The information on this website is not intended for diagnosis or treatment. Please consult your physician for health concerns.

+90 850 321 50 00

Urinary Tract Infection in Pregnancy

Asymptomatic bacteriuria, cystitis and pyelonephritis: screening, diagnosis and safe treatment.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Kadın Hastalıkları ve Doğum department. Book Appointment →

What is Urinary Tract Infection in Pregnancy?

Pregnancy increases the risk of urinary tract infection due to ureteric dilatation, bladder displacement, urinary stasis and immunological changes.

Spectrum includes asymptomatic bacteriuria (2-10%), acute cystitis (1-2%) and acute pyelonephritis (0.5-2%) in pregnant women.

Untreated asymptomatic bacteriuria progresses to pyelonephritis in 20-40% of cases and increases preterm labour and low birth weight risk by 2-3 fold.

Symptoms

Asymptomatic bacteriuria: positive culture (≥100,000 CFU/mL of one organism on midstream urine) without symptoms
Acute cystitis: dysuria, frequency, urgency, suprapubic pain; no fever; pyuria on microscopy
Acute pyelonephritis: fever over 38°C, chills, flank or back pain, costovertebral angle tenderness, nausea, vomiting
Severe pyelonephritis: sepsis, hypotension, respiratory distress (acute respiratory distress syndrome) and hyperbilirubinaemia
Common pathogens: Escherichia coli (70-80%), Klebsiella pneumoniae, Proteus mirabilis, Staphylococcus saprophyticus, Group B Streptococcus, Enterococcus
Premature contractions or preterm labour may be triggered by infection
Foetal: intrauterine growth restriction, preterm birth, low birth weight

Risk Factors

Multiparity and lower socioeconomic status
Diabetes mellitus and gestational diabetes
Sickle cell trait and disease
Previous UTI or pyelonephritis
Urological abnormalities (vesicoureteral reflux, kidney stones, neurogenic bladder)
Sexual activity
Recent catheterisation or urological procedure
Immunosuppression

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • All pregnant women should undergo urine culture screening at 12-16 weeks (early prenatal visit)
  • Repeat urine culture in patients with previous bacteriuria, urological abnormality or diabetes
  • Symptoms of cystitis (dysuria, frequency, urgency) require urine culture and prompt treatment
  • Fever, flank pain or systemic symptoms warrant emergency admission for pyelonephritis evaluation
  • Failure to respond to oral antibiotics within 48-72 hours needs reassessment and possible hospitalisation
  • Recurrent or persistent infections require urological investigation postpartum

Treatment Methods

01
Universal screening: midstream urine culture at first prenatal visit (12-16 weeks); repeat in second and third trimesters in high-risk patients
02
Asymptomatic bacteriuria and acute cystitis: 5-7 day oral antibiotic course (nitrofurantoin 100 mg every 6-8 hours, cefuroxime axetil 250-500 mg every 12 hours, fosfomycin 3 g single dose)
03
Avoid: trimethoprim-sulfamethoxazole in first trimester and near term, fluoroquinolones throughout pregnancy, nitrofurantoin in last weeks
04
Acute pyelonephritis: hospitalisation, intravenous antibiotics (ceftriaxone 1-2 g daily, ampicillin plus gentamicin), hydration, antipyretics, fetal monitoring
05
Convert to oral antibiotics after 48-72 hours of clinical improvement; complete 10-14 day total course
06
Test of cure urine culture 1-2 weeks after treatment completion
07
Recurrent pyelonephritis: low-dose antibiotic prophylaxis (nitrofurantoin 50-100 mg or cefalexin 250 mg at bedtime) until 4-6 weeks postpartum
08
Postpartum urological evaluation for recurrent or complicated cases

Which Department to Visit?

You can visit our Kadın Hastalıkları ve Doğum department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Kadın Hastalıkları ve Doğum Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

Book AppointmentContact Us

Related Health Topics

Other articles from the same department you may want to explore.

Regular Gynecological Check-up

Kadın Hastalıkları ve Doğum

Regular gynecological check-ups enable early diagnosis of many women's diseases and increase treatment success. It is recommended that every sexually active woman or woman over 21 see a gynecologist at least once a year.

Cervical Cancer

Kadın Hastalıkları ve Doğum

Cervical cancer develops from uncontrolled growth of cells in the cervix and is among the most common women's cancers worldwide. Precancerous lesions can be recognized with regular Pap smear and HPV testing.

HPV and Vaccination

Kadın Hastalıkları ve Doğum

HPV is a common virus transmitted sexually that can lead to certain types of cancer. Vaccination provides over 90% protection against high-risk HPV strains.

Ovarian Cyst

Kadın Hastalıkları ve Doğum

Ovarian cysts are fluid-filled sacs that form in or on the ovarian tissue. Most are asymptomatic and disappear spontaneously; however, large or complex cysts can cause pain and complications.

Endometriosis

Kadın Hastalıkları ve Doğum

Endometriosis affects about 10% of women of reproductive age, causing cyclic pelvic pain, dysmenorrhea, dyspareunia, and infertility; combined medical and laparoscopic treatment improves quality of life.

Uterine Fibroids

Kadın Hastalıkları ve Doğum

Uterine fibroids are benign tumors developing from the uterine muscle layer. They affect 20-50% of women of reproductive age; most are asymptomatic, but can cause bleeding and pain.

Polycystic Ovary Syndrome (PCOS)

Kadın Hastalıkları ve Doğum

PCOS is the most common endocrine disease affecting approximately 10% of women of reproductive age, characterized by androgen excess, ovulation disorder, and polycystic ovarian appearance.

Menopause

Kadın Hastalıkları ve Doğum

Menopause is the life stage defined by not having a period for 12 consecutive months and the natural cessation of ovarian function. The average age is 51, but it can vary between 45-55 years.

Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.