Re: Asymptomatic bacteriuria
From: james connerth (babydoc@apex.net)
Thu Apr 20 15:18:01 2000
Was initially described by Kass--others have found similar results.
Efrain Ramirez wrote:
> 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
> >
> >Certified AllExperts Expert
> >Check out my bio/ratings page!
> >http://www.allexperts.com/displayExpert.asp?Expert36
> >
> >-----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"
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