How to diagnose and treat UTI on pregancy

Pregancy with UTI(preexisting or fresh infection):-An overview by Dr S K Pal (Kolkata) about the one of the most neglected topic of UTI (mostly asymptomatic ) –in 5 kinds of cases like A)  persistent white discharge, B) Rec white discharge)  those who are planning for preg D) waiting for fertility enhancing treatment) & above all routinely to all categories of preg women at booking vist?? Let us have a thread bare discussion on this very common topic. Members are requested to share their experiences please. But such investigations screening for asymptomatic bacteriuria (C/S and the appropriate drugs) :-are to be cost-effective,

Q.1:-Self criticism :-Have we, the practicing Obstetricians ever –asked ourselves about the a) relevance and b) financial feasibility of routine Urine C/s prepreg & early preg including subfertile women or women who suffering from recurrent obstinate White discharge? Have we ever thought what changes the normal vaginal flora or yourself??

Q.2: Is Urine C/S and then choiced antibiotics for Asymp is feasible/ affordable in our motherland? Can retired person Dr Pal become Krorepati(Mr. A. Bacchan )  at all?? Can Dr Pal have an own car at the age of 76 yrs with meager pension?? Ans:-The answer is No. A pensioner cant purchase a new car, Similarly,  workload of Govt hospital microbiologists and Financial commitment by average or poor women (slum dwellers) desirous of preg –the question is can they afford?? If even affordable are the ASHA workers been adequately trained in this tests?? But the fact remains that all women desirous of fertility & pregnant women should be screened for bacteriuria and subsequently treated with antibiotics such as nitrofurantoin, sulfisoxazole or cephalexin. What about ampicillin as written in Text Books?  Ampicillin should no longer be used in the treatment of asymptomatic bacteriuria because of high rates of resistance.

Q.3:-Shoud we insist on routine urine C/S in all women planning for Pregancy or subfertile women?? :-Shoud we insist on routine urine C/S in all women at booking visit? If so why give reasons. Ans;-Because untreated such preexisting UT may flare up in preg even in early preg

. Q. 4 : Tips on treating UTI (Asymp) in persistent white discharge after excluding DM, fungal infection( hanging drop prepn –Mycellium) ? Ans to Q 4:- In early preg too (booking visit) diagnosis / exclusion of Asymp bact this C/S is very essential. Agreed in preg but why urine C/S in persistent white discharge cases? The reason is ,I may be permitted to say persistent white discharge may be dribbling of few drops of urine in birth canal for days in and out à  may colonize the lower  urethra à ascending up to Cervix even  by the foreign uropathogens à altered ecosystem of vagina & pH in particular, killing natural inhabitant L bacilli. Thus, I Dr Pal , like other specialists do  feel that there is every reason  to believe that if we believe that E coli can crawl in from perineum to  lower urethra and  colonize then why not urine can drop in the birth canal and can spoil the health game of Pregancy. .

Q.5 Any member like to differ? Any member having objection to the belief that urethral  then why such pathogens from urine can’t go in vagina and can cause  distressing whites for months and also Rec abortion /PROM .  Then what is the harm to insist on Urine RE & C/S in cases of persistent white discharge?

Q. 6: Few important tips on Urinary Tract Infections during Pregnancy which all practioners must remember. Ans to Q. 5:  Why Dr Pal is threatening us about relevance of Asymp Bacteriuria time and again? We won’t read his post onwards. That’s not cricket !!  Logic & reasoning :-Asymp Bacteriuria: prevalence at UK is7% of which 40% will develop symptomatic UTI if Asymp bact is left untreated.  But those who have already had preexisting UTI and achieved preg with UTI untreated à (i.e. UTI in nonpreg    state and had conception while Chr UTI untreated ) ===in such  women the chance of having acute infn (acute cystitis/en acute pyelonephritis) as preg advances may result into e acute cystitis will be somewhere 10 fold chance (flare of ) of acute infn both in Asymomtatic  Bact as well as more  prevalence of  & cystitis, in contrast who were treated prior to conception