Dr. M Vijayasree
Introduction: Asymptomatic bacteriuria is a common condition occurring due to the physiological changes in the genitourinary tract during pregnancy. If left untreated, it may lead to acute pyelonephritis with adverse fetal and maternal outcome.
Aim of the study: To determine prevalence, risk factors, etiological agents, maternal and fetal complications among antenatal women with asymptomatic bacteruria in our hospital.
Methodology: A cross sectional study on 200 antenatal women was conducted, over a period of 3 years. Relevant history was obtained from them and the mid- stream clean catch urine specimen was collected and processed. The isolates from all the women were identified and antimicrobial susceptibility was tested and interpreted.
Results: Prevalence of ASB was 12% in the antenatal women studied. ASB was significantly more frequent in primi-gravidas 64% than the multi- gravidas 36%. Un-booked women had significantly increased incidence of ASB. Pus cells were more than 8 in 60% of women. As the number of pus cells increased, chances of a significant colony count increased proportionately. E. coli was the most common organism causing ASB (54%) followed by Klebsiella sp. (28%). ASB also occurred due to Pseudomonas sp. (6%), Enterobacter sp. (4%), Others like Citrobacter, Acenitobacter, β- Hemolytic Streptococci, Non- hemolytic Streptococci and Morganella (8%).Mixed infections occurred more frequently with under lying urinary tract abnormalities and pyelonephritis; more commonly involving E. coli and Klebsiella sp. Adverse maternal outcome like maternal anemia (56%), lower mean Hb% (10%), need for blood transfusions (0.5%) and pyelonephritis (6%); Maternal events like symptomatic UTI (18%), fever (16%), wound infections (10%) and sub- involution (14%) was found. Hospital stay was prolonged in women with ASB 7.5 days. Threatened abortion (10%), abortion (8%), hypocalcaemia (6%), hyponatremia (2%), HMD (6%), still births (4%) and neonatal deaths (4%) were more common in women with ASB, Adverse fetal outcome like threatened pre-term (24%), PROM (20%), decrease in mean period of gestation at delivery (34 weeks 5 days), lower APGAR scores at 1st minute (6.2) and 5th minute (8.4), lower mean birth weight (2.4 kgs), higher IUGR rates (26%), longer mean NICU stay (9.2 days), hypoglycemia (12%), neonatal infections
(16%) hyperbilirubinemia requiring photo-therapy (14%), apnea (8%) and birth asphyxia were seen in babies born to women with ASB.
Conclusion: Undiagnosed and untreated asymptomatic bacteriuria is associated with complications during pregnancy. Hence routine screening of antenatal women for Asymptomatic bacteruria during all trimesters must be considered for preventing the adverse maternal and foetal outcomes particularly with known risk factors like increasing age, multi-parity and previous history of Urinary tract infection.
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