Infecção urinária na gravidez

Abstract

Several factors cause urinary tract infection (UTI) to be a relevant complication of the gestational period, aggravating both the maternal and perinatal prognosis. For many years, pregnancy has been considered to be a factor predisposing to all forms of UTI. Today, it is known that pregnancy, as an isolated event, is not responsible for a higher incidence of UTI, but that the anatomical and physiological changes imposed on the urinary tract by pregnancy predispose women with asymptomatic bacteriuria (AB) to become pregnant women with symptomatic UTI. AB affects 2 to 10% of all pregnant women and approximately 30% of these will develop pyelonephritis if not properly treated. However, a difficult-to-understand resistance against the identification of AB during this period is observed among prenatalists. The diagnosis of UTI is microbiological and it is based on two urine cultures presenting more than 10(5) colonies/mL urine of the same germ. Treatment is facilitated by the fact that it is based on an antibiogram, with no scientific foundation for the notion that a pre-established therapeutic scheme is an adequate measure. For the treatment of pyelonephritis, it is not possible to wait for the result of culture and previous knowledge of the resistance profile of the antibacterial agents available for the treatment of pregnant women would be the best measure. Another important variable is the use of an intravenous bactericidal antibiotic during the acute phase, with the possibility of oral administration at home after clinical improvement of the patient. At our hospital, the drug that best satisfies all of these requirements is cefuroxime, administered for 10-14 days. Third-generation cephalosporins do not exist in the oral form, all of them involving the inconvenience of parenteral administration. In view of their side effects, aminoglycosides are considered to be inadequate for administration to pregnant women. The inconsistent insinuation of contraindication of monofluorinated quinolones, if there is an indication, norfloxacin is believed to be a good alternative to cefuroxime. In cases in which UTI prophylaxis is indicated, chemotherapeutic agents are preferred, among them nitrofurantoin, with care taken to avoid its use at the end of pregnancy due to the risk of kernicterus for the neonate.

Perfil de recém-nascidos pré-termo internados na unidade de terapia intensiva de hospital de alta complexidade

“…Um estudo analisou 1.006 mulheres que deram à luz a recém-nascidos vivos e verificou que o trabalho de parto prematuro ocorreu em 40% dos casos, fatos que evidenciam sua alta prevalência e a necessidade de atenção especial no que se refere ao período gestacional 15,16 . Não menos impactantes são suas consequências, pois o RNPT pode sofrer complicações, visto que a prematuridade aumenta o risco de dificuldades de adaptação à vida extrauterina, principalmente devido à imaturidade anatômica e fisiológica 1 .…”

“…Sem contar que a bacteriúria assintomática acomete entre 2 e 10% de todas as gestantes 16 . No estudo de Duarte, 29,3% das gestantes analisadas também apresentaram ITU, consistindo na intercorrência mais comum e com proporções de parto prematuro em 33% delas 17 .…”

Aspectos da mortalidade infantil, conforme informações da investigação do óbito

“…In relation to the use of health services, about 65% of the mothers received prenatal care in PHC units, and 83.4% of the childbirths were funded by SUS, which agrees with a study conducted in Pelotas, RS, Brazil where socio-economic variables were significantly associated with the coefficient of child mortality; children of low income families had a 2.5 times greater risk of dying (9) . Another finding that should be highlighted is related of UTI (14) . However, some women develop asymptomatic bacteriuria, one of the main causes of intrauterine growth retardation and premature rupture of membrane, which definitively leads to PL (15) .…”

Infecção urinária na gestação e sua correlação com a dor lombar versus intervenções de enfermagem

“…When symptomatic, the infection is also important however its diagnosis is faster due to the presence of symptoms which are defined according to the type of urinary tract infection. In some types of infections, low back pain may be the most reported clinical manifestation [2][3][4][5] . Among bacterial strains able to cause UTI in pregnant women, Escherichia coli is the most common urinary pathogen, responsible for approximately 80% of cases.…”

“…Micturition urgency may be present but in a lower scale, affecting approximately 1% to 5% of pregnant women. However, such manifestations may also be present in cystitis and pyelonephritis by urethral epithelium irritation or as irradiated pain of a higher urinary tract infection process 3 . Topographic infection history should be added to the diagnosis since, pedagogically, signs and symptoms are characteristic of each clinical presentation, but in practice such manifestations may confuse health professionals 3 .…”