Bacteriuria in the puerperium: risk factors, screening procedures, and treatment programs

Article Abstract:

Urinary tract infections (UTI) often affect women in the period immediately after delivery. Since many antibiotic drugs pass into the breast milk, treatment should be given only when necessary. Diagnosis of bacteria in the urine (bacteriuria) is made by culturing a urine sample obtained during midstream urine sampling. However, contamination of the urine sample with postpartum discharge can result in false-positive test. Contamination can be reduced by sampling the bladder contents directly. Suprapubic aspiration removes urine with a small needle that enters the bladder from above the pubic bone. The reliability of midstream urine sampling was compared with results obtained from sampling the bladder contents directly in 6,803 patients. Bacterial growth was detected by midstream sampling in 8.1 percent of the patients. Bacterial growth was confirmed by suprapubic sampling in 52 percent of the patients, and the true incidence of bacteria in the urine was 3.7 percent. Women with a past history of UTI, and those requiring a cesarean section delivery, epidural anesthesia and a bladder catheterization to remove urine, were at a greater risk of a UTI after delivery. There were a total of 251 women who required treatment with antibiotics. Amoxicillin was required in 153 patients. The treatment was successful in 19 patients (84 percent) receiving one-day treatment, 69 patients (94 percent) receiving a three-day treatment, and 65 patients (98 percent) undergoing 10 days of treatment. A seven-day treatment with cephalexin or nitrofurantoin antibiotics was successful in 91 percent of the 46 women with bacteria resistant to amoxicillin. Of the 52 women receiving no treatment, 24 patients (27 percent) still had bacteria in the urine 10 weeks later. Treating the women with antibiotics for at least three days produced a better cure rate than a one-day treatment plan or no treatment at all (spontaneous cure). Since only 21 percent of the patients had symptoms of a UTI, such as pain on urination or lower abdominal pain, all patients at risk for urinary tract infections should have urine cultures performed after delivery. Positive midstream cultures should be repeated. A three-day treatment regimen should be offered to patients with confirmed bladder infections. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Diagnosis, Risk factors, Drug therapy, Postnatal care, Bacteria in the urine, Bacteriuria

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Effectiveness of antibiotic prophylaxis in preventing bacteriuria after multichannel urodynamic investigations: a blind, randomized study in 124 female patients

Article Abstract:

There has been some indication that testing of urination and bladder function in women may lead to the development of urinary tract infections. Such testing can involve measurement of urine flow, testing of muscle function, and catheterization, which can potentially irritate surfaces, allowing any bacteria present to attach and grow. The incidence of unsuspected bacteriuria (bacteria in urinary tract) before urodynamic testing and the effect of preventive antibiotic therapy on post-instrumentation infections were studied in 124 female patients. All patients had sterile (no bacteria present) urine when specimens were obtained from midstream flow, but 10 women tested positive for infection when urine was obtained by catheter. Of the 102 women who completed the study, 4 of the 49 women who received antibiotics and 10 of the 53 women who received a placebo did not develop urinary tract infections. Although the rate of infection in treated women was half that of the untreated group, a statistically significant difference was not observed. A greater number of study subjects or a different dose or type of antibiotic might have led to a statistically significant trend. Prophylactic antibiotic treatment may be beneficial before urodynamic testing, but further research is needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Antibiotics, Urinary organs, Urinary tract

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Osteoporotic fractures and the recurrence of thromboembolism during pregnancy and the puerperium in 184 women undergoing thromboprophylaxis with heparin

Article Abstract:

Treatment with heparin may increase the risk of osteoporotic fractures of the spine in pregnant women regardless of the dosage or duration of treatment. Heparin is an anticoagulant used to prevent the development of a blood clot. A study examined the incidence of spinal fractures and recurrent blood clots during pregnancy or after labor in 184 pregnant women undergoing long-term treatment with subcutaneous heparin. Two percent of the women developed osteoporotic fractures of the spine. Women who developed an osteoporotic fracture of the spine had been receiving 15,000 to 30,000 IU of heparin per day. The duration of treatment among these women ranged from seven to 27 weeks. Three percent of the women suffered recurrence of a blood clot despite treatment with heparin. The dosage of heparin should be increased during pregnancy, because blood levels of different coagulation factors increase during pregnancy.

Thromboembolism, Osteoporosis, Pregnancy, Complications of, Pregnancy complications, Spinal fractures, Heparin, Spine

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