Editing Bacteruria in Pregnancy (section)

== Pathophysiology ==

* '''<span style="color:#ff0000">Urologic Anatomic and Physiologic Changes during Pregnancy (4)'''
*# '''<span style="color:#ff0000">Increase in renal size</span>''' (≈1cm); thought to be result of increased renal vascular and interstitial volume
*# '''<span style="color:#ff0000">Hydronephrosis from:</span>'''
*## '''<span style="color:#ff0000">Obstructive effect of the enlarging uterus (likely main factor)</span>'''
*## '''<span style="color:#ff0000">Progesterone mediated relaxation</span>''' of smooth muscle of collecting system and bladder resulting in decreased collecting system and ureteral peristalsis, ureteral dilatation, increased bladder capacity
*# '''<span style="color:#ff0000">Bladder changes</span>'''; enlarging uterus displaces bladder, progesterone stimulates relaxation resulting in '''increased capacity'''; estrogen may cause '''bladder hypertrophy'''
*# '''<span style="color:#ff0000">Improved renal function; glomerular filtration increases by 30-50%,</span>''' and urinary protein excretion increases; '''values considered normal in non-pregnant females may represent renal insufficiency during pregnancy'''. Similarly, urinary protein in pregnancy is not considered abnormal until > 300 mg of protein in 24 hours is excreted
* '''<span style="color:#ff0000">Changes to the urinary tract in pregnancy that increase risk of UTI:'''
*# '''<span style="color:#ff0000">Decreased bladder tone because of edema and hyperemia</span>'''
*# '''<span style="color:#ff0000">Increased urine volume in the upper collecting system as the physiologic dilation of pregnancy evolves,''' can increase the propensity to develop pyelonephritis</span>
* '''Complications associated with bacteruria during pregnancy'''
*# '''Pyelonephritis'''
*# '''Prematurity and prenatal mortality'''
*# '''Maternal anemia (conflicting evidence)'''
* Recurrent UTIs are not a contraindication to pregnancy
* Pregnancy in women with renal insufficiency
** The degree of renal function impairment is the major determinant for pregnancy outcome
*** Fetal survivors of pregnant women with mild or moderate renal disease is only slightly diminished.
*** However, the perinatal mortality is approximately 4x higher with severe disease