Dr Anjelly Sebestian1, Dr Santosh Benjamin2, Dr Reeta Vijayaselvi2, Dr Grace Rebekah4, Dr Rani Diana Sahni3, Dr Sudha Jasmine Rajan1
1Department of Medicine 3 and Obstetric Medicine, Christian Medical College, Vellore, Vellore, India, 2Department of Obstetrics, Christian Medical College, Vellore, Vellore, India, 3Department of Clinical Microbiology, Christian Medical College, Vellore, Vellore, India, 4Department of Biostatistics, Christian Medical College, Vellore, Vellore, India
Biography:
I am a physician working in a university teaching hospital in South India in the field of obstetric Medicine since 2015. I started the Obstetric Medicine services along with my colleague Dr Sowmya Satyendra. We currently see 3000 outpatients annually, 1200 inpatient consultations, and 30-40 multidisciplinary meetings.
Abstract:
Urinary tract infection (UTI) during pregnancy is associated with adverse maternal and fetal outcomes. . The aim of this study was to assess maternal and fetal outcomes that occur after symptomatic UTI during pregnancy with the increasing incidence of extended-spectrum beta-lactamase (ESBL) producing organisms and the more extensive use of newer antibiotics.
This observational cohort study was conducted in a university teaching hospital in South India, which has 13000 deliveries every year after approval from the institutional research board (IRB No. 10627). The sample size was calculated for 80% power and 5% significance level with an anticipated proportion of 8% preterm delivery among pregnant women with UTI(1), which was 200 with exposure and 200 without exposure. 410 patients(202 with and 208 without UTI) were recruited from June 2017 to August 2018 if they fulfilled the inclusion criteria: pregnant women aged>18 years, with three antenatal visits, who delivered in the hospital. Exposure was defined as symptomatic urinary tract infection with significant growth in urinary culture. Maternal and fetal outcomes were assessed at delivery. Risk ratios for each adverse outcome were calculated.
The incidence of pyelonephritis in the UTI group was 8%. Adverse maternal events of pyelonephritis, preterm premature rupture of membranes(PPROM), Preterm delivery and post-partum sepsis had significant increased relative risks of 18.53(95% CI 2.49-137.5, p 0.004), 2.403 (95% CI 1.355-4.261, P =0.002), 2.552(95% CI 1.637- 3.977, p < 0.001), 3.707 (95% CI 1.403-9.795, p 0.004) respectively.
Intrauterine growth restriction (IUGR), need for neonatal ICU admission. Low birth weight(LBW) was more among the infants born to patients with UTI with a relative risk of 1.561(95% CI 0.963-2.532, p 0.068), 3.771(2.201-6.462, p<0.001), and 1.883 (95% CI 1.309-2.709, p<0.001) respectively. Urinary tract infection in pregnancy is associated with adverse maternal and fetal outcomes. ESBL infections did not have worse outcomes.
Keywords
Urinary tract infections, pregnancy
References
Mazor-Dray E, Levy A, Schlaeffer F, Sheiner E. Maternal urinary tract infection: is it independently associated with adverse pregnancy outcome? J Matern Fetal Neonatal Med. 2009 Feb;22(2):124–8