Urinary Tract Infections in Pregnant Women in Second Trimester and the Risk of Preterm Birth

Abstract

Introduction. Preterm birth, defined as delivery less than 37 weeks of gestation, is the most common cause of neonatal mortality and morbidity accounting for 11% of pregnancies worldwide. Pregnancy causes nume¬rous changes in the woman’s body that increase the risk of urinary tract infections (UTIs). Hormonal and mechanical changes can promote urinary stasis and ve¬sicoureteral reflux, along with an already short urethra (3-4 cm in females) and difficulty with hygiene due to a distended pregnant belly, help make UTIs the most common bacterial infections during pregnancy predo¬mi¬nantly with Escherichia coli, but also with Staphylococcus saprophyticus, Klebsiella, Enterobacter, Proteus, Entero¬coccus, etc. The aim of the study was to prove the re¬lationship between UTIs in pregnancy and their risk to cause preterm birth (<37 g.w.). Methods. This is a prospective case- control study, conducted at the University Clinic of Gynaecology and Obstetrics, Ss’ Cyril and Methodius University, Medical Faculty, Skopje, Republic of North Macedonia at the Department of High-Risk pregnancy. The study included 103 patients with signs and symptoms of preterm labour. Patients between 28-36 g.w. were followed until the end of the pregnancy. Obstetric ultrasound on Voluson 730 pro machine was performed by two experienced ultrasound observers calculating the fetal weight, esti¬mating the gestational week and measuring the cervi¬cal length so the variations for the measurements have been minimized. Mid-stream urine sample was sent for cytology and culture-sensitivity. Results. All 103 patients in the study had signs and symptoms of preterm labour. Out of the total of 103 patients 65 (63%) had a positive urine sample, and 38 (36.9%) patients had negative urinalysis. The results showed that patients who had signs and symptoms of preterm birth were significantly different in women who had po¬sitive compared to those who had negative urine sample (p=0.0049). Microorganisms cultured in urine were predominantly gram-negative bacilli, although there were also gram-positive bacilli detected. E coli was the commonest microorganism cultured in the urine. Conclusion. Urogenital infections contribute signi¬fy-can¬tly to the preventable causes of preterm labor. The be¬nefit of the study lies in detecting asymptomatic ca-ses, so that this complication can be timely prevented. Making early diagnosis of urogenital infections and treating them adequately with the antimicrobials will help in dec¬reasing the incidence of preterm labor, preterm births, and the associated neonatal and maternal morbidities.