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Re: Asymptomatic bacteriuriaFrom: Braun, R. Daniel (rbraun@iupui.edu)Thu Apr 20 12:23:23 2000
No such association recorded in the literature. There are E. coli in the vagina and the rectum all the time. ASB is only associated with Pyelo. Treating it in 1st Tri decreases incidence of Pyelo 50%. You also treated her ASB. Quit beating yourself up. Some days, feces happens. Dan R. Daniel Braun, MD FACOG Clinical Professor Department of Obstetrics and Gynecology Indiana U. School of Medicine Indianapolis, IN 46202 OBGYN.net International Representative for United States Certified AllExperts Expert Check out my bio/ratings page! http://www.allexperts.com/displayExpert.asp?Expert=1236 -----Original Message----- From: wilsonk@gtn.net [mailto:wilsonk@gtn.net] Sent: Thursday, April 20, 2000 8:24 AM To: Multiple recipients of list OB-GYN-L Subject: Asymptomatic bacteriuria Time to ask a clinical question. Had a birth a few weeks ago, a G1 who booked into care with us at 32 weeks gestation because she had no health card (from the US, not landed, husband just lost his job and she couldn't afford to pay for prenatal visits w/ her family physician. At intake I did our routine 10L urine dip, and she was about 3+ for leuks and the nitrites reagent went neon pink. Patient denied any sx of UTI. I sent an MSU for C&S (remembering that she has to pay for all of this) and it came back >100K cfu/L for E. coli. Tx'ed with Macrobid, and F/U MSU was fine. Fast forward to term. She goes into labour, calls me after about 4 - 5 hours of contractions. She's 6-7 cm dilated, unsure about ROM. I can't feel any hair on babe's noggin (and Mom is black, so I figure there should be some), feels slick like membranes. First two - three FH's by auscultation are 160 - 170, mom's leuks are normal, she's afebrile, no uterine tenderness. However, I have a scalp clip applied to see the bigger picture (mom is very heavy, so external monitoring just won't do it). Interesting, no ROM occurs w/ the clip, so she *is* ruptured -- hmmm. Strip is, to be frank, crappy. Baseline tachycardia, not much BTBV, and then about 2 - 3 great big variables. Consulted w/ the first (and started an IV), told to carry one, but w/ the third, I went back to the OB with the strip and said "I'm really not happy with this". He agreed and we went to section (sigh, $$$$). When they open her up, out pours incredibly foul, pussy fluid -- OB said he hadn't smelled any that rank in 10 years (and this is a busy level III hospital). End of story, baby has E. coli sepsis (from which she recovers nicely), and that's what we grow from mom, as well. So, the question is this. We, in this community, don't see a lot of asymptomatic bacteriuria. The literature talks about increased chances of preterm labour and pyelo, but doesn't really talk about ascending infection and chorioamnionitis. It makes sense to me that it could occur, but, in the experience of those of you who see lots of this, is it just coincidence that she had E. coli in her urine (and probably had for the whole pregnancy until I picked it up -- family doc hadn't screened), and had E. coli chorio, or did A lead to B?
-- Kathi Wilson, BHSc, RM Thames Valley Midwives, London, Ontario, Canada mailto:wilsonk@gtn.net http://tvm.on.ca
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