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Mgr Paulina Durka
Rozprawa doktorska na stopień doktora nauk o zdrowiu
Urinary tract infections (UTI) are one of the most commonly recognized diseases during pregnancy. Because of the functional and anatomical changes in the urinary tract during pregnancy, over 5% of women experience colonization of urine. Untreated asymptomatic bacteriuria may develop into acute cystitis in 30% of women, while over 20% are at risk of developing acute pyelonephritis. Many foreign organizations recommend routine urine culture tests at the end of the first trimester of pregnancy as to reduce the risk of complications associated with asymptomatic bacteriuria. However, no such recommendations have yet been developed in Poland. Instead, antibiotic therapy is often implemented only on the basis of an abnormal Purpose: To analyze the impact of asymptomatic UTI on pregnancy, delivery and
infant health among patients who had not been given a urine culture test to verify the pathogen type before treatment. The specific objectives were as follows: 1. Compare the course of pregnancy, delivery and the occurrence of complications in the newborn in a group of women treated for a UTI and a 2. Compare the course of pregnancy, delivery and the occurrence of complications in the newborn in a subgroup of women only with UTI and those with UTI who were additionally treated for vaginal infections. 3. Analyze the impact of various types of UTI treatments on the incidence of complications in the mother and the newborn. 4. Make recommendations on the importance of early diagnosis of asymptomatic Methods: The study population was a group of 400 female patients and their
newborn children. The work involved a retrospective analysis of medical records of women who gave birth between 2010-2012 in the Szpital im. św. Rodziny hospital (St. Family Hospital) in Warsaw, Poland. Both the control and case groups enrolled 200 postpartum women. Each group included a twin pregnancy, resulting in a total of 201 neonates per group. During recruitment to the control group, women were matched according to their due dates in order to give birth about the same time as The case group included pregnant women treated for a UTI without a prior urine culture test with pathogen identification. Their treatment was prescribed solely after the results of a basic urinalysis, which is capable of identifying only the presence of bacteria, nitrites, leukocytes, and erythrocytes. Antibiotic treatment was introduced in the third trimester in 56% of women while another 3% were treated in the first trimester of pregnancy. Five percent of women were treated twice during the pregnancy. A separate analysis was done for women who were additionally treated for a vaginal infection. This subgroup included 74 women and they were treated with vaginal nifuratel, nystatin, natamycin, and/or clotrimazole. The control group consisted of healthy female patients who did not receive any Results: Asymptomatic UTI has a negative impact on pregnancy, delivery and
health of a newborn. The differences in the average duration of pregnancy between the two groups reached statistical significance of p <0.01. Duration of pregnancy was 38.82 ± 1.76 weeks in the case group, compared to 39.41 ± 1.35 weeks in the control group. There were significantly more preterm deliveries in the case group (18%) compared to the control group (6.97%) (p=0.0002). There were statistically significant differences in parity between the two groups as 44.78% of women in the case group were multiparous compared to 25.5% in the control group (p <0.0001). The infant birth weight average was different between the groups, 3317 ± 527.90 grams in the case group, and 3448 ± 469.09 grams in the control group (p <0.05). There was a significant difference in the number of newborns whose condition after the first minute of life was evaluated as unwell or poor, eight in the case group, while only one in the control group (p = 0.0374). Significantly more infants with an early-onset neonatal infection required antibiotic treatment in the case group (n=17, 12 requiring more than one type) than in the control group (n=10) (p = 0.0003). Low birth weight was observed more commonly among the cases then the controls. There were 16 infants with birth weight below 2500g in the case group, and 5 in the control group (p=0.023). Analysis of the subgroup of women with UTI additionally treated for vaginal infection and women with UTI without this diagnosis found no statistically significant effects on pregnancy, labor, and the condition of the newborn. Conclusions:
1. Asymptomatic UTI has a negative impact on pregnancy, labor, and health of the newborn. Compared with the healthy control group, women with UTIs had a higher incidence of premature delivery. Newborns of these mothers were more likely to exhibit symptoms of early-onset neonatal infection which required treatment with multiple antibiotics. Additionally, more infants born in this group had a low birth weight and received a worse Apgar score compared 2. Women with UTI who were concurrently treated for vaginal infections were less likely to go into preterm labor, experience premature rupture of membranes, give birth to a small for gestational age, low birth weight infant, or an infant experiencing an early-onset neonatal infection. However, these findings were not statistically significant. 3. Because of the multitude of complications which may occur as a result of UTI during pregnancy it is critical to develop recommendations for the early diagnosis of these infections. Urine culture should become a routine test for all pregnant women at the beginning of their second trimester. Furthermore, each pregnant woman diagnosed with asymptomatic bacteriuria should be treated with an appropriate pathogen-specific therapy.


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