Practice 10-Minute Consultation

A likely urinary tract infection in a pregnant woman

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1777 (Published 27 April 2017) Cite this as: BMJ 2017;357:j1777
  1. Catherine L Johnston, specialist trainee year 3 in obstetrics and gynaecology1,
  2. Maximilian J Johnston, core trainee year 2 in urology2,
  3. Alison Corke, general practitioner partner3,
  4. Melissa C Davies, consultant in urology2
  1. 1Department of Obstetrics and Gynaecology, Hampshire Hospitals NHS Foundation Trust, Basingstoke, UK
  2. 2Department of Urology, Salisbury District Hospital, Salisbury SP2 8BJ, UK
  3. 3The Orchard Partnership, Wilton, UK
  1. Correspondence to: M J Johnston maxj101{at}gmail.com
  • Accepted 23 March 2017

What you need to know

  • Pregnant women with lower urinary tract infections are at increased risk of pyelonephritis, resulting in preterm delivery and low fetal birth weight

  • Antibiotic treatment taken for at least seven days reduces these risks

  • Pregnant women with sepsis or recurrent urinary tract infection should be referred to secondary care

A 27 year old pregnant woman of 28 weeks’ gestation complains that she is urinating more often and that it is painful. She is worried that she might have an infection. A urine dipstick test indicates the presence of nitrites, leucocytes, and microscopic haematuria.

Urinary tract infection (UTI) in pregnancy is the most common non-obstetric indication for antenatal admission.1 UTIs can cause morbidity such as preterm labour, sepsis, and adult respiratory distress syndrome, and can cause mortality if left untreated.23 Lower urinary tract infection occurs in approximately 1-4% of pregnancies, while upper tract infection (pyelonephritis) occurs in 0.5-2% of pregnant women.4

What you should cover

Find out how the woman’s pregnancy is progressing and whether there is anything that she is particularly worried about.

  • Fetal wellbeing—Ask about fetal health and movements. Maternal systemic illness can affect fetal wellbeing.

  • Current urinary symptoms—Ask about symptoms such as dysuria, urinary frequency, urgency and abdominal pain. These symptoms may also be present in pregnant women without a UTI and are difficult to differentiate in the absence of …

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