Bharati Vidyapeeth Deemed University Medical College, Pune 411043

Department of Obstetrics and Gynaecology

SOP: Urinary tract infection in pregnancy

INTRODUCTION: Urinary tract infection (UTI) is an infection involving the kidneys, ureters,
bladder, or urethra. Urinary tract infection occurs 2-7% in pregnancy. It is a common infection in
pregnancy. Patient can present with fever, chills, nausea, vomiting, and other severe symptoms
(urgency, frequency, hematuria).UTI in pregnancy is associated with IUGR, Preterm birth,
Preeclampsia.UTI in pregnancy is further classified as asymptomatic Becteriauria (colony count
>10,000/ml),acute cystitis and acute pyelonephritis. All pregnant women should be screened for
ASB at first prenatal visit

PRIMARY EVALUATION: Assure it is a mid-stream urine sample. An ultrasound to done to rule

out calculi. Antibiotic treatment for asymptomatic Becteriauria is indicated to reduce the risk of
acute cystitis, pyelonephritis as well as to reduce risk of preterm and IUGR. It is recommended that
antibiotic treatment should be started upon ASB diagnosis in pregnancy.

Among the drugs that can be used are nitrofurantoin (not near term), co-amoxiclav or cephalosporin
depending on sensitivity results of urine. A 5-7 day course of antibiotics is to be recommended.

BEFORE 20 WEEKS OF PREGNANCY

Cap amox 500 mg TDS for 5 days

Tab cefixime 200 mg BD for 5 days

AFTER 20 WEEKS OF PREGNANCY (UPTO 36 WEEKS)

Tab nitrofur SR 100mg for 5-7 days

Urine alkaliser (ie syrup cital 2tsf TDS) can be added

Plenty of fluids to be encouraged

INVESTIGATIONS: Lab diagnosis of acute cystitis can be determined by presence of significant

pyuria > 8 pus cells/cmm or positive leucocyte esterase or nitrate test.

SOP UTI OBGYN Page 1