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Pregnancy and Urinary Tract Infection
A urinary tract infection is an infection in the body's system involved in excreting urine. This system includes:

The kidneys
The ureter (tube that carries urine from the kidneys to the bladder)
The bladder
The urethra (a short tube that carries urine from the bladder to outside the body)
The infection most often occurs in the urethra and bladder. It can also travel from the bladder into the ureter and kidneys.

What Causes Urinary Tract Infections (UTIs)?
Bacteria are usually the cause of UTIs. Normally a person's urine does not contain bacteria. Bacteria are naturally present on the skin, in the lower bowel and in the stool itself. Sometimes bacteria from one of these sources enter the urinary tract system. Once there, they multiply and cause pain and irritation.

How Does Bacteria Lead to an Urinary Tract Infection?
Many times there is no obvious reason. The ways urinary tract infections occur in pregnancy is the same as in a nonpregnant woman. Some of the ways bacteria enter the urinary tract include:

Partial blockage of a urinary passage (from the pressure of an enlarged uterus, for example).
Sexual intercourse.
Catheters (tubes placed into the bladder that empty the bladder for sick people).
Stool that gets wiped into the vagina after a bowel movement.
Who Gets Urinary Tract Infections?
Anyone can get a urinary tract infection, but it is most common in women. Women can get the infection from sexual intercourse when bacteria near the vagina gets pushed up into the urinary tract.

Do Urinary Tract Infections Cause Serious Health Problems?
With proper care, urinary tract infections rarely cause serious health problems. Most infections are limited to the bladder and urethra. Once in awhile a urinary tract infection will lead to a kidney infection.

Are Urinary Tract Infections Harmful to Pregnant Women?
Pregnancy and urinary tract infections often go hand in hand since pregnant women are at an increased risk to develop UTIs. Pregnancy hormones cause changes in the urinary tract which predispose women to infections. In addition, as the uterus grows it presses on the bladder and can prevent complete emptying of urine. This stagnant urine is a likely source for infection. Untreated, these infections may lead to kidney infections. Urinary tract infections in pregnant women should be treated to prevent complications.

How Do I Know If I Have an Urinary Tract Infection?
Urinary tract infection symptoms include:

Feeling an urgent need to urinate or frequent urination.
Having difficulty urinating.
Having a burning sensation or cramps in the lower back or lower abdomen.
Having a burning sensation during urination.
Urine that looks cloudy or has an odor.


If I Think I May Have an Urinary Tract Infection, What Should I Do?
If you think you have a urinary tract infection, tell your health care provider. He or she will test a small sample of urine for bacteria and red and white blood cells. The urine may also be tested to see what kind of bacteria are in the urine (called a urine culture).

If your infection is causing discomfort, you will probably be treated before the urine test results come back.

How Are Urinary Tract Infections Treated?
Urinary tract infections are treated with antibiotics. You will need to take the medicine for 7 days or as determined by your health care provider.

How Soon Does the Medicine Work for Urinary Tract Infections?
The symptoms should go away in three days. But, don't stop taking your medication early, even if the symptoms go away (unless instructed by your health care provider).

How Can I Avoid Getting Urinary Tract Infections?
Drink at least eight glasses of water a day.
Wipe yourself from front to back.
Empty your bladder shortly before and after sex.
Use a water-based lubricant during intercourse if you feel dry.
Don't douche.
Don't use feminine deodorants or strong soaps.
Change feminine pads often.
Wash the genital area with warm water before sex.
Wear cotton underwear.
Take showers instead of baths.
Avoid tight fitting clothing and pantyhose.
Reviewed by The Cleveland Clinic OB/GYN & Women's Health Institute.

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http://www.webmd.com/baby/guide/pregnancy-urinary-tract-infection?print=true

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Making the diagnosis of UTI is of critical importance. Health care providers should have an index of suspicion in infants and children with fever and no other obvious source of infection. This also is true in children with diurnal or nocturnal enuresis that were previously toilet trained, infants and children with poor growth, or infants and children with previously diagnosed and treated renal disease. Factors that complicate the diagnosis of a UTI in infants and children include the nonspecific nature of symptoms like fever, vomiting, and pain that are associated with many childhood illnesses. The most recent guidelines issued by the AAP (1999) suggest that a UTI should be considered in infants and young children with unexplained fever, and warrants the collection of specimens for urinalysis and urine culture. Afebrile children older than 2 years of age, who present without fever but with symptoms of dysuria, urgency/frequency, hematuria, flank pain, or new onset of enuresis, should also be evaluated with a urinalysis and urine culture (Johnson, 1999).

The urinalysis and urine culture are the two diagnostic tests that will assist with making the diagnosis. The urinalysis is a helpful screening and diagnostic tool, while the urine culture is considered the "gold standard" and the only absolute way to make the diagnosis of a UTI (Wald, 2004).

The urinalysis is used to provide quick information to support the diagnosis of a UTI. In most office settings, urinalysis is performed using a dipstick method. When using a urine dipstick one must be careful to ensure that the dipsticks have not expired. When interpreting the results it is important to check the urine dipstick at the appropriate time intervals as indicated on the dipstick bottle. The urine dipstick test checks for the presence of leukocyte esterase and nitrites. Leukocyte esterase is a biochemical that is released from white blood cells (WBCs) secondary to bacterial invasion, which causes the release of esterase. Urinary nitrites are produced by the bacterial breakdown of dietary nitrate. Leukocyte esterase, nitrites, and microscopy are the components of the urinalysis that are most useful in the evaluation of a UTI (Poole, 2002). The sensitivity of both esterase and nitrites is low and therefore there is a high risk of missing a UTI (Wald, 2003). The specificity or accuracy for leukocyte esterase is in the range of 78% while the specificity for urine nitrite is about 98% (Rushton & Long, 2002). When either the leukocyte esterase or the nitrite tests are positive, the likelihood of a UTI increases but the number of false positives also increases (Ahmed & Swedlund, 1998).

The enhanced urinalysis is a newer technique developed to predict UTI in low-risk infants and children. It utilizes uncentrifuged urine and a Neubauer hemocytomer to evaluate the number of WBC/mm3 (cell count). This method is far superior to the standard urinalysis in successfully distinguishing between colonization, contamination, and asymptomatic bacteriuria, thus providing health care providers with the ability to detect a true UTI, especially in the febrile infant (Herr, Wald, Pitetti, & Sylvia, 2001).

To make a definitive diagnosis of UTI, a quantitative urine culture must be performed. This requires that urine be properly collected and the specimen transmitted to a lab for inoculation on culture media within 1 hour of collection. Urine specimens that cannot be processed within 1 hour of collection should be refrigerated to prevent the growth of organisms that occur with prolonged exposure to room temperature.

The challenge in obtaining a reliable urine culture is related directly to the difficulty in collecting uncontaminated urine from infants and young children. Methods to obtain a urine specimen include the suprapubic aspiration (SPA), transurethral catheterization, midstream collection, and bagged collection. The method of collection least likely to result in contaminated urine is the SPA because collection bypasses the distal urethra. Transurethral catheterization is considered the next best approach for obtaining uncontaminated urine.

In the infant or child aged 2 months to 2 years, the most effective and reliable way of obtaining a urine specimen is to perform either a SPA or transurethral catheterization (AAP, 1999). It is important to keep in mind, however, that parents may resist the recommendation to obtain urine by SPA, in which case the health care provider should be prepared to acquire the urine specimen through another method of collection. For older children a midstream urine collection is adequate when obtained correctly. In our experience a good way to obtain the clean catch urine is to have the child sit facing the back of the toilet (straddle). The nurse or parent should be positioned behind the child holding a sterile container for urine collection. Cleansing is not helpful or necessary because the first few drops of urine are discarded into the toilet to allow for collection of the midstream specimen.

A bagged specimen is useful for urinalysis, but unsuitable for urine culture. If urinalysis of a bagged specimen suggests the presence of a UTI, then a second specimen (preferably obtained by transurethral catheterization) is needed to verify the diagnosis. To increase the likelihood of obtaining an uncontaminated bag specimen, the child's perineum should be cleansed with soap and rinsed thoroughly with water before the bag is applied. As soon as the child has voided the bag should be removed. If voiding does not occur within 15 minutes after applying the bag, the bag must be removed and reapplied following the same cleaning routine. The bag must be checked every 15 minutes until the child voids. According to the AAP (1999), most pediatricians believe that the analysis of urine obtained through bag collection is an effective means of eliminating the diagnosis of UTI in children not receiving antimicrobial therapy. Moreover, the procedure is noninvasive, requires limited staff training or involvement, and is reliable so long as the urine is not contaminated by antibacterial agents used for perineal skin cleansing.