urinary tract infection in pregnancy (2023)

continuing education activity

Urinary tract infections (UTIs) are common in pregnant women. Pyelonephritis is the most common serious condition in pregnancy and can present in a similar way and even be the result of inadequate treatment of urinary tract infections. Therefore, it is crucial that clinicians be able to differentiate between normal and abnormal findings of the urinary tract and kidneys, assess for abnormalities, and treat disease. Fortunately, UTIs in pregnancy are usually easy to treat and respond well to treatment. This activity reviews the evaluation and management of UTIs in pregnancy and highlights the role of interprofessional team members in working together to provide well-coordinated care and improve patient outcomes.


  • Identify the etiology of urinary tract infections in pregnancy.

  • Explain how urinary tract infections are diagnosed in pregnant patients.

  • Outline the treatment options available for urinary tract infections in pregnant patients.

  • Review of interprofessional team strategies to improve care and outcomes in pregnant patients with urinary tract infections.

Access free multiple-choice questions on this topic.


Urinary tract infections (UTIs) are common in pregnant women. Pyelonephritis is the most common serious disease in pregnancy. Therefore, it is crucial that obstetricians are aware of normal urinary tract findings, evaluation for abnormalities, and treatment of disease. Fortunately, UTIs during pregnancy are easier to treat with excellent results. Rarely, pregnancies complicated by pyelonephritis result in significant maternal and fetal morbidity.

Changes in the urinary tract and immunological changes during pregnancy predispose women to urinary tract infections. Physiologic changes in the urinary tract include dilatation of the ureter and calyces of the kidneys; This is due to progesterone-induced smooth muscle relaxation and ureteral compression by the gravid uterus. Ureteral dilatation may be marked. Decreased bladder capacity often leads to frequent urination. Vesicoureteral reflux can occur. These changes increase the risk of urinary tract infections.


During pregnancy, changes in the urinary tract predispose women to infections. Dilation of the ureters is seen due to compression of the ureters by the gravid uterus. The hormonal effects of progesterone can also cause smooth muscle relaxation, leading to urinary dilation and stasis and increased vesicoureteral reflux. The organisms that cause UTIs in pregnancy are the same uropathogens seen in non-pregnant women. As in non-pregnant patients, these uropathogens have cell surface proteins that increase bacterial adhesion, resulting in increased virulence. Urinary catheterization, which is often done during labor and delivery, can introduce bacteria that cause urinary tract infections. In the postpartum period, changes in bladder sensation and bladder distension may predispose to UTIs.

Pregnancy is a state of relative immunodeficiency. This immunodeficiency may be another reason for the increased frequency of urinary tract infections seen in pregnancy.

(Video) Urinary Tract Infection in Pregnancy | Signs, Symptoms, Complications & Treatment- Dr. H S Chandrika


The most important factor predisposing women to UTIs in pregnancy is asymptomatic bacteriuria (ASB). ASB is defined as more than 100,000 organisms/mL in a clean urinalysis from an asymptomatic patient. If asymptomatic bacteriuria is not treated during pregnancy, the subsequent UTI rate is about 25%.[1]Due to the high incidence and potential severity of pyelonephritis, it is recommended that all pregnant women be screened for ASB at their first prenatal visit. This is usually done with a clean urine culture. Treatment of ASB reduces the clinical infection rate from 3% to 4%.

The rate of asymptomatic bacteriuria in nonpregnant women is 5% to 6%, which compares with estimated rates in pregnancy of 2% to 7%. ASB is seen more frequently in multiparous women and women of low socioeconomic status. Women with sickle cell signs also have a higher incidence of ASB.[1]

UTIs are a common cause of serious infections in pregnant women. In one study, 3.5% of prenatal admissions were due to urinary tract infections.[2]Pyelonephritis is the most common cause of septic shock in pregnant women. Risk factors for urinary tract infections in pregnancy include low socioeconomic status, young age, and nulliparity. As with ASB, some patients may be predisposed to infection and report a history of ASB, cystitis, or pyelonephritis. Pyelonephritis is more common on the right side, but can be bilateral in up to 25% of cases.


The organisms that cause UTIs in pregnancy are the same uropathogens that commonly cause UTIs in nonpregnant patients.Escherichia coliIt is the most frequently isolated organism. A retrospective analysis of 18 years foundE. colibe the causative agent in 82.5% of cases of pyelonephritis in pregnant women.[3]Other bacteria that may be seen includeKlebsiella pneumoniae, Staphylococcus, Streptococcus, Proteus,mithe enterococcusSpecies.

history and body

Patients with asymptomatic bacteriuria have no symptoms; Therefore, it is important to check for the disease. These patients may have a history of frequent urinary tract infections or may have had ASB in a previous pregnancy.

Cystitis presents the same symptoms that are seen in non-pregnant people. Symptoms may include pain or burning when urinating (dysuria), frequent urination, or the urge to urinate. Suprapubic pain and tenderness may be noted.

Also, patients with pyelonephritis have symptoms that have been observed in non-pregnant patients with the same disease. Symptoms can include flank pain, fever, and chills. Nonspecific symptoms such as malaise, anorexia, nausea, and vomiting may occur, so the differential diagnosis at initial presentation is usually broad. The differential diagnosis includes acute intra-abdominal processes such as appendicitis, cholecystitis, and pancreatitis, as well as pregnancy complications including preterm labor and placental abruption. Patients may report contractions or contractions may be observed with uterine monitoring. This uterine activity is usually due to smooth muscle irritability caused by infection. Patients should be evaluated, and if no cervical dilation is noted, treatment for preterm labor is usually not required. However, patients should be closely monitored as preterm labor may develop.

(Video) Urinary tract infections during pregnancy | Woman's Doctor

Signs and symptoms of sepsis may be present. These include tachycardia and hypotension. These patients require immediate evaluation and intervention.

A complete physical examination should be performed with particular attention to vital signs and examination of the heart and lungs. An abdominal examination may show tenderness, and costovertebral tenderness can usually be detected. A urogenital examination (UG) should be performed to assess for cervical infection and assess for cervical dilation on admission. Although complications of pregnancy are not an initial concern, it is still useful to assess for abnormalities in labor or other abnormalities during the hospital stay.


Evaluation includes a urinalysis and a clean urine culture. There are some considerations worth mentioning when collecting urine samples during pregnancy. Well-hydrated patients may excrete dilute urine, which makes some parameters evaluated less precise. Hematuria may be seen as a result of contamination, particularly when collecting samples from labor or postpartum patients. Due to reduced protein reabsorption, small amounts of protein can normally be excreted. Contamination, such as that which can occur with mucous secretions, can also contribute to the presence of proteinaceous material in the urine of pregnant women.

Laboratory tests should include a complete blood count (CBC), electrolytes, and serum creatine. Where appropriate, custom studies should be included to rule out other causes of the patient's symptoms, e.g. B. amylase and lipase when pancreatitis is considered as a diagnosis. If there is concern about sepsis, lactic acid and blood cultures should be taken. All cultures should be collected as soon as possible and before starting antibiotic therapy.

If the fetus is viable, fetal heart rate and contractions should be monitored. Cervical cultures and GBS should be considered on admission if pregnancy-related complications occur. Rarely, renal ultrasonography may be indicated to evaluate for possible renal abscess.

Treatment / Management

ASB and acute cystitis are treated with antibiotic therapy. The choice of antibiotic can be tailored based on the susceptibility of the organism when it becomes available from urine culture results. One-day courses of antibiotics are not recommended during pregnancy, although 3-day courses are effective.[4]Commonly used antibiotics are amoxicillin, ampicillin, cephalosporins, nitrofurantoin, and trimethoprim-sulfamethoxazole. Fluoroquinolones are not recommended as first-line treatment in pregnancy due to conflicting studies of teratogenicity. Short courses are unlikely to be harmful to the fetus, so it makes sense to use this class of drugs for recurrent or resistant infections.

Evidence has recently emerged suggesting a link between the use of sulfa derivatives and nitrofurantoin and birth defects when these drugs are prescribed in the first trimester. These studies had limitations; However, it is currently recommended not to use these drugs in the first trimester if alternatives are available.[5]Because the potential consequences of an untreated UTI during pregnancy are significant, it makes sense to use these medications when necessary, as the benefits far outweigh the risks of use. There is extra caution with these two classes of antibiotics. Patients with G6P deficiency should not be prescribed sulfa derivatives or nitrofurantoin, as these drugs can induce hemolysis. At the end of the third trimester, trimethoprim-sulfamethoxazole should be avoided due to the potential risk of the baby developing kernicterus after birth.

If group Bstreptococci(GBS) on urine cultures, patients should receive intravenous (IV) antibiotic therapy at the time of delivery in addition to treatment indicated for ASB or UTI. This is to prevent the development of early-stage GBS sepsis, which can occur in babies born to women colonized with GBS.

Pyelonephritis in pregnancy is a serious condition that often requires hospitalization. Once evaluation is complete, treatment consists primarily of targeted antibiotic therapy and intravenous fluids to maintain adequate urinary output. Fever should be treated with a cooling blanket and paracetamol if necessary. Second- or third-generation cephalosporins are often used for initial treatment. Alternatives are ampicillin and gentamicin or other broad-spectrum antibiotics. Patients should be closely monitored for the development of worsening sepsis.

differential diagnosis

The differential diagnosis includes acute intra-abdominal disorders, such as appendicitis, pancreatitis, or cholecystitis, as well as pregnancy-related complications, such as preterm labor, chorioamnionitis, or placental abruption.

(Video) UTIs in pregnancy | Reproductive system physiology | NCLEX-RN | Khan Academy


Patients with pyelonephritis are at risk of several major complications.

Sepsis may worsen, resulting in hypotension, tachycardia, and decreased urine output. Admission to the intensive care unit may be required.

Pulmonary complications are not uncommon and occur in up to 10% of pregnant patients treated for pyelonephritis.[4]This is due to endotoxin-mediated alveolar damage and can manifest as pulmonary edema or acute respiratory distress syndrome (ARDS). Urine output and oxygen status must be closely monitored, and patients may require respiratory support in the intensive care unit.

The release of endotoxins can lead to anemia, which usually resolves spontaneously after treatment. This is the most common complication of pyelonephritis, occurring in up to 25% of patients.[3]

Endotoxin release can also cause uterine contractions and patients should be monitored for preterm labor; Patients should receive treatment for preterm labor when indicated. Caution should be exercised when using tocolytic therapy because of the increased risk of pulmonary edema in urinary tract infections.

A small number of patients may have a persistent infection. In these cases, urinary obstruction or renal abscess should be considered. The choice of antibiotic should be reassessed and the culture results reviewed.

Warning and information for the patient

A urine culture should be taken 2 to 4 weeks after stopping treatment to ensure that reinfection has not occurred.

Suppressive antibiotic therapy, usually once daily with nitrofurantoin, is often recommended, particularly in cases where patients have had a previous urinary tract infection. This usually continues throughout the pregnancy and early postpartum period.

Improve the results of the health team

Interprofessional collaboration is essential in the treatment of these patients. When antibiotics are given, patients may initially worsen due to endotoxin release, but most patients improve within 72 hours. Long-term complications, such as kidney damage, are rare.

(Video) Urinary Tract Infection (UTI)during Pregnancy by Dr. Nitika Sobti



Gilstrap LC, Ramin SM. Urinary tract infections during pregnancy.Obstetricia Gynecol Clin North Am.September 2001;28(3):581-91.[PubMed: 11512502]


Gazmararian JA, Petersen R, Jamieson DJ, Schild L, Adams MM, Deshpande AD, Franks AL. Hospitalizations during pregnancy among those participating in managed care.Obstetrics Gynec.July 2002;100(1):94-100.[PubMed: 12100809]


Wing DA, Fassett MJ, Getahun D. Acute pyelonephritis in pregnancy: an 18-year retrospective analysis.Soy J Obstet Gynecol.2014 March;210(3):219.e1-6.[PubMed: 24100227]


Sheffield JS, Cunningham FG. urinary tract infection in women.Obstetrics Gynec.November 2005;106(5 point 1): 1085-92.[PubMed: 16260529]


Committee Opinion No. 717: Sulfonamides, Nitrofurantoin, and the Risk of Birth Defects.Obstetrics Gynec.September 2017;130(3):e150-e152.[PubMed: 28832488]

(Video) UTI in Pregnancy - CRASH! Medical Review Series


Urinary tract infection in pregnancy? ›

UTIs are a common cause of serious infection in pregnant women. In one study, 3.5% of antepartum admissions were due to UTI. [2] Pyelonephritis is the most common cause of septic shock in pregnant women. Risk factors for UTIs in pregnancy include low socioeconomic status, young age, and nulliparity.

Can a UTI while pregnant hurt the baby? ›

UTIs are equally common in pregnant and non-pregnant patients and usually require medication to clear the infection. But if left untreated during pregnancy, a UTI can progress to s serious infection that can lead to preterm labor, premature delivery, or even fetal loss.

What are the symptoms of urine infection in pregnancy? ›

Common UTI Symptoms in Pregnant Women
  • Strong and frequent urge to use the bathroom.
  • Burning while urinating.
  • Regularly passing only small amounts of urine.
  • Cloudy, red, pink or cola-colored urine.
  • Foul-smelling urine.
  • Pelvic pain, usually in the center of the pelvis.
Mar 16, 2020

What to do if you have urinary tract infection during pregnancy? ›

UTIs can be safely treated with antibiotics during pregnancy. Urinary tract infections are most commonly treated by antibiotics. Doctors usually prescribe a 3-7 day course of antibiotics that is safe for you and the baby.

Should I go to the hospital if I have a UTI while pregnant? ›

Women who have symptoms of a UTI during pregnancy should see their doctor immediately. Without treatment, UTIs can cause serious complications for a pregnant woman and the developing fetus. Prompt intervention can help to prevent these complications.

Can a baby pass a UTI to a mother? ›

A mother with a UTI or BV may pass the infection on to the baby during the birthing process. This can lead to sepsis (infection of the blood), meningitis (infection of the membranes surrounding the brain and spinal cord), and permanent brain damage such as cerebral palsy.

How long does UTI last in pregnancy? ›

UTI diagnosis and treatment

If you are diagnosed with a UTI, your doctor will likely provide a pregnancy-safe antibiotic for seven to 14 days to get rid of all of the bacteria. Be sure to take the recommended full course, even if you start to feel better midway through treatment, and drink plenty of water.

What complications can a UTI cause in pregnancy? ›

All pregnant mothers should be screened for UTI. Untreated UTI will lead to pre-term premature rupture of membrane, maternal chorioamnionitis, intrauterine growth retardation and low birth weight baby.

How long can a UTI go untreated before it becomes serious? ›

How long can you leave a UTI untreated? You shouldn't leave a UTI untreated for an entire week. It's recommended for healthy adult women to receive treatment after at least two days. Try and visit AFC Aurora Saddle Rock or your primary care physician as soon as you notice the symptoms of a UTI.

Can I take azo while pregnant? ›

Over-the-counter treatments for UTI in pregnancy

Phenazopyridine (Azo, Pyridium, or Uricalm) is an over-the-counter medication that helps ease urinary tract pain during a UTI. You can buy Azo at almost any pharmacy, and it is safe to use for a UTI during pregnancy.

Is cranberry juice good for UTI while pregnant? ›

You can safely drink cranberry juice while you're pregnant. It's safe for you and your baby, and may even help prevent a UTI. It can also keep bacteria overgrowth down there in check. However, you can't treat a UTI with cranberry juice.

Can a dirty diaper cause a UTI? ›

Bacteria and other infection-causing microbes may enter the urinary tract when an infant has a dirty diaper or when babies are wiped from back to front. Good hydration enabling frequent urination and maintaining proper hygiene can help prevent UTIs.

Can sperm cause urinary tract infections? ›

Sometimes after not having any sex for a long time, the vaginal flora may be thrown out of balance chemically (yes, sperm has a chemical makeup), increasing your risk of UTIs (especially if your vaginal immune system is already weakened)- some studies show increased bacteria in the urine after intercourse.

Can UTI cause stillbirth? ›

An intrauterine infection can cause the following complications: preterm prelabour rupture of the membranes (waters breaking early) premature birth. stillbirth.

How much water does it take to flush out a UTI? ›

During the infection — and after — make sure to drink a lot of water, at least 12 8-ounce cups per day. This will flush out your system and help prevent future infections. If you feel like you've got to go, GO! Don't hold it, as this simply delays getting rid of more bacteria.

What is the most common cause of UTI in pregnancy? ›

Urinary tract infections are common during pregnancy, and the most common causative organism is Escherichia coli.

Can you flush out a UTI without antibiotics? ›

Most UTIs need to be treated with antibiotics. But some will go away on their own without antibiotics after a few days. If you're pregnant or in a high-risk group, you should start antibiotics right away.

How do you know if a UTI has spread to your kidneys? ›

When bacteria or viruses get into your kidneys, usually through your urinary tract, they can cause a kidney infection. If you have symptoms such as pain in the sides of your lower back, fever, chills or pain while urinating (i.e., peeing), contact your doctor right away.

What should you not do with a UTI? ›

Avoid consuming foods and beverages that can irritate your bladder or worsen your symptoms, such as:
  • Caffeinated coffee.
  • Caffeinated sodas.
  • Alcohol.
  • Spicy foods.
  • Acidic fruits.
  • Artificial sweeteners.
Mar 9, 2018

Can UTI cause fetal distress? ›

Untreated bacteruria during pregnancy is associated with risks to both the fetus and the mother, including pyelonephritis, preterm birth, low birth weight, and increased perinatal mortality.

Can UTI antibiotics cause miscarriage? ›

Many classes of commonly prescribed antibiotics, including macrolides, quinolones, tetracyclines and sulfonamides may be associated with an increased risk of miscarriage during the first 20 weeks of pregnancy, a Canadian research study has concluded.

How long does it take to flush out a UTI? ›

Treatment for UTIs

Your symptoms will normally pass within 3 to 5 days of starting treatment. Make sure you complete the whole course of antibiotics that you've been prescribed, even if you're feeling better. Over-the-counter pain relief such as paracetamol can help with any pain.

Are there warning signs of stillbirth? ›

The most common symptom of stillbirth is when you stop feeling your baby moving and kicking. Others include cramps, pain or bleeding from the vagina. Call your health care provider right away or go to the emergency room if you have any of these conditions.

What is the most common cause of stillbirth? ›

In more than 1 of every 10 stillbirths, the fetus had a genetic or structural birth defect that probably or possibly caused the death. Infection. In more than 1 of every 10 stillbirths, the death was likely caused either by an infection in the fetus or in the placenta, or by a serious infection in the mother.

How long does it take for a UTI to go away with antibiotics while pregnant? ›

UTI diagnosis and treatment

If you are diagnosed with a UTI, your doctor will likely provide a pregnancy-safe antibiotic for seven to 14 days to get rid of all of the bacteria. Be sure to take the recommended full course, even if you start to feel better midway through treatment, and drink plenty of water.


1. UTIs During Pregnancy, Prevention and Treatment
(The Maternity Mentor)
2. Urinary Tract Infections (UTI) During Pregnancy | You Must Know This
(Mom Com India)
3. Warning Signs & symptoms of UTI in Pregnancy - Dr. Maheshwari V.G of Cloudnine Hospitals
(Doctors' Circle World's Largest Health Platform)
4. Urinary Tract Infection in Pregnancy | Dr. Kavitha Kovi | Aster Women & Children
(Aster Hospitals, Bangalore)
5. UTIs during pregnancy: causes & prevention
(Nourish with Melanie)
6. Can a urinary tract infection cause early labor. What should I do?


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