|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Bacteriuria and UTIFrom: Mats Bergstrom (matsb@cor.sos.sll.se)Wed Nov 20 05:08:21 1996
On Tue, 19 Nov 1996 MBK80@aol.com wrote:
> we still do urine c/s at first prenatal visit and yield about 15% This is a practise with many sources of errors. 15% is a high incidence internationally (4-11% in one meta-analysis). A bladder incubation period of more than 4 hours, strict midstream sampling and avoidance of coitus 24 hours before sampling will give more true results, but even then both sensitivity and specificity are low according to studies comparing with bladder puncture. And the lower the true incidence, the higher is the rate of false positives. The incidence of ABU in pregnancy in Sweden is about 2% (cummulatively, culturing 3 times during pregnancy), slightly higher than in non-pregnant women of the same age, with the positive predictive value of 1 urine culture around 50% (and a significant number of true ABU will be missed). The original studies by Kass (1960), where 40% of pregnant women with ABU (>100.000/ml) subsequently developed pyelitis during the same pregnancy, started this whole thing with screening for bacterias in the first trimester. Those results are certainly not relevant for the situation in Sweden (and many other countries) now. The incidence of pyelitis in pregnancy in one study was 0.3%, 2/3 of these patients had negative cultures at screening earlier in that pregnancy. Another point of notice is the high rate of false negative traditional cultures in women (not neccessarily pregnant) *with* urinary tract symptoms, around 50% compared to culturing after bladder puncture. Testing none + treating all with symptoms would probably be as beneficial as screening (at least with incidences in the Swedish range). This has been discussed here a lot recently and many centers have changed their routines. (I guess most do culture at symptoms, though; it can be of some benefit in cases of treatment failure.)
-- Mats Bergstrom, MD Ob Gyn South Hospital Sweden
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Mon Nov 2 05:19:56 2009 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.