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Explanation of analyzes

Cystitis in pregnancy: symptoms and treatment

What it is?

Cystitis is characterized by an inflammatory process in the bladder caused by microorganisms. According to statistics, every third woman for pregnancy has at least 1 episode of urinary tract infections - cystitis accounts for about 2%. In pregnant women, it can be either acute or relapsing.

Content

What to do if there is a cystitis in pregnancy?

Cystitis in pregnancy is diagnosed - what should I do? The most important thing about what a woman needs to know is that this disease develops as a result of the acquisition of pathogenic properties by normal bacteria living in the periurethral area.

Therefore, it is very important in addition to treating a specialist to observe hygienic measures in the intimate zone. It should be avoided funds (soap, gel), containing antibacterial component.

They can become an additional factor that disrupts the normal relationship between microorganisms. And this becomes the reason, causing "acquisition" of bacteria by pathogenic properties.

Cystitis in Pregnancy

Is cystitis dangerous during pregnancy?

Cystitis can predispose to the development of complications on the part of the mother and the fetoplacental system (mother-child-placenta). The maternal risk caused by cystitis increases if:

  • Violation of excretion of urine due to swelling of the walls of the bladder and urethra;
  • There is urolithiasis;
  • Renal failure;
  • Insufficiency of the liver;
  • Anemia (especially sickle cell);
  • Diabetes;
  • Viral infection.

The risks of cystitis for the fetus are to increase the likelihood of certain obstetric complications:

  • Premature delivery;
  • Infection in utero;
  • Stunting and weight gain;
  • Fatal outcome (in utero or after birth).

Symptoms of cystitis during pregnancy

Symptoms of cystitis during pregnancy

Symptoms of cystitis during pregnancy are quite bright:

  1. Increased urination and aching, reaching a maximum at the end of urination;
  2. Pain above the lump;
  3. Desires to urinate, which are not crowned with success.

Diagnosis of cystitis doctor puts on the basis of a comprehensive study of the results of a survey of a pregnant patient:

  • Clinical symptoms;
  • Identification in the urine of an increased number of leukocytes - more than 10 in 1 field of research (leukocyturia);
  • Determination of bacteria in urine;
  • Identification of terminal hematuria, which can be observed in rare cases (the presence of unchanged erythrocytes in the urine of the average portion).

In some cases, the diagnosis is made erroneously - only to identify leukocyturia in the absence of clinical symptoms. It is not right.

A combination of clinical and laboratory signs of inflammatory lesion is necessary. In addition, leukocytes in the urine in an increased amount can be the result of getting them there from the genital tract. Therefore, when collecting urine for analysis, it is recommended to wash thoroughly and close the vagina with a cotton disc.

An important diagnostic value is also the bacteriological study, with the help of which it is possible to estimate the number of bacteria in the urine. It is extremely necessary if an ordinary urinalysis reveals only leukocytes, and microorganisms are not detected. Usually this happens if:

  1. The pregnant woman herself started taking antibiotics;
  2. The infection is caused by rare microorganisms - candida, tuberculous mycobacteria, chlamydia, herpes virus, ureaplasma;
  3. There is non-infectious kidney disease (interstitial nephritis, congenital anomalies);
  4. Helminthiasis .

The diagnostic titer of bacteriuria in cystitis is 100 cfu / ml for E. coli and 100 000 for all other microorganisms. These values ​​help distinguish cystitis from urethritis, the symptoms of which are similar. However, with urethritis, the bacteria in the urine are not detected in diagnostically meaningful titres.

Cystitis in early pregnancy

A pregnant woman is predisposed to developing an infectious process in the bladder. This is a consequence of several causal mechanisms:

  • The small length of the urethra and its large diameter;
  • The proximity of the urethra to the rectum, which is a natural reservoir of infectious agents;
  • Decrease in tone of the bladder and sphincter, caused by elevated levels of estrogens and progesterone due to gestation;
  • Stagnation of urine, observed in the second half of pregnancy and associated with increased size of the uterus;
  • Decrease in the tone of the sphincter of the urethra, which develops closer to the term of labor;
  • The alkalinization of urine associated with increased excretion of bicarbonates through renal glomeruli;
  • Change in the functioning of the immune system (during pregnancy, a shift in her work towards immunosuppression is observed, as a result of which the E. coli is activated).

How to treat cystitis in pregnancy?

How to treat cystitis in pregnancy

Treatment of cystitis during pregnancy in early terms is carried out by antibacterial drugs, however, as well as late. The choice of means depends on the particular causative agent, but it is not always possible to carry out a bacteriological study in each case. In addition, this is an additional loss of time.

Therefore, in selecting an antibiotic, the physician focuses on existing epidemiological data on the prevalence of certain microorganisms, which are causative agents of cystitis (this is called empirical treatment). This list in descending order is as follows:

  • E. coli (detected in 80% of cases);
  • Klebsiella (10%);
  • Proteus (5%);
  • Staphylococcus aureus (4%);
  • enterococcus (4%);
  • enterobacteria (2%);
  • Morganella (0.8%);
  • candidates (0.8%) and others.

A recent study found that antibiotics previously used for the treatment of cystitis proved to be ineffective against E. coli as the most frequent pathogens - they found themselves resistant to them. Therefore, in modern conditions, pregnant women are not trying to prescribe: ampicillin and amoxicillin with clavulanic acid, some cephalosporins.

The ideal antibiotic for the treatment of cystitis should accumulate as much as possible not in the walls of the bladder, but in the urine. So he can have a longer effect on the tissue. At the same time, it should not be dangerous to the fetus.

These two requirements are best met by the following antibiotics, which should be used to treat cystitis in obstetric practice:

  1. Fosfomycin (its advantage is the sufficiency of a single dose, however, it is allowed to be used from 13 weeks).
  2. Aztreonam (treatment course - a week).
  3. Some cephalosporins of the 2nd - 4th generation (Cefixime and Cefuroxime).

If they are ineffective in the second trimester, you can use an alternative drug Nitrofurantoin (Furadonin). The duration of its administration should be 7 days.

The drug can not be used from the 34-35th week and later, because this can cause the development of hemolytic disease in the fetus.

Antibacterial treatment is carried out on average 1 week. Then after 7-14 days, urine is examined. If you get good results, you do not need to repeat courses.

Unsatisfactory tests (pathogen found) - a second course of antibiotics, after which a bacteriological study is carried out, which is repeated every month until the term of labor.

If, after such events, the pathogen is detected, then the treatment according to a special scheme is performed before the delivery and within 2 weeks after them, for fear of a high risk of septic condition.

Medicinal plants in the treatment of cystitis

Medicamentous therapy of cystitis in pregnant women is rationally supplemented by the intake of medicinal plants. Their important advantage is security. The most reasonable application is:

  • bearberry;
  • rose hips;
  • sage;
  • nettle;
  • St. John's wort;
  • field horsetail;
  • chamomile and others.

You can use the official herbal preparation - Kanefron. It has a complex effect on the urinary system in pregnant women:

  • increases diuresis;
  • relieves spasm;
  • has antibacterial action;
  • dilates blood vessels;
  • suppresses the inflammatory reaction;
  • struggles with free radicals;
  • protects the kidneys;
  • Suppresses the attachment of E. coli to the cells of the urinary system.

Preventive maintenance of a cystitis at pregnancy

In women at risk, effective prevention of cystitis in pregnancy is performed with the drug Kanefron. However, to achieve this goal, it is recommended to apply at least four months. It can be carried out in a continuous mode immediately before childbirth or courses a month with interruptions of 2 weeks.

Prevent serious complications and timely examination of urinary sediment during pregnancy. This analysis is assigned to women before each visit to the gynecologist.

In the event of detection of even minimal deviations, it is recommended to have a follow-up examination and, if necessary, administer treatment.

Interesting
2017-02-22 18:10:22
Good article, informative! Has given answers to many questions. Author Respect!

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