Vivekanand Polyclinic & Institute of Medical Sciences, Lucknow, India.
Indian J Med Res. 2013 Apr;137(4):753-8.
BACKGROUND & OBJECTIVES: Asymptomatic bacteriuria during pregnancy if left untreated, may lead to acute pyelonephritis, preterm labour, low birth weight foetus, etc. Adequate and early treatment reduces the incidence of these obstetric complications. The present study was done to determine presence of asymptomatic bacteriuria (ASB) and obstetric outcome following treatment in early versus late pregnancy.
A prospective cohort study was conducted at a tertiary care teaching hospital of north India. Pregnant women till 20 wk (n=371) and between 32 to 34 wk gestation (n=274) having no urinary complaints were included. Their mid stream urine sample was sent for culture and sensitivity. Women having > 10 [5] colony forming units/ml of single organism were diagnosed positive for ASB and treated. They were followed till delivery for obstetric outcome. Relative risk with 95% confidence interval was used to describe association between ASB and outcome of interest.
ASB was found in 17 per cent pregnant women till 20 wk and in 16 per cent between 32 to 34 wk gestation. Increased incidence of preeclamptic toxaemia (PET) [RR 3.79, 95% CI 1.80-7.97], preterm premature rupture of membrane (PPROM)[RR 3.63, 45% CI 1.63-8.07], preterm labour (PTL) [RR 3.27, 95% CI 1.38-7.72], intrauterine growth restriction (IUGR)[RR 3.79, 95% CI 1.80-79], low birth weight (LBW) [RR1.37, 95% CI 0.71-2.61] was seen in late detected women (32-34 wk) as compared to ASB negative women, whereas no significant difference was seen in early detected women (till 20 wk) as compared to ASB negative women.
INTERPRETATION & CONCLUSIONS: Early detection and treatment of ASB during pregnancy prevents complications like PET, IUGR, PTL, PPROM and LBW. Therefore, screening and treatment of ASB may be incorporated as routine antenatal care for safe motherhood and healthy newborn.
如果不治疗妊娠期间无症状菌尿，可能会导致急性肾盂肾炎、早产、低出生体重儿等。充分及早的治疗可降低这些产科并发症的发生率。本研究旨在比较早孕期与晚孕期治疗无症状菌尿（ASB）对妊娠结局的影响。
这是一项在印度北部一家三级教学医院进行的前瞻性队列研究。纳入了妊娠 20 周前（n=371）和妊娠 32-34 周（n=274）且无尿路症状的孕妇。对其中段尿样进行培养和药敏试验。如果女性的单一菌培养物中菌落形成单位>10[5]个，则诊断为 ASB 阳性并进行治疗。直至分娩，对孕妇的妊娠结局进行随访。采用 95%置信区间的相对风险来描述 ASB 与感兴趣结局之间的关联。
妊娠 20 周前 ASB 的检出率为 17%，妊娠 32-34 周时为 16%。与 ASB 阴性孕妇相比，晚孕期（32-34 周）检测到 ASB 的孕妇发生子痫前期-子痫（PET）的风险增加（RR 3.79，95%CI 1.80-7.97）、早产胎膜早破（PPROM）（RR 3.63，95%CI 1.63-8.07）、早产（PTL）（RR 3.27，95%CI 1.38-7.72）、胎儿宫内生长受限（IUGR）（RR 3.79，95%CI 1.80-79）、低出生体重儿（LBW）（RR 1.37，95%CI 0.71-2.61）的风险更高，而早孕期（20 周前）检测到 ASB 的孕妇与 ASB 阴性孕妇相比，上述产科并发症的风险无显著差异。
妊娠期间早期发现和治疗 ASB 可预防 PET、IUGR、PTL、PPROM 和 LBW 等并发症。因此，ASB 的筛查和治疗可以作为常规产前护理的一部分，以实现母婴安全和新生儿健康。
