Bacteriuria and Pyelonephritis of Pregnancy

Urinary Concentrating Ability in Pregnant Women With Asymptomatic Bacteriuria*

“…For example (8), in 33 pregnant women with over 100,000 gramnegative bacteria per ml in an initial random, cleanvoided urine specimen, a second clean-voided urine culture gave the same result in 21 women (63.6 per cent). After two successive cultures showing over 100,000 gram-negative bacteria per ml, a third culture, or more, gave the same result in over 85 per cent of the women.…”

“…Similarly, Winberg (3) has reported that impaired concentrating ability occurring with acute, nonobstructive urinary tract infections in children possibly lasted for 4 to 6 weeks after symptoms and urinary findings cleared. The presence of silent pyelonephritis in pregnant women with asymptomatic bacteriuria is also suggested by their high incidence of the subsequent development of acute pyelonephritis (7,8). Impaired concentrating ability with bacteriuria may also be attributed to an increase in the hydronephrosis of pregnancy due to ureteritis and ureteral reflux in the absence of renal infection, but a clear distinction between pyelonephritis and infection limited to the ureter cannot easily be made.…”

“…A detailed report concerning bacteriuria and pyelonephritis in this group has been presented elsewhere (8). The technique used to obtain clean-voided urine cultures was as follows.…”

“…It was difficult to match the groups exactly with respect to parity since the incidence of bacteriuria rose sharply with the number of prior pregnancies (7,8). However, as many grandmultiparous control subjects as could be obtained were included to make the groups as comparable as possible.…”

Endotoxin Shock in Pregnancy

“…In m ost of these cases the organisms belong to the gram negative group, therefore, the possibility of a developing endotoxin shock m ust be kept in mind. U nfortunately about 5% to 8% of urinary tract infections are asym ptom atic by pregnant patients [25,62] and rem ain untreated until more severe complications occur. The mechanism of circulatory collapse in gram negative infection is still not clear enough.…”