Genitourinary tract infections in pregnancy Dr.T.V.Rao MD

Genitourinary tract infections in pregnancy

Dr.T.V.Rao MD

URINARY TRACT INFECTIONS - Urinary tract infections remain the most common infections at any stage of pregnancy. Many presents with asymptomatic infections, Asymptomatic Bacteriuria which can only be identified on culturing the urine. It is ideal to order culturing in early pregnancy to be followed up to the last trimester of pregnancy. Most neglected part of urine culturing remains with proper collection of specimen and often left to an inexperienced nursing staff. The treating physicians should instruct the staff how to collect a mid-stream and a clean catch sample. Less experienced Microbiologists give confusing reports but should not forget to specify the validity of report. A cut off point of 100,000 bacteria/ml is the minimal criteria in healthy pregnant women with isolation of a single species e.g. E. coli, Klebsiella species will strengthen the diagnosis of urinary tract infections. Missing of asymptomatic Bacteriuria can cause premature labor and pyelonephritis in pregnant women GROUP-B STREPTOCOCCAL INFECTION There is a growing awareness on infections with Group B Streptococci. CDC advises culturing for Streptococcus B group at 35-37 weeks of pregnancy is important which can help to prevent early neonatal infection particularly premature labor. Appropriate collection of specimen from cervix remains the minimal requirement. GONOCOCCAL AND CHLAMYDIA INFECTION. They need specific or specialized techniques for precise diagnosis but only ordered in high risk group of women as they can lead to pelvic inflammatory diseases. The physician should discuss with clinical microbiologist as routine testing is not possible in less equipped laboratories BACTERIAL VAGINOSIS AND CANDIDA INFECTIONS There is a growing incidence of Gardnernella Vaginalis and Candida infection. Few laboratories have adequate facilities for characterization of etiological agents. The clinical requests should specify what they are looking for. Today we have an ever-growing list of microbes including Varicella, Herpes simplex, Parvovirus B19, Listeriosis and many others encroaching on pregnant women. An appropriate investigation and management can reduce adverse outcome, unnecessary interventions and anxiety . CAUTION ON MOLECULAR METHODS All molecular methods for diagnosis of infectious diseases ordered with caution. It is ideal to try all time-tested laboratory methods and to consider the using of molecular methods which on many occasions are research or academic tools with good number of false positive reactions. A feedback from Physicians is essential when we opt for more advanced tests, and documentation of clinical outcomes is essential in modern clinical practice

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Dr.T.V.Rao MD

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