Re: Asymptomatic bacteriuria
From: Efrain Ramirez (eramirez@icepr.com)
Thu Apr 20 15:00:52 2000
Dan - I believe there is evidence of untreated bacteriuria and preterm
labor.
Efrain
At Thu, 20 Apr 2000, Braun, R. Daniel wrote:
>
>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
>
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>
>-----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
>
--
"The things you learn after you know everything are the important ones"
