electrolyte disturbances, hypoproteinemia. In acute tubular necrosis of pregnancy, treatment is aimed at combating ischemia (restoring blood supply to the kidneys), maintaining fluid and electrolyte balance, and treating infection. With the development of obstructive acute renal failure, it is necessary to restore urine passage, if necessary, massive antibacterial and detoxification therapy (gestational pyelonephritis), and combat vascular insufficiency when complicated by bacteremic shock.

The reproductive system is very closely related to the kidneys, for this reason they are combined into the genitourinary system. It often happens that they have the same infections.

Types of infections

The resulting kidney infection can be specific or nonspecific:

• A specific infection in the kidneys is associated with pathogens that are sexually transmitted (gonococcus, trichomonas, ureaplasma). The cause of the disease is clear. It's unprotected sexual intercourse. In men, the infection immediately enters the urethra, and from there to the overlying areas of the genitourinary system. In women, the infection from the vagina enters the urethra and then moves along the same path of the genitourinary system. Infections must be treated, as quite dangerous complications are possible.
• Nonspecific. Such infections include staphylococcus, E. coli, streptococcus, enterococcus, candidal fungus and others.

A kidney infection can spread in several ways:

• The ascending route is from the urethra and rectum during sexual intercourse.
• Descending - passes from the renal pelvis down the ureters.
• Hematogenous route - brought by blood flow from other areas.

Escherichia coli is a common causative agent of kidney infections.

Causes

When an infection enters the human body, the kidneys are the first to suffer as they try to expel it.

A weakened body cannot always cope with such a problem, so the kidneys become infected and require adequate treatment.

The most common causes infectious diseases kidney:

• Urolithiasis disease.
• Anemia.
• Penetration through the circulatory system.
• Diabetes.
• Low immunity.
• Inflammatory processes in other organs.

Also, kidney damage may be associated with diseases of the gastrointestinal tract and uterus. Even dental caries can cause infection. This also includes hypothermia and improper treatment of colds.

Symptoms of a kidney infection

The presence of infectious inflammation in the kidneys can be determined by the following signs:

• General malaise.
• Pain in the lower back, abdomen and groin.
• Temperature increase.
• Frequent urination.
• Little urine is excreted, and it does not come out completely.
• Nausea.
• Loss of appetite.
• Itchy and sometimes sharp pain when urinating.
• Swelling of the face.
• The color and smell of urine changes.
• Presence.

Lower back pain is a common accompaniment of kidney infection

The most common diseases:

• Pyelonephritis is an inflammatory process in the kidneys as a result of the penetration of microorganisms. In addition, other pathologies are associated (for example, reduced immunity, kidney stones, hypothermia, inflammation in the adrenal glands and other ailments).
• Glomerulonephritis– an inflammatory process of the renal glomeruli, which develops against the background of an infectious allergy or due to the production of antibodies to one’s own organ. The spread is more common in children and adults young(up to 30 years old).

The child has infancy infections in the kidneys are more complicated and, due to weak immunity, are treated much worse. For this reason, it is necessary to consult a doctor when the first signs appear. The first symptoms will be changes in the color of urine and an increase in temperature. In addition, the child becomes capricious, sleeps poorly, refuses to eat, and does not gain weight.

During pregnancy, kidney and urinary tract infections are quite common. Since the uterus, enlarged in size, compresses the organs of the genitourinary system, thereby creating good conditions for the occurrence of pyelonephritis. Its signs are more pronounced in a pregnant woman, and complications are observed more often. Therefore, in order to avoid infection of the fetus and premature birth, the woman is placed in a hospital where she undergoes a course of treatment.

Pregnant women have an increased risk of developing kidney infection

Diagnostics

First of all, the patient's medical history is collected, an examination is performed, and a urine test is taken to find out whether there is a bacterial infection.

For complications of pyelonephritis, the patient is placed on hospital treatment. It is also necessary to draw blood for general analysis. The kidneys are checked for the presence of stones using an ultrasound or x-ray.

If the infection is protracted, complications such as an abscess, kidney swelling, and blood poisoning may occur (the infection enters the blood). The symptoms of the complication are clearly pronounced and cannot be ignored. People who have concomitant diseases are more susceptible to the occurrence of acute pathologies.

There are also several categories of people who are at risk of complications:

• Pregnant women.
• Elderly people.
• With diabetes.
• With availability chronic diseases kidney
• With weak immunity.

Bacteriological culture of urine is the only way to identify the causative agent of a kidney infection

Treatment

For all infectious diseases associated with the kidneys, antibacterial, anti-inflammatory and symptomatic treatment. The following medications are prescribed:

• Antibiotics - first, broad-spectrum drugs are prescribed, and when the causative agent of the disease is identified, an individually selected drug is prescribed.
• Disinfection solutions intravenously - cleanse the body and blood.
• Anti-inflammatory drugs - to eliminate inflammatory processes. This allows the patient’s condition to improve in a short period of time.
• Diuretics – to improve kidney function and prevent urinary stagnation. For this, diuretics are prescribed.
• Antihypertensive drugs - to normalize blood pressure, as a rule, they lower it.
• Antispasmodics – relieve spasms and improve urine flow during genitourinary tract infections.
• Painkillers – relieve pain.
• Antipyretics – to lower body temperature.

In the presence of chronic forms of pyelonephritis, constant relapses are observed, so it is necessary to remove the primary focus of the disease. For this, either surgical or complex therapy is used.

Urgent surgical intervention is performed if available.

During the operation, the entire kidney or part of it is removed, then a drainage is installed to ensure the release of pus.

Antibiotics are the mainstay of treatment for any kidney infection.

ethnoscience

Milder forms of pyelonephritis can be treated at home. Also, during treatment, you need to follow a diet that includes low salt intake, and it is also necessary to exclude protein foods.

Traditional medicine recipes are often used as an additional measure:

• It is necessary to drink at least two liters of water per day, which will increase the amount of urine output, which removes bacteria from the body.
• Drink a glass of water with a spoonful of soda dissolved in it 2-3 times a day, this will make it possible to cleanse the body of toxins.
• Eating blueberry mousse will help remove pathogenic bacteria from the body.
• Add a spoonful of vinegar to a glass of water and drink it in the morning on an empty stomach. This recipe helps stop the inflammatory process and improve digestion.

Infectious processes in the kidneys must be treated in order to avoid chronic forms of the disease, which often lead to kidney failure and can sometimes cause human disability.

For pregnant women, urine analysis is one of the main diagnostic methods. It is carried out almost before every visit to the gynecologist. This is due to the fact that changes in the composition of urine indicate not only disorders in the urinary system, but also the condition of the entire organism. Bacteria in urine during pregnancy can be either a sign of a serious illness or a consequence of an incorrectly performed procedure for collecting material.

Therefore, when they are detected, the doctor always conducts a clarifying conversation and prescribes a retake of the analysis. Sometimes additional diagnostic procedures are necessary.

Pregnancy is accompanied by constant changes in a woman’s body. The fetus grows and this leads not only to an increase in the abdomen, but also to compression of nearby organs. The kidneys are also compressed.

During normal operation of these paired organs, the resulting urine is constantly filtered and discharged into the bladder. When the kidneys are pinched, it begins to stagnate. Under these conditions, bacteria multiply quickly. Their spread leads to inflammation of organ tissues, most often the mucous membranes.

A urine test can detect the disease before it develops and manifests symptoms. Early diagnosis helps to avoid many negative consequences infectious disease, prevent the development of gestosis.

Causes of bacteria in urine during pregnancy

The reasons for the proliferation of bacteria in the urine of pregnant women may be different. The spread of microorganisms is facilitated by changes occurring in a woman’s body: the uterus grows and begins to put pressure on the kidneys, as a result of which their work is disrupted. Delayed urine flow promotes the growth of bacteria in it.

Bacteriuria can be true or false. In the first case, microorganisms multiply and live in the urine, in the second they come from other foci of infection through the bloodstream. This condition may be a sign of a sexually transmitted infection, diabetes mellitus, caries, chronic inflammatory process in the body (usually in combination with reduced immunity).

Most often, bacteria in the urine during pregnancy indicate a disease of the urinary system. Depending on the accompanying symptoms defined:

• cystitis – inflammation of the inner layer of the bladder with the addition of an infectious component (most often E. coli);
• pyelonephritis - an inflammatory process in the renal pelvis caused by Escherichia coli, Staphylococcus aureus, fungus or other pathogens;
• urethritis - inflammation of the mucous membrane of the urethra, often accompanied by bacterial infection: enterococci, streptococci, E. coli, chlamydia.

How does bacteria in urine affect pregnancy?

Bacteria in urine negatively affects both the course of pregnancy and the health of the unborn child. Most often, infection indicates an inflammatory disease in the urinary organs. At laboratory analysis Streptococcus is detected Staphylococcus aureus, E. coli and other pathogens.

The genital organs and uterus are located close to the source of infection, so there is a high risk of its spread through the birth canal. A woman's urine flow is disrupted, which can result in cystitis, pyelonephritis or urethritis. Lack of treatment leads to severe forms of gestosis ( late toxicosis) with a risk of miscarriage or premature birth.

In addition, the infection enters amniotic fluid which the child swallows. Bacteriuria can cause disturbances in intrauterine development: lead to pathologies of the nervous, immune and other systems, and in some cases, to fetal death.

Symptoms

Most often, bacteriuria is accompanied by certain symptoms, but in some cases it develops latently and is detected only during laboratory testing. IN clinical picture may be present:

• pain during urination;
• pain of various types in the lower abdomen;
• cutting bad smell urine;
• impurities of blood and/or pus in the urine (cloudy, flaky, brownish);
• fever (if kidney infection);
• nausea and vomiting;
• pain in the lumbar region.

These symptoms may appear in various combinations depending on the disease. Sometimes they disappear temporarily, creating the illusion of recovery, but the lack of treatment only leads to a greater spread of infection.

Diagnostics

Urine testing for the presence of bacteria is carried out monthly. Thanks to this, emerging infectious and inflammatory diseases are detected in the early stages and successfully treated. Bacteriological tests (reducing glucose, nitrite and others) help determine the type and number of microorganisms.

After a urine test, additional research methods are prescribed to help determine the underlying disease:

• Ultrasound of the kidneys and urinary tract;
• dopplerometry vascular system kidney;
• additional blood and urine testing;
• microscopic examination of a smear from the urethra.

In addition to these procedures, the pregnant woman may be given referrals for consultations with specialists: urologist, nephrologist, therapist. This contributes to a faster and more accurate diagnosis, as well as timely initiation of treatment.

Treatment

What treatment will be prescribed for bacteriuria is determined by the established diagnosis. But in any case, it is complex and includes:

• correction of the diet with the introduction of foods and drinks that lower the pH of urine (vegetables, cereals, lean meat);
• drinking plenty of fluids to increase the volume of urine and bacteria excreted;
• taking medications.

Drug treatment is necessary both for obvious symptoms of bacteriuria and in their absence. Antibiotics are prescribed without fail: Ceftazidime, Cefoperazone, Cefuroxime, Ampicillin, Azithromycin, Doxycyline and others. All drugs in this group can be taken only as prescribed by a doctor and strictly in the dosage prescribed by him. May also be recommended herbal preparations complex action: Phytolysin, Canephron.

The duration of treatment is 1-3 weeks. If necessary, medication can be continued until the end of pregnancy and for two weeks after birth.

Bacteria in urine are often detected before pregnancy. Diseases occur chronically and under favorable conditions, such as a natural decrease in immunity, hormonal changes, and compression of the kidneys by the uterus, become aggravated. The prognosis of treatment depends on the severity of the infection and the duration of pregnancy. Treatment of bacteriuria in the first trimester has a positive outcome in 80% of women, and 5% have miscarriages.

Prevention

In order to avoid the development of bacteriuria during pregnancy, you must adhere to several rules:

1. Regularly submit urine for analysis. This diagnostic procedure should not be neglected, despite its frequency. Sometimes bacteria are found in urine during pregnancy due to improper collection of the material. To prevent this from happening, you need to use sterile containers and follow all hygienic requirements. For analysis, a fresh (no more than two hours) morning urine sample is required. The day before, you should avoid salty and spicy foods.
2. Carefully observe genital hygiene. You need to wash yourself in the morning and evening, as well as after each act of bowel movement. Movements when wiping should go from front to back, in otherwise You can spread an infection from the anus to the urethra. It is worth giving up underwear from synthetic materials: They are poorly breathable and create a damp environment, ideal for the spread of bacteria.
3. Attend scheduled consultations with your doctor and follow all his appointments. This will help identify the problem early stage and quickly eliminate it.

Preventive measures help reduce the risk of developing infectious and inflammatory diseases in the genitourinary system. During pregnancy, this becomes not only a guarantee of the mother’s health, but also a necessary condition for the proper development of the child.

Do not ignore the occurrence of even minor infectious infections of the genitourinary organs. They can lead to serious consequences.

Urinary tract infections

Urinary tract infections are common in pregnant women. About 10% of them suffer from various infectious diseases, the cause of which, however, is not always pathogenic microorganisms. The disease can also occur due to hypothermia and, what most often happens, due to dehydration. The water your baby needs to thrive comes from your blood, so you should drink more fluids. If you don't drink enough, your blood becomes thicker and your urine irritates your urinary tract.

Symptoms

• You feel a slight burning sensation when urinating. The presence of pathogenic microbes in urine can be quickly determined using a control strip of special tests. The detection of nitrites in urine serves as a signal of infectious infection.
• You have a frequent urge to urinate, both day and night, during which you experience a sharp burning sensation. These are clinical signs of infection.

In any case, you should consult a doctor. You will have to do a urine test to check for pathogens. Most often this is Escherichia coli, which lives in the intestines of a healthy person, for the normal functioning of which it is necessary. The penetration of E. coli into the urinary tract causes colibacillosis, a disease that requires special treatment. Urinary tract infections can also be caused by other microorganisms.
If microbes are found in the urine, the doctor will prescribe appropriate treatment.
Do not self-medicate using medications previously prescribed in a similar case. The disease may be caused by another type of microorganism, and you risk complications.

Consequences
Left unattended, urinary tract infections can have serious consequences:

• for the mother: if the infection penetrates the kidneys;
• for a child: inhibits his development;
• there is a risk of miscarriage or premature birth for more later pregnancy.

Warning

• Drink plenty of fluids regularly.
• Try to stay warm. Avoid hypothermia and exposure to high humidity.
• Monitor the acidity of your urine with a urine test paper strip special tests, which changes color depending on the acidic or neutral reaction of urine. To restore the acid-base balance in case of sudden oxidation of urine, drink mineral water, prune juice, milk, eat boiled fruits and vegetables. If your urine is not acidic enough (which encourages germ growth), you should eat more meat and drink tea.

When correct balanced diet the urine will have, as it should, a neutral reaction.

Genital infections

Pregnancy is accompanied by increased vaginal secretion, that is, leucorrhoea (pathological vaginal discharge) appears. They should not cause much concern unless they have unusual properties.

Symptoms

• You have suspicious discharge - more abundant than usual, thicker, or having an unpleasant odor.
• You experience itching and burning in the external genital area.
• Sexual intercourse causes pain.
• Your partner is also a carrier of the infection.

In any case, you should immediately visit a gynecologist. Laboratory tests of vaginal discharge will help determine the type of infection affecting the genitals. Your partner must also undergo the prescribed treatment.

Consequences
Don't ignore infectious diseases. Timely treatment will avoid serious consequences. Otherwise you face:

• spontaneous miscarriage in the first three months of pregnancy;
• premature birth if the disease occurs later in pregnancy;
• acute infectious disease during childbirth - puerperal fever;
• subsequently chronic inflammation of the uterus and fallopian tubes;
• infection of the child during childbirth.

Warning
Only possible remedy preventing infectious diseases is personal hygiene.

• After each bowel movement, it is necessary to remove the remains of excrement, making movements from the external genitalia to the anus, so as not to introduce microbes that live in the intestines into the vagina.
• You should wash yourself after each bowel movement.
• Change your towel and toilet gloves frequently.
• Your partner should also strictly observe the rules of personal hygiene, especially before sexual intercourse.

Compliance with several simple rules personal hygiene will help you avoid many troubles associated with infectious diseases.

Genital infections

• Excessively copious liquid discharge with a disgusting odor, itching in the vagina - characteristic features mycosis! This disease is most often caused by the Candida fungus, which multiplies rapidly in an acidic environment. During pregnancy, the acidity of the vaginal environment increases. This is provided by nature to protect the fetus from excessive proliferation of common microbes living in the vagina. The acidic environment of the vagina contributes to the development of mycosis.
• If the discharge is thick and foul-smelling, this means that the genitals are infected with microbes, the type of which can only be accurately determined by laboratory research. The results of the research will allow us to determine the antibiotic necessary for treatment, which is prescribed in the form of vaginal suppositories. If necessary, an antifungal course of treatment is carried out.

The course of treatment should only be prescribed by a gynecologist.