القائمة الرئيسية

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Urinary Tract infection and it is risk factors during pregnancy


Urinary Tract infection and it is risk factors during pregnancy

Naamat Abeid1, Amel Morgham1, Mohammed Ben Saud 2

1 Obstetrics and Gynaecology Department, Aljala Maternity Hospital, Faculty of Medicine, University of Tripoli, Tripoli / Libya
2 National Cancer Institute Misurata, Faculty of Medicine, Misurata University, Misurata, Libya
Abstract
Background:Urinary tract infection (UTI) is the single commonest bacterial infection and the range of clinical effect varies from asymptomatic bacteriuria (ABU) to acute pyelonephritis. In addition; it has important maternal and neonatal effects.
Objective: A study was conducted in pregnant women with the objectives of estimating prevalence of UTI and to determine the risk factors of urinary tract infection among pregnant women in Aljala Maternity hospital, University of Tripoli, Libya. Methods: A cross-sectional study design was used to collect 100 mid-stream urine samples from pregnant women compared with 100 pregnant women without UTI. Study conduct in Aljala Maternity Hospital and , Tripoli, Libya, from December 2017 to May 2018.
Result: we found that significant number of patients presented with UTI had  previous history of UTI (P value < 0.05). The analysis showed no relation between UTI and maternal age, previous operative delivery, blood group, multiparity, multiple pregnancies, vaginal infection and chronic diseases (P value > 0.05). Statistically; significant relation with the number of admission to hospital (P <0.05) and the advanced gestational age (P=0.001) but not significant with the increased maternal BMI (P =0.040). Conclusion: UTI is common among pregnant women in the presence of associated risk factor such as past history of UTI, advanced gestational age (third trimester) and increased maternal body mass index
Keyword: Urinary Tract Infection (UTI), Pregnant Women
Introduction:
Urinary tract infection is a common bacterial infection posing serious health problem among pregnant women (1). Asymptomatic bacteriuria (ABU) is a common bacterial infection of the urinary tract requiring medical treatment in pregnancy. Diagnosis and treatment of ABU is important as approximately 20–40% of pregnant women (2,3). UTI begins in week 6 and peaks during weeks 22 to 24 of pregnancy due to a number of factors including urethral dilatation, increased bladder volume and decreased bladder tone, along with decreased urethral tone which contributes to increased urinary stasis and uretero-vesical reflux. About 70 % of pregnant women develop glycosuria, which encourages bacterial growth in the urine (4).
Treatment of UTI is important to help women safely go through pregnancy and childbirth and produce healthy babies.The most common microorganisms caused UTI are: E. coli, Klebsillapneumoniae, Enterobacter, Citrobacter, Proteus mirabilis, and P. aeruginosa. Other common pathogens include: Staphylococcus epidermidis, Enterococcus species and Serratia species which presumably result in UTI following colonization of the genito-urinary tract (5). In literature; regarding the common cause, many studies showed that E.coli (60–70%), Klebsiellaspecies (10%), Proteus species(5–10%) (6,7,8)
Untreated Women with ABU during pregnancy is a risk factor for acute cystitis (40%) and pyelonephritis (25–30%) in pregnancy and could lead to adverse obstetric outcomes such as prematurity, low-birth weight, and higher fetal mortality rates compared with women without bacteriuria (2,9,10,11).Pre-eclampsia and chronic renal disease that has been cited as significant adverse obstetric outcome and medical conditions (12). The prevalence of UTI is increased by several factors. Poor socioeconomic status is reported to be a major risk factor with indigent patients having a fivefold increased risk (13). Other risk factors include increased age, high parity, poor perineal hygiene, history of recurrent UTI, diabetes mellitus and urinary tract abnormality (14).
Methods: this study was carried out in Aljala Maternity Hospital from December 2017 to May 2018. One hundred patients with history of UTI were randomly selected from the hospital clinic, and compared to one hundred pregnant women without UTI. The following data was obtained by well-designed questioner: the age, parity, previous c/s, gestational age, blood grouping Rh, BMI, presenting complain, fever, vaginal infection, history of previous admission to hospital, history of previous UTI,  multiple pregnancy, and chronic diseases (like diabetic, hypertensive, thyroid disease, anemia) Aim of study: to determine the risk factors of urinary tract infection among pregnant women in Aljala Maternity hospitals.
Statistical analysis: Statistical analysis was computerized using the Statistical Program for Social Sciences (SPSS version 16) that used for data entry and analysis. Descriptive statistics were used and all results are presented as frequencies, means ± standard deviation and percentages. Categorical data were compared using the Chi-square test and Fisher's exact test if appropriate. A P-value of less than to 0.05was considered statistically significant.
Results: we found that the mean age for the patients in our cohort was (29.6 ± 6.6 years). The maximum age of the patients was 45 years and the minimum age was 17years. Most of the age distribution of the patients in this study was between 30 and 40 years, which accounts for 47% (Figure 1). Nearly 30% of the patients were primigravida, and 48.8% of the patients were between para 1 and para 3 and only 0.5% were more than para 6 (Table 1). In addition; Two third of the pregnant patients had history of previous one cesarean section or more than one cesarean section .
Classification UTI pregnant patients in the relation to pregnancy stage, we found that 45% have UTI during second trimester and only 12% have UTI during first trimester (Figure 2). In relation to the blood group, major part of the patients with UTI have blood group O+ (50.5%) and nearly 50% of them presented episode of UTI and minority (18%) of patients have both A+ and B+. 52% of women with UTI have also vaginal infection during current pregnancy. Regarding the past medical history; we documented that 33.8% of patients had previous history of UTI (Figure 3). Forty three percent of the pregnant patients have normal body mass index ( between18-24) but 50% were overweight (BMI from 25-30), and only 5.6% had obesity with BMI between 30 - 40 (Figure 4). Most of the patients (92.5%) had single pregnancy and only 7.5% have pregnancy with twins. Regarding the presence of chronic disease, we documented that only 8% of participants have diabetes mellitus, 9% with hypertension and 7.5% of them diagnosed thyroid disease and all of them on treatment.
Discussion: The urinary tract infection is significant obstetric problem and is important cause of maternal and neonatal morbidity. The etiology, pathogenesis, management and prevention of urinary tract infection are still burning problems (15). The overall prevalence of urinary tract infection in pregnant women, asymptomatic UTI has been previously reported to be 2% to 13% in pregnant women (16-18) compared with that of symptomatic UTI which accounts 1-18% during pregnancy (19). Reported in africa11.6% in Ethiopia (20) and in Tanzania was 16.4% (21). Our results going with the literature; it showed that the most important factors proposed to affect the frequency of  bacteriuria during pregnancy is multiparity, gestational age, previous medical history of UTI, chronic disease as diabetes mellitus and anatomic urinary tract abnormalities (15,22-25). In addition anemia, socio-economic status and catheterization are also associated with increased risk of UTI in pregnant women. Nearly 50% of our patients with UTI were between para 1 and para 3 and 20% of the patients were para 4 or more; in literature, some studies documented the association between multiparity and UTI such as Okonko et al (26) on UTI in Nigeria, Enayat et al (23) on asymptomatic pregnant women in Iran, Haider et al (27) on UTI in Pakistan. However; other studies showed that the parity was not significantly associated with UTI in pregnancy(28-31). We documented that most of our patients with UTI were between 30 and 39 years, some studies showed that the prevalence of UTI increased with age (32,33), this similar to our results while others studies found it more with a younger age group (34). In our study, we confirmed that 45% of the patients have UTI during second trimester. This is opposite with some studies in literature (25,28). The prevalence of urinary tract infection in pregnant women with previous history of urinary tract infection was significantly higher than those without previous history (p < 0.005), similar to result documented in Pakistan pregnant patients (25). Our data showed that the majority of the patients with UTI have blood group O+ (50.5%) and  significant the association between UTI and anemia, because 36.5% of the patients with anemia. In addition; 52% of UTI women have in association with vaginal infection during current pregnancy. Regarding patients BMI; 50% were overweight (BMI from 25 to30) and only 5.6% were obese with BMI between 30-40.We found only 8% of participants were diabetic, 9% have hypertensive and 7.5% of them have thyroid disease and they are on treatment
Conclusions: The study revealed an overall high prevalence of UTI in pregnant women. Significant bacteriuria was observed in asymptomatic pregnant women. Periodic studies are recommended to check the outcome of asymptomatic bacteriuria and also monitor any changes in the susceptibility patterns of urinary tract pathogens in pregnant women.

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                                        Fig 1: Age distribution of the patients

Tab 1: parity distribution of the patients
Fig. 2: UTI and Gestational age



                                      

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