This clinical article presents information on the etiology, incidence, diagnosis, and management of asymptomatic bacteriuria and cystitis. He is actively involved in studying clinical policies within the Society of Teachers of Family Medicine and the American Academy of Family Physicians. When the lower UTIs of asymptomatic bacteriuria and cystitis are not eradicated, the subsequent risk of the development of pyelonephritis is increased. Clin Obstet Gynecol. Effective prophylaxis for recurrent urinary tract infections during pregnancy. Puerperal and perinatal infections with group B streptococci. Outpatient treatment of pyelonephritis in pregnancy: a randomized controlled trial. ACOG educational bulletin no. What are the management recommendations for cystitis in pregnancy? National Library of Medicine Asymptomatic bacteriuria, acute cystitis, and acute pyelonephritis. All pregnant women should be screened for bacteriuria and subsequently treated with antibiotics such as nitrofurantoin, sulfisoxazole or cephalexin. el Sheikh M, Uncomplicated urinary tract infections (UTIs) are one of the most common diagnoses in the United States. Experts say you're more likely to get a urinary tract infection (UTI) while you're pregnant, which may cause frequent urination, pain or burning during urination, and abdominal discomfort. A UTI may manifest as asymptomatic bacteriuria, acute cystitis or pyelonephritis. Campbell-Brown M, Shelokov A. Teaching Parents to Nurture. Mazor M, 1994;84:405–10. Brumfitt W. 2016 Mar. Escherichia coli accounts for 80 to 90 percent of infections. ACOG educational bulletin no. Aim: The purpose of the present study was to describe effective nursing care through evaluation of a nursing intervention that enhanced acceptance of pregnancy and focused on a comfortable experience for pregnant women. A study of various tests to detect asymptomatic urinary tract infections in an obstetric population. 33. Effective prophylaxis for recurrent urinary tract infections during pregnancy. Immediate, unlimited access to all AFP content. When the lower UTIs of asymptomatic bacteriuria and cystitis are not eradicated, the subsequent risk of the development of pyelonephritis is increased. 1995;50:675–83. Single-dose antimicrobial therapy for asymptomatic bacteriuria during pregnancy. Roark ML. 2a. 1995;864 pt 1560–4. Nursing Diagnosis for Urinary Tract Infection Nursing Care Plans for UTI 5 Nursing Care Plans for Urinary Tract Infection. 1981;141:709–16. The most common reason for initial treatment failure is resistance of the infecting organism to the antibiotic. Patel NB, MMWR Morb Mortal Wkly Rep. Plante DA. Whalley PJ, Am Fam Physician. Davis F. In pregnant women, the incidence of UTI can be as high as 8 percent.1,2 This article briefly examines the pathogenesis and bacteriology of UTIs during pregnancy, as well as patient-oriented outcomes. Romero R, Cochrane Database Syst Rev. Asymptomatic bacteriuria and symptomatic urinary tract infections in pregnancy. 38. Renal infection and pregnancy outcome. Neiger R, Dillon HC Jr. Learn more from WebMD about the causes, symptoms, treatment, and prevention of UTIs in pregnancy. Paldi E. The cost of screening for bacteriuria to prevent the development of pyelonephritis in one patient was $1,605, while the cost of treating one patient with pyelonephritis was $2,485. Urinary tract infection prophylaxis in men and antibiotic course length for prostatitis Alternative management of lower urinary tract infection in non-pregnant women Decision aid for diagnosis and management of suspected urinary tract infection (UTI) in people with indwelling catheters Wood EG, Single-dose antimicrobial therapy in the treatment of asymptomatic bacteriuria in pregnancy. Alternatively, cephalosporins are well tolerated and adequately treat the important organisms. Some authorities have advocated shorter courses of treatment—even single-day therapy. Neiger R, Resistance of urinary tract isolates of Escherichia coli to cotrimoxazole, sulphonamide, trimethoprim and ampicillin: an 11-year survey. Pass MA, Results indicated a significant reduction in rates of premature rupture of membranes and preterm delivery in the women who received antibiotics. Washington, D.C.: American College of Obstetricians and Gynecologists, March 1998;245:8–10. 1993;36:855–68. Hospitalization, although often indicated, is not always necessary. Sacks TG. Vila J, Dillon HC Jr. Semin Perinatol 1993;17:367–78, and Krieger JN. Morales WJ, Asymptomatic bacteriuria can lead to the development of cystitis or pyelonephritis. Vinson R. 1998;92:249–53. Thomsen AC, 26. Gilstrap LC 3d. Lake M, Diokno AC, In the 2016 point-prevalence survey of Healthcare-associated infection and Antimicrobial use in Long-Term care facilities (“HALT”), 4.7% of residents in long-term care facilities (LTCFs) were on an antibiotic for either treatment or prophylaxis (prevention) of UTI. 2c. Borch K, Lower urinary tract dysfunction in pregnancy: a review. Recommendations. 24. Hansen KB. A seven- to 10-day course of antibiotic treatment is usually sufficient to eradicate the infecting organism(s). Beta-lactam resistance in gram-negative bacteria: global trends and clinical impact. Obstet Gynecol. The significance of eradication of bacteriuria during pregnancy. Harris RE, It includes the management of treatment failure following initial antibiotic treatment. 25. Management of acute uncomplicated infections in non-pregnant women is usually simple and involves antibiotic treatment for 3–5 days. Benvie DT. Urinary tract infection (UTI) is one of the most common infections affecting the elderly. Torres PJ, Urinary tract infections (UTIs) are one of the most frequent complications of pregnancy. Weight management. UTIs are common during pregnancy. J Reprod Med. 3. Leigh DA, Gruneberg RN, Urinary tract infection is a common health problem, affecting millions of people each year. Which antibiotics used to treat UTI can be safely prescribed in pregnancy? urinary tract infection. Persky V, Risk of preterm delivery in pregnant women with group B streptococcal urinary infections or urinary antibodies to group B streptococcal and. Antibiotic elimination of group-B streptococci in urine in prevention of preterm labour. Alonso PL, Careers. J Fam Pract. Puerperal and perinatal infections with group B streptococci. He is a co-chair of the Group on Family-centered Perinatal Care for the Society of Teachers of Family Medicine.... MICHAEL L. LEFEVRE, M.D., M.S.P.H., is professor of family and community medicine at the University of Missouri-Columbia School of Medicine, where he completed his medical degree, a residency in family medicine and a fellowship in academic medicine. Kass EH. JAMA. 39. 17. el Sheikh M, 1992;14:810–4. Millar LK. Asymptomatic bacteriuria is common, with a prevalence of 10 percent during pregnancy.6,8 Thus, routine screening for bacteriuria is advocated. Methods: Thirty‐two subjects who were expected to have a normal pregnancy were assigned into either the intervention or the control group. A single, postcoital dose or daily suppression with cephalexin or nitrofurantoin in patients with recurrent UTIs is effective preventive therapy.37 A postpartum urologic evaluation may be necessary in patients with recurrent infections because they are more likely to have structural abnormalities of the renal system.26,30,38 Patients who are found to have urinary stones, who have more than one recurrent UTI or who have a recurrent UTI while on suppressive antibiotic therapy should undergo a postpartum evaluation.30,38, The maternal and neonatal complications of a UTI during pregnancy can be devastating. 1987;100:341–2. However, hospitalization is indicated for patients who are exhibiting signs of sepsis, who are vomiting and unable to stay hydrated, and who are having contractions. Complications and treatment of urinary tract infections during pregnancy. In the 1960s, Kass6 noted the subsequent increased risk of developing pyelonephritis in patients with asymptomatic bacteriuria. Infect Dis Clin North Am. Major goals for the patient may include: Relief of pain and discomfort. Without treatment, as many as 20 to 35 percent of pregnant women with asymptomatic bacteriuria will develop a symptomatic urinary tract infection (UTI), including pyelonephritis, during pregnancy . Increased bladder volume and decreased bladder tone, along with decreased ureteral tone, contribute to increased urinary stasis and ureterovesical reflux.1 Additionally, the physiologic increase in plasma volume during pregnancy decreases urine concentration. Lancet. Paul RH, 2,3 The incidence of asymptomatic bacteriuria in pregnant women as determined in UK studies is 2–5%. Pregnant women should be treated when bacteriuria is identified (Table 217,18). COVID-19 is an emerging, rapidly evolving situation. Paul RH, Am J Obstet Gynecol. Cararach V. Campbell-Brown M, Fortunately, … Bacteriuria in pregnancy. 2c. Management. What are the possible complications of UTI during pregnancy? Copyright © 2000 by the American Academy of Family Physicians. 2008 Oct;38 Suppl 2:50-7. doi: 10.1111/j.1365-2362.2008.02009.x. JOHN E. DELZELL, JR., M.D., is assistant professor of clinical family and community medicine and assistant residency director at the University of Missouri-Columbia School of Medicine, where he received his medical degree and completed a residency in family medicine. All pregnant women should be screened for bacteriuria and subsequently treated with appropriate antibiotic therapy. Barr JG, 1984 Jun;75(8):153-7, 161. doi: 10.1080/00325481.1984.11698643. 1981;140:515–20. Confirming the … Debuque L, Clin Infect Dis 1992;14:810–4, Address correspondence to John E. Delzell, Jr., M.D., MA 303 Health Sciences Center, University of Missouri-Columbia School of Medicine, Columbia, MO 65212. Evans DC, As a result of antibiotic resistance, an accurate diagnosis is imperative and should be based on clinical history, presence of typical signs and symptoms and test results. Table 217,18 lists oral antibiotics that are acceptable treatment choices. Fairley KF, Unable to load your collection due to an error, Unable to load your delegates due to an error. . Hendershott CM, Even with appropriate treatment, the patient may experience a reinfection of the urinary tract from the rectal reservoir. Leveno KJ, Clin Infect Dis. See related patient information handout on urinary tract infections during pregnancy, written by the authors of this article. 61/No. / Vol. Pregnant women are more vulnerable to getting urinary tract infections. 74 Catheter-Associated Urinary Tract Infection 99 Renal Abscess ... Philippine Clinical Practice Guidelines on the Diagnosis and Management of Urinary ... UTI in pregnancy and asymptomatic bacteriuria, Cluster C – complicated UTI, and Cluster D – recurrent UTI. Whalley PJ, Urinary tract infections (UTIs) are frequently encountered in the family physician's office. EXECUTIVE SUMMARY. Historically, ampicillin has been the drug of choice, but in recent years E. coli has become increasingly resistant to ampicillin.19 Ampicillin resistance is found in 20 to 30 percent of E. coli cultured from urine in the out-patient setting.20 Nitrofurantoin (Macrodantin) is a good choice because of its high urinary concentration. Women are more likely to get UTIs than men. 1985;92:498–505. There are approximately 6 million pregnancies each year in the United States. Andrews WW, 8600 Rockville Pike Screening and treatment of asymptomatic bacteriuria in pregnancy prevent pyelonephritis. 2b. Urinary tract infection during pregnancy, angiogenic factor profiles, and risk of preeclampsia. Plante DA. Clin Infect Dis. 2d ed. Urine Sampling The specimen should be mid-stream. Krieger JN. Urinary tract infections (UTIs) are a common complication of pregnancy. Other common antibiotics (e.g., fluoroquinolones and tetracyclines) should not be prescribed during pregnancy because of possible toxic effects on the fetus. Vila J, Sanders CC, Obstet Gynecol. UpToDate. Masterton RG, U.S. Preventive Services Task Force. In this study, about 1 in 10 pregnant women had a diagnosis of a UTI just before or during pregnancy. Barr JG, Pregnancy, pyelonephritis and prematurity. 27. Want to use this article elsewhere? ABSTRACT: An estimated 11% of U.S. women report at least one physician-diagnosed urinary tract infection (UTI) per year, and the lifetime probability that a woman will have a UTI is 60% 1 2.Despite the frequency of UTIs, there is confusion about diagnostic strategies, and changes in antimicrobial resistance among uropathogens require alterations in traditional treatment regimens. Gilbert GL. Gilstrap LC 3d, Acute pyelonephritis in pregnancy: an anterospective study. Timmerman MG. What is the incidence of UTI in pregnancy? Lucas MJ, Don't miss a single issue. Peddie BA, Heise RH, Semin Perinatol. It is of importance to obstetricians because of its association with significant maternal and perinatal morbidity and mortality. Urinary tract infection during pregnancy. Urol Clin North Am. Loughlin KR. This activity reviews the evaluation and management of urinary tract infection in pregnancy and highlights the role of interprofessional team members in collaborating to provide well-coordinated care and enhance outcomes for affected patients. Group B streptococcus is generally susceptible to penicillin, but E. coli and other gram-negative rods typically have a high rate of resistance to this agent. Absence of complications. Guest editor of the series is Robert L. Blake, Jr., M.D. Wadland WC, 19. A randomized trial of three antibiotic regimens for the treatment of pyelonephritis in pregnancy. N Engl J Med. Lower urinary tract infections generally present as cystitis, which is an infection of the superficial bladder mucosa. el Deeb K. The bacteria enter through the tube that carries pee out of the body (urethra). Guest editor of the series is Robert L. Blake, Jr., M.D, urinary tract infections during pregnancy, Recognizing an Index Case of Tuberous Sclerosis, Treatment of Psoriasis: An Algorithm-Based Approach for Primary Care Physicians. 31. [ Gram-positive organisms such as group B streptococcus and Staphylococcus saprophyticus are less common causes of UTI. A study of various tests to detect asymptomatic urinary tract infections in an obstetric population. [3] Rouse DJ, 16. Pfau A, Knuppel RA. Am J Obstet Gynecol. Masterton21 demonstrated a cure rate of 88 percent with a single 3-g dose of ampicillin in ampicillin-sensitive isolates. Increases in urinary progestins and estrogens may lead to a decreased ability of the lower urinary tract to resist invading bacteria. CDC’s Division of Reproductive Health conducts research to better understand pregnancy-related problems, with the aims of making pregnancy healthier, preventing or managing complications, and reducing poor pregnancy outcomes, including death—the most extreme adverse outcome. The gold standard for detection of bacteriuria is urine culture, but this test is costly and takes 24 to 48 hours to obtain results. Pregnant women are more vulnerable to getting urinary tract infections. Seski J, Diagnostic tests may include renal ultrasonography or an abbreviated intravenous pyelogram. Relieve pain. 34. Pregnant women with urinary group B streptococcal infection should be treated and should receive intrapartum prophylactic therapy. Bracken M. Prevention and treatment information (HHS). It includes adult women (including pregnant Sirtori M, Women have a shorter urethra than men. 1982;143:147–52. Bracken M. Treatment of urinary tract infections during pregnancy. Centers for Disease Control and Prevention . This has not been studied in pregnant women, and finding more than 105 colony-forming units per mL of urine remains the commonly accepted standard. Some pharmacies offer a UTI management service and can prescribe antibiotics if they're needed. UTIs during pregnancy are a common cause of serious maternal and perinatal morbidity; with appropriate screening and treatment, this morbidity can be limited. 10. Heise RH, Gilstrap LC 3d, / While this does not prove a cause and effect relationship, randomized trials have demonstrated that antibiotic treatment decreases the incidence of preterm birth and low-birth-weight infants.13 A risk of urosepsis and chronic pyelonephritis was also found.40 In addition, acute pyelonephritis has been associated with anemia.41, Low birth weight (weight less than 2,500 g [5 lb, 8 oz]), Prematurity (less than 37 weeks of gestation at delivery), Preterm low birth weight (weight less than 2,500 g and less than 37 weeks of gestation at delivery), Premature labor (less than 37 weeks of gestation at delivery), Amnionitis (chorioamnionitis, amnionitis). Wadland and Plante15 performed a similar analysis in a family practice obstetric population and found screening for asymptomatic bacteriuria to be cost-effective. . Members of various medical faculties develop articles for “Practical Therapeutics.” This article is one in a series coordinated by the Department of Family and Community Medicine at the University of Missouri–Columbia School of Medicine, Columbia, Mo. Harris RE. enefits of screening for asymptomatic bacteriuria Early screening for and treatment of asymptomatic bacteriuria in pregnancy … A clinical trial comparing three parenteral regimens found no differences in length of hospitalization, recurrence of pyelonephritis or preterm delivery.29 Patients in this trial were randomized to receive treatment with intravenous cefazolin (Ancef), intravenous gentamycin plus ampicillin, or intramuscular ceftriaxone. Lancet. Antimicrobial therapy for obstetric patients. What is the incidence of UTI in pregnancy? Dillon HC Jr. Bailey RR, 11. Stamm WE, The choice of antibiotic should address the most common infecting organisms (i.e., gram-negative gastrointestinal organisms). Bramham K, Parnell B, Nelson-Piercy C, Seed PT, Poston L, Chappell LC. Complications and treatment of urinary tract infections during pregnancy. Bachman and associates16 compared these screening methods with urine culture and found that while it was more cost effective to screen for bacteriuria with the esterase dipstick for leukocytes, only one half of the patients with bacteriuria were identified compared with screening by urine culture. Complications and treatment of urinary tract infections during pregnancy. 1989;73:576–82. Urinary tract infection (UTI) is common in pregnancy.It can be asymptomatic,as well as symptomatic,complicating the diagnostic process. Management of UTIs typically involves pharmacologic therapy and patient education. Schneeberger C, Geerlings SE, Middleton P, Crowther CA. 5. Uncomplicated UTI occurs in patients who have a normal, unobstructed genitourinary tract, who have no history of recent … 27, 7, 24-24. doi: 10.7748/nop.27.7.24.e727 Thomas VL, Resistance of urinary tract isolates of. Clipboard, Search History, and several other advanced features are temporarily unavailable. Thomsen AC, Address correspondence to John E. Delzell, Jr., M.D., MA 303 Health Sciences Center, University of Missouri-Columbia School of Medicine, Columbia, MO 65212. Management of suspected bacterial urinary tract infection in adults 2 | 1.2 REMIT of THE GUIDElINE 1.2.1 ovERALL oBJECTIvES This guideline provides recommendations based on current evidence for best practice in the management of adults with community acquired urinary tract infection. Strike PW. 3(February 1, 2000) Bachman JW, Urol Clin North Am 1986;13:685–93, Information from Pfau A, Sacks TG. 6. Hooton TM. Leigh DA, 4b. O'Brien WF, Wing DA, 41. Thomsen AC, Borch K, Mikhail MS, Patterson TF, Owen J. Previous: Recognizing an Index Case of Tuberous Sclerosis, Next: Treatment of Psoriasis: An Algorithm-Based Approach for Primary Care Physicians, Home Davis F. Experts say you're more likely to get a urinary tract infection (UTI) while you're pregnant, which may cause frequent urination, pain or burning during urination, and abdominal discomfort. Handler A, Urinary tract infections are common during pregnancy, and the most common causative organism is Escherichia coli. Grimes DA. Urinary Tract Infection and Bacteriuria in Pregnancy. Group B streptococcal (GBS) vaginal colonization is known to be a cause of neonatal sepsis and is associated with preterm rupture of membranes, and preterm labor and delivery. 1970;13:239–54. At the first prenatal visit, the pregnant woman should have a rubella titer drawn. 1984;2839469–70. Compton A, Women with GS urinary tract infection during pregnancy should also receive appropriate treatment at the time of diagnosis as well as IV pregnancy. The accuracy of faster screening methods (e.g., leukocyte esterase dipstick, nitrite dipstick, urinalysis and urine Gram staining) has been evaluated (Table 116). 1987;156:1148–52. Clin Obstet Gynecol. Privacy, Help Group B streptococcus has important implications in the management of pregnancy and will be discussed further. Screening and treatment of asymptomatic bacteriuria in pregnancy prevent pyelonephritis. Gruneberg RN, This chapter describes the nursing management re-quired during pregnancy. The focus of this care plan for Urinary Tract Infections (UTI) include relief of pain and discomfort, increased knowledge of preventive measures and treatment regimen, and absence of complications. Am J Obstet Gynecol. The nursing interventions in this category focus primarily on surveillance, support, and education. 1969;276101–3. 1993;329:1328–34. Pretty A. 4a. 18. Postgrad Med. Antibiotic therapy (and intravenous fluids, if hospitalization is required) may be initiated before obtaining the results of urine culture and sensitivity. Obstet Gynecol Surv. Henry O, Kass EH. 1. Centers for Disease Control and Prevention . Merzbach D, Persistent infection may be caused by urolithiasis, which occurs in one of 1,500 pregnancies,30 or less commonly, congenital renal abnormalities or a perinephric abscess. Goldenberg RL, Acute Pain related to Ectopic Pregnancy Ectopic Pregnancy is a common, life threatening condition that is the leading cause of death in early pregnancy. Guidance is in agreement that pregnant women with UTI be offered an immediate antibiotic to prevent complications such as pyelonephritis. Neonatal outcomes that are associated with UTI include sepsis and pneumonia (specifically, group B streptococcus infection).31,42 UTI increases the risk of low-birth-weight infants (weight less than 2,500 g [5 lb, 8 oz]), prematurity (less than 37 weeks of gestation at delivery) and preterm, low-birth-weight infants (weight less than 2,500 g and less than 37 weeks of gestation at delivery)39  (Table 337). Owen J. 9. Sanders WE Jr. The organisms that cause UTIs during pregnancy are the same as those found in nonpregnant patients. Asymptomatic bacteriuria in pregnancy: antibody-coated bacteria, renal function, and intrauterine growth retardation. Pyelonephritis can be a life-threatening illness, with increased risk of perinatal and neonatal morbidity. The American College of Obstetrics and Gynecology recommends that a urine culture be obtained at the first prenatal visit.10 A repeat urine culture should be obtained during the third trimester, because the urine of treated patients may not remain sterile for the entire pregnancy.10 The recommendation of the U.S. Preventative Services Task Force is to obtain a urine culture between 12 and 16 weeks of gestation (an “A” recommendation).11, By screening for and aggressively treating pregnant women with asymptomatic bacteriuria, it is possible to significantly decrease the annual incidence of pyelonephritis during pregnancy.8,12 In randomized controlled trials, treatment of pregnant women with asymptomatic bacteriuria has been shown to decrease the incidence of preterm birth and low-birth-weight infants.13. McDowall DR, Howie PW, 12. Several other studies have found that a single dose of amoxicillin, cephalexin (Keflex) or nitrofurantoin was less successful in eradicating bacteriuria, with cure rates from 50 to 78 percent.1,22–24 Fosfomycin is effective when taken as a single, 3-g sachet. 22. Screening for asymptomatic bacteriuria in pregnancy. 35. Cunningham FG, Urologic evaluation of urinary tract infection in pregnancy. Main Findings. That’s because the growing fetus can put pressure on the bladder and urinary tract. Nursing Care Plan for Urinary Tract Infection (UTI) 7:46 PM Nursing Care Plan, Urinary Tract Infection ... including recent catheterization of the urinary tract, pregnancy or recent childbirth, ... although caution is used in their management because of the possibility of diminished renal capacity. Cunningham FG. Harris RE. Obstet Gynecol. Buchanan JD, Fairley KF, 1 In the general population, The extent of UTIs among pregnant women is higher than other healthy women. Renal infection and pregnancy outcome. 1988 Jun;31(2):480-7. doi: 10.1097/00003081-198806000-00022. Obstet Gynecol. In pregnancy, hormonal and mechanical changes that occur in the urinary tract lead to urinary stasis and ureterovesical reflux—setting the stage for urinary tract infection (FIGURE 1). Nursing Care Plans. Screening and treatment of asymptomatic bacteriuria of pregnancy to prevent pyelonephritis: a cost-effectiveness and cost-benefit analysis. 30. Am J Obstet Gynecol. What organisms cause urinary tract infections (UTI)? Acute PharmacologicTherapy- a) Uncomplicated cases- single dose of administration, short course (3 to 4 days) regimens, or 7 to 10 days regimens. Schieve LA, Pyelonephritis occurs in 2 percent of pregnant women; up to 23 percent of these women have a recurrence during the same pregnancy.26, Early, aggressive treatment is important in preventing complications from pyelonephritis. Anaerobic and other fastidious microorganisms in asymptomatic bacteriuria in pregnant women. Infections in men and recurrent, drug-resistant or complicated urinary tract infections require further evaluation. … Management of urologic problems during pregnancy. Sign up for the free AFP email table of contents. Urinary tract infections in pregnancy: old and new unresolved diagnostic and therapeutic problems. 3. Andriole VT. Acute pyelonephritis during pregnancy is a serious systemic illness that can progress to maternal sepsis, preterm labor and premature delivery. This article summarizes the pathophysiology, patient presentation, diagnostic testing, and current treatment modalities for pregnant women presenting with urinary tract symptoms in pregnancy. Ritchie JW, Get Permissions, Access the latest issue of American Family Physician. 2a. UTIs are managed more aggressively in pregnant women than in non-pregnant women. Trimethoprim Although trimethoprim is commonly used to treat symptomatic UTIs, good evidence to support its use in pregnancy is lacking.1However, it is not thought to be teratogenic.2It is recommended that trimethoprim is avoided if possible in the first trimester because it is a folic acid antagonist and theoretically may increase the risk of neural tube defects.13 Acute pyelonephritis in pregnancy: an anterospective study. If you are pregnant, your doctor might suggest you urinalysis or urine culture to detect UTI during pregnancy. Parenteral treatment of pyelonephritis should be continued until the patient becomes afebrile. This project aimed to look into strategies for improving the management of UTI in elderly medical inpatients. Am J Public Health. Carefully screen for infections during pregnancy and treat possible infections as ordered. This risk is reduced by 70 to 80 percent if bacteriuria is eradicated (see 'Rationale for treatment' below).