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Pregnant women: detect and treat bacteriuria

In pregnant women, it is better to detect and treat the presence of bacteria in the urine, even if there are no clinical symptoms.

Pregnant women frequently have asymptomatic bacteriuria (bacteria in the urine with no accompanying symptoms). Bacteriuria is defined as the presence of at least 100,000 bacteria per millilitre in urine sampled under hygienic conditions. Cytobacteriological urine examination with culture is the best diagnostic examination.

In the absence of treatment, bacteriuria can lead to a kidney infection (pyelonephritis), which is a risk factor for premature birth and delayed growth. Recommendations on this issue have been updated in the United States. This update is based on a trial comparing antibiotic treatment with placebo in 2,302 pregnant women with asymptomatic bacteriuria. In the women treated with antibiotics, the frequency of pyelonephritis was markedly reduced, as was the frequency of low birth weight, with no effect on the frequency of premature births.

In practice, it is better to test pregnant women routinely for asymptomatic bacteriuria, offering them a cytobacteriological urine examination at least once at the beginning of the pregnancy. And if bacteriuria is found, it is advisable to treat it.

©Prescrire September 2009

Source: "Dépister les bactériuries asymptomatiques chez les femmes enceintes" Rev Prescrire 2009; 29 (309): 526.

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