Transcript The course of pregnancy, childbirth and the postpartum period in

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Asymptomatic bacteriuria, bacteriuria,
quantitatively true (more than 100,000
bacteria in 1 ml of urine) in at least two
samples in the absence of clinical infection.
Asymptomatic bacteriuria detected in 6% (211%) of women, depending on their socioeconomic status.
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Generally asymptomatic bacteriuria detected
Esherichia coli.
More rarely provided by other members of
the family Enterobacteriaceae and
Staphilococcus epidermidis, Staphilococcus
saprophiticus.
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The required survey methods for medical
observation, which should be conducted on a
monthly basis for all pregnant women, include
clinical and biochemical analyzes of blood and
urine, urine culture, renal ultrasound and the
fetus. The courses of antibiotic therapy reduces
the risk of septic forms of acute pyelonephritis,
fetal malnutrition and premature births, which
had more than 30% of pregnant women with
untreated bacteriuria.
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Asymptomatic bacteriuria has significant
clinical value. The vast bolschinstve cases
bacteriuria during pregnancy can be
diagnosed at the first visit to the doctor in
the early stages of pregnancy, lisch 1% of
bacteriuria develops at a later date.
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the threat of termination of pregnancy;
anemia during pregnancy;
hypertensive state pregnancies;
threat of premature birth;
placental insufficiency;
IUGR;
fetal death.
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The main treatments for asymptomatic
bakterurii during pregnancy:
Amoxicillin 250-500mg three times a day for
3 days.
Amoxicillin - clavulanic acid is 375-625 mg
2-3 times a day.
Kanefron
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Kidney disease in pregnancy is second only to
cardiovascular disease. Among infectious
second only to colds. Pyelonephritis is most
common (20%), glomerulonephritis (0.1 0.2%), urolithiasis (0.1 - 0.2%). Pyelonephritis
during pregnancy occurs in 48% of women in
the postpartum period, 35%, 17% at delivery.
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Occurrence of pyelonephritis (PN) contribute
to the hormonal changes of the characteristic
of pregnancy, the growing uterus ureteral
compression, the presence of foci of infection
in the body (angina, carious teeth, abrasions,
etc.).
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Under the influence of progesterone produced by the
placenta, there is a relaxation of smooth muscles of the
intestine, bladder and ureters. There is a tendency to
constipation and a significant slowdown in the passage of
urine. Marked expansion, elongation, distortion of the
ureter with the excesses and looping, increasing the pelvis
cavity. Disturbed urodynamics upper urinary tract and
blood flow in the kidney. These conditions create a
favorable background for the spread of infection by the
rising of the urethra, bladder subepithelial layer of tissue
in the pelvis. Know the infection lymphatic and
hematogenous route from the source of inflammation of
the tonsils, teeth, genitals, gall bladder, etc. Any
obstruction of urine outflow aggravates it possible to
develop a urinary tract infection - stones, abnormalities,
bends ureteral etc.
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E. coli is planted in 36-88% of pregnant women and
causes sclerosis renal pelvis, perirenal fat and renal
capsule. Proteus (5-20%) for its enzyme breaks down
proteins and urea to form ammonia and other
substances that damage the epithelial cells of the
kidneys and ureters. This infection causes the
formation of stones and has a relapsing course. From
the urine of pregnant sow as Klebsiella, Enterococcus,
etc. But the most common pathogens are gramnegative microorganisms Mon - streptococcus group
D and B, staphylococci and micrococci. Inflammation
of the kidneys can also cause Candida, Mysoplasma
hominis, Ureaplasma urealyticum, Trichomonas
vaginalis, anaerobic bacteria.
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During pregnancy on the 23-28 week
(maximum lift corticosteroid Dov).
At 32-34 weeks, when the uterus reaches a
maximum size
39-40 weeks - the head is pressed against
the entrance to the pelvis.
After delivery - 2-5 days, 10-12 days.
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There are acute and chronic Mon The
emergence or worsening Mon often occurs in
22-28 weeks of pregnancy, when sharply
rising levels of sex hormones and
corticosteroids. This period is critical for
pregnant women
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usually begins in childhood. The long period of
remission promotes frivolous attitude to the
disease. Aggravation of are associated with
hormonal changes (puberty, marriage,
pregnancy, childbirth). Without exacerbation
patients feel good, sometimes appear indistinct
complaints of malaise, headache, dull pain in the
lower back. At 5-10% of pregnant women
asymptomatic bacteriuria occurs without any
signs of inflammation of the urinary tract or in
the present, either before pregnancy.
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Blood. Acute process high leukocytosis with a left shift, accelerated
erythrocyte sedimentation rate, decreased hemoglobin. In the
biochemical analysis of blood - hypoalbuminemia. In severe cases,
elevated creatinine and urea. In chronic process - reduction of
hemoglobin, since the kidneys are involved in eritrpoeze as vyrabatyayut
humoral factor - erythropoietin. Against the background of low
leukocytosis and elevated ESR.
Urine. Sample Zimnitsky - gipoprotenuriya, nocturia. Total urine alkaline, urine sediment - leykotsitouriya (upper limit of normal - 6-8 in
sight), the lack of cylinders, Pyuria (pyuria). Rarely in zakupokre ureter
on one side may not pus and urine does not contain white blood cells.
Sample Nechiporenko, Addis Kakovskogo, Amburzhe - quantification of
the formed elements. Sample Nechiporenko - the norm for pregnant
women: WBC 4000, 100 cylinders, erythrocyte 2000.
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Principles of treatment of PN:
 Increased passage of urine
 Eliminate stagnant urine
 Intensive breeding of germs and their toxins
 Sanitation of the urinary tract - antibiotics and uroseptiki
 antispasmodics
 Diuretic herbs
 Bozeman's position
 Fortified Diet
 Principles of antibiotic therapy
 urine culture with the definition of sensitivity to antibiotics
 Security for the mother and fetus
 High Performance
 The objectives of antibiotic therapy:
 The rapid relief of symptoms
 Rehabilitation
 Prevention of complications of the mother and fetus
 Prevention of relapse
 Security antibiotics for UTI in pregnancy (FDA)
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