El Taha Lina, Bazi Tony, Maalouf Hala, Hajjar Rima, Hasbini Yasmin, El Ouweini Hala, Chamsy Dina
Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon.
American University of Beirut Medical Center, Beirut, Lebanon.
Eur J Obstet Gynecol Reprod Biol. 2021 Jun;261:154-159. doi: 10.1016/j.ejogrb.2021.04.034. Epub 2021 Apr 24.
Urinary tract infection (UTI) is the most common bacterial infection to complicate pregnancy. Medical authorities recommend screening for asymptomatic bacteriuria (ASB) in pregnancy; albeit there is no consensus on ideal timing and frequency for testing. Due to the persistent physiologic changes of pregnancy postpartum, a recent trend to perform urinalysis upon presentation for delivery has been adopted at our institution and various satellite hospitals to putatively minimize cases of postpartum pyelonephritis. The aim of this study is to examine whether routine testing with urinalysis and screening for ASB following suspicious urinalysis with treatment can decrease the incidence of postpartum pyelonephritis, and to determine whether certain urinalysis parameters are more predictive of a positive urine culture.
A retrospective chart review study of all term deliveries was conducted over two years at the American University of Beirut Medical Center, a university teaching hospital. A total of 2359 deliveries of women with no increased susceptibility to UTIs were reviewed. None had urinary symptoms upon presentation. Urinary parameters including time of urinalysis and urine culture collection with respect to time of delivery, corresponding results and mode of urine collection were correlated to intrapartum course, incidence of ASB and of postpartum pyelonephritis.
The incidence of ASB among women presenting for delivery was 4.83 %, with Escherichia coli as the most commonly detected pathogen. The presence of nitrite on urinalysis was significantly associated with a positive urine culture (p-value<0.001). Women with history of antenatal ASB or UTI were more likely to have ASB intrapartum with an odds ratio of 3.14 (95 % CI 1.71-5.75, p-value <0.001). Intrapartum urinalysis with subsequent diagnosis and treatment of ASB did not significantly affect the incidence of postpartum pyelonephritis (p-value 0.280). Similarly, intrapartum urinalysis in the setting of positive history of antenatal ASB or UTI did not increase the incidence of postpartum pyelonephritis compared to women with no such history (p-value 0.659).
Urinalysis screening intrapartum does not decrease the incidence of postpartum pyelonephritis. Universal urinalysis screening intrapartum is not warranted and should be reserved for women reporting urinary symptoms and/or women at high risk of UTI.
尿路感染（UTI）是妊娠期间最常见的细菌感染并发症。医学权威机构建议对妊娠期无症状菌尿（ASB）进行筛查；尽管对于理想的检测时间和频率尚无共识。由于产后妊娠的生理变化持续存在，我院及多家卫星医院最近采用了在分娩时进行尿液分析的趋势，以推测性地减少产后肾盂肾炎的病例。本研究的目的是检查常规尿液分析检测以及对可疑尿液分析进行ASB筛查并治疗是否能降低产后肾盂肾炎的发病率，并确定某些尿液分析参数是否更能预测尿培养阳性。
在大学教学医院贝鲁特美国大学医学中心对所有足月分娩进行了为期两年的回顾性图表审查研究。共审查了2359例对UTI无易感性增加的女性分娩病例。所有产妇入院时均无泌尿系统症状。将包括尿液分析时间、尿培养采集时间与分娩时间的关系、相应结果以及尿液采集方式等尿液参数与产程、ASB发病率和产后肾盂肾炎发病率进行关联分析。
分娩女性中ASB的发病率为4.83%，其中大肠杆菌是最常检测到的病原体。尿液分析中存在亚硝酸盐与尿培养阳性显著相关（p值<0.001）。有产前ASB或UTI病史的女性在产时更易发生ASB，比值比为3.14（95%CI 1.71 - 5.75，p值<0.001）。产时尿液分析及随后对ASB的诊断和治疗对产后肾盂肾炎的发病率没有显著影响（p值0.280）。同样，与无此类病史的女性相比，有产前ASB或UTI阳性病史的女性进行产时尿液分析并未增加产后肾盂肾炎的发病率（p值0.659）。
产时尿液分析筛查并不能降低产后肾盂肾炎的发病率。产时普遍进行尿液分析筛查并无必要，应仅用于报告有泌尿系统症状的女性和/或UTI高危女性。
