Management Recommendations of Cystitis in Pregnancy

Urine specimen must be taken for culture and sensitivity before initiating treatment. The mid-stream urine sample and clean catch urine samples are preferred. For the purpose the first part of the urine is discarded and a 10 ml of the sample is collected in the sterile container for sample analysis.

Empirical treatment can then be initiated with trimethoprim, nitrofurantoin or cephalexin and if the sensitivity of the cultured organisms is identified then adjustments to the antibiotic can be made accordingly.

The pain and fever can be managed with the use of paracetamol, and at the end of completion of antibiotic regimen after 7 days, again urine sample is collected for examination of complete eradication of bacteria.

During pregnancy every month the urine sample is collected for analysis of asymptomatic symptoms.

Case Study-Complications of UTI in Pregnancy

     Possible complications include:

• Developmental delay in infant,
• Cerebral palsy in infant,
• Fetal death.

Case Study-Incidence of UTI in Pregnancy

A review of UTI in pregnancy reported that:

• The incidence of asymptomatic bacteruria (presence of bacteria in urine without symptoms) is 2-10%,
• The incidence of acute cystitis (infection of the bladder) is in the range of 1-4% and
• 20-40% of the women with asymptomatic bacteruria develop pyelonephritis (infection of the kidney) later in pregnancy. 

Case Study-UTI in Pregnancy

Urinary Tract Infections are caused by bacteria in the gastrointestinal tract, Escherichia coli accounts for about 90% of the cases of UTIs in the community settings.

Other organisms responsible for UTIs include Staphylococcus species, Proteus mirabilis, Enterococci and Candida albicans

Candida albicans UTI is caused in the hospital settings due to indwelling catheters, diabetes mellitus, immunosuppression and those on antibiotic treatment.

Case Study- Counselling with the use of Mefenemic Acid Tablets

You have prescribed mefenemic acid 500 mg tablets, take one tablet three times a day before or at the onset of menstruation, and take till the pain lasts. Ibuprofen belongs to the same class as that of mefenemic acid, so avoid taking both together as it may result in stomach upset.

Case Study- Other option for Dysmenorrhoea

Combined oral contraceptives are helpful, if prostaglandin inhibition fails. They work by thinning endometrial lining and inhibiting ovulation, causing low levels of uterine prostaglandins.

Case Study- Non-drug treatment for dysmenorrhoea

High frequency transcutaneous electrical nerve stimulation (TENS) is preferred in woman who does not prefer to take medicines. It works by altering the body’s ability to receive or perceive pain rather than having a direct impact on uterine contractions.

Case Study- Mechanism of action of mefenemic acid

Elevated levels of prostaglandins are present in the endometrial fluid of dysmenorrhoeic women and present well with a degree of pain. The use of mefenemic acid which works by inhibiting prostaglandin synthetase helps in relieving pain by decreasing uterine prostaglandin levels and uterine contractility.

Case Study- Risk factors of dysmenorrhoea

Risk factors include:

• Cigarette smoking,
• Nulliparity,
• Obesity,
• Positive family history,
• Late child bearing,
• Being sexually inactive.