Indore-based IT professional Rhea Sharma was ten weeks into her pregnancy when she tested positive for Escherichia coli (E Coli). Her doctor detected this in her urine test that she had to frequently undergo because of her history of three miscarriages. Sharma was then treated with antibiotics. Six weeks later, she again experienced frequent urination and other mild symptoms of urinary tract infection (UTI). On further diagnosis, her urine and vaginal cultures too came positive for E Coli. She was administered antibiotics yet again. But she showed signs of cervical length shortening along with a full-blown UTI.
Studies have indicated that E Coli (a form of bacteria) can colonise the urinary tract most easily in pregnant women. The other lesser-known bacteria include Proteus mirabilis, Pseudomonas aeruginosa and Klebsiella pneumoniae.
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These bacteria, through rapid multiplication, can consequently lead to a condition known as asymptomatic bacteriuria (ASB).
“Asymptomatic bacteriuria (also known as commensals) contaminates the urinary tract without causing any symptoms. However, when these colonised bacteria multiply at a very high rate, the condition can develop into a full-blown UTI,” says Dr Chinmay Naik, general physician, Apollo Clinic, Viman Nagar, Pune.
How to know it is infection due to ASB
Dr Naik advises pregnant women to keenly observe their urination frequency. The warning signs include:
- High fever with chills
- Burning sensation while passing urine
- Increased frequency of urination
Dr Astha Jain Mathur, consultant, obstetrician and gynaecologist, Motherhood Hospital, Mechanic Nagar, Indore, says that in some cases the symptoms also include “pelvic pain and painful urination.”
Those at risk of infection
“Asymptomatic bacteriuria affects around five per cent of healthy premenopausal women and seven per cent of pregnant women,” says Dr Mathur.
Dr Naik specifies that most often, the women who develop Asymptomatic bacteriuria are between 16 and 35 years. He says the following are the multi-dimensional reasons for women being more vulnerable to this condition:
- Smaller size of a woman’s urethra compared to a man’s allows easier access to the commensals into the urinary system during an infection
- Lack of hygiene that facilitates pathogenic bacteria to colonise the urinary tract
- Sexual activities (since the vaginal and the urethral orifices are situated in proximity)
The incidences of ASB are also higher among pregnant women with the following co-existing conditions, says Dr Mathur:
- Immunosuppressive disorders, such as HIV or AIDS
- Loss of bladder control
- Kidney failure/transplant
- Presence of urinary tract obstructions (like stones)
“Although ASB can affect women during early pregnancy, the lack of symptoms in early stages will lead to late diagnosis (in the second or third trimester),” Dr Mathur says. “During pregnancy, immediate attention and appropriate treatment are necessary.”
Dr Mathur enumerates the various issues that can arise if the condition is left untreated or if any pregnant woman develops severe ASB:
- Low birth weight of the baby (less than 2.5 kg)
- Prematurity (less than 37 weeks of gestation)
- Preterm low birthweight (less than 2.5 kg/less than 37 weeks of gestation)
- Developmental delays/mental retardation
- Perinatal mortality (death of the foetus)
- Preterm labour (less than 37 weeks of gestation)
- Severe hypertension/pre-eclampsia
- Chorioamnionitis (bacterial infection of the amniotic fluid and membranes that surround the fetus)
Why ASB is common among pregnancy
While discussing the rationale behind pregnancy and ASB, Dr Mathur says, “the apparent reduction of immunity during pregnancy encourages the growth of pathogens in women.”
Dr Naik adds, “during pregnancy, the uterus induces pressure on the urinary bladder. This increases the frequency of urination and/or may cause urinary leakage. Consequently, lack of hygiene or leftover urine in the urinary tract allows rapid multiplication of commensals. This increases the chances of developing ASB in pregnancy.”
In his study ‘Asymptomatic bacteriuria in pregnancy from the perspective of public health and maternal health care: review and case report’, Bulgarian obstetrician and gynaecologist Dr Teodor Markov Garnizov said that pregnancy induces hormonal and metabolic changes (such as changes in the urine composition, ie, higher levels of glucose, amino acid or other nutrients) that can trigger microbial growth in urine which can lead to ASB in pregnant women.
How to treat infection due to ASB
For pregnant women who develop ASB, “the first line of treatment is optimum dosage of antibiotics,” says Dr Naik.
Dr Mathur recommends regular screening and urine tests to avoid developing ASB. Screening, she says, “should be done between the 12th to 16th week of pregnancy.”
Discussing Sharma’s case, Dr Mathur tells Happiest Health that she was asked to regularly check her urine sample based on her medical history of miscarriages. “Hence, in the 16th week, she underwent McDonald’s cervical cerclage (a procedure which involves sewing the cervix to prolong the pregnancy in the uterus). This procedure restored her and her baby’s health until 26 weeks.
“Around the 27th week, she again showed symptoms of full-blown UTI. After administering a course of antibiotics, we decided to deliver her baby through Caesarean section (C-section). The healthy baby (which weighed 920gm) was admitted for eight weeks to the neonatal intensive care unit for consistent examination and antibiotic therapy. After eight weeks, the infant was discharged as it was healthy and did not show any signs of infection.”
How to prevent asymptomatic bacteriuria
To prevent ASB, Dr Mathur advises pregnant women to:
- Drink enough fluids
- Take care of intimate hygiene
- Urinate after every intercourse as bacteria is highly likely to be transferred during intercourse
- Avoid feminine hygiene products if they irritate the skin