Re: Asymptomatic bacteriuria
From: Efrain Ramirez (eramirez@icepr.com)
Thu Apr 20 15:28:34 2000
Yes-- anecdotally - I think in Puerto Rico the prevalence ASB must be at
least 10% - I do first trimester UC and repeat at 28-30 weeks- no
regrets.
At Thu, 20 Apr 2000, james connerth wrote:
>
>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"
--
"The things you learn after you know everything are the important ones"
