Abstract Background: Urinary tract infection (UTI) is one of the highest frequently problem caused by bacterial
factors in a pregnant woman, which can lead to significant complications for both fetus and mother that hasten early
detection for problems and prevention. The study aimed to identify the maternal markers for detecting urinary tract
infection among pregnant women in port said City, Egypt. Subjects and Methods: A cross-sectional descriptive
design was performed on 101 pregnant women who attend the obstetrics and gynecology clinic at Port Said general
hospital with the inclusion criteria from first September 2017 to end of February 2018. The structured interviewing
questionnaire and Laboratory test record were used to collect the data using a purposive sample. Result: In this study,
53.5 % of the studied women had positive bacteria in the urine culture. E. coli (39%) had the highest percentage of
the isolated bacteria followed by Staphylococcus aureus (26%). The frequency of micturition, followed by dysuria,
lower abdominal pain, urine color change, painful burning sensation, incomplete bladder evacuation were the most
common maternal markers, predisposing factors associated with UTI during pregnancy were age, occupation, family
income, previous treatment for UTI during current pregnancy, regular urination, diabetes mellitus, and previous
urinary tract infection. Recommendations: A guidelines about preventive measures of UTI for pregnant women
should be providing. Since the symptoms are considered reliable markers for detecting UTI during pregnancy, so
suitable screening for early detection and provide proper treatment for infected cases should be implemented.
Keywords: Urinary tract infection (UTI), pregnancy, bacteria
Urinary tract infections (UTIs) are more frequent bacterial
infections in humans, caused by recognized bacteria
named as uropathogenic species. UTIs are considered a
common health problem during pregnancy in the world,
particularly in developing countries . Pregnancy is
considered one of the susceptibility reasons to increase the
risk of urinary tract infection due to the burden of gravid
uterus on the ureters producing stasis of urine flow.
Moreover, urethral dilatation which occurs in 90%
of pregnant women at 6 and 22-24 weeks, gestation.
Hormonal and immunological responses during normal
pregnancy, Sexual activity, age and the presence of
genitourinary defects increase the prevalence of UTI
The main bacteria that cause urinary tract infections are
Enterobacteriaceae, particularly Escherichia coli and
Klebsiella pneumonia. Escherichia coli are considered the
main organism to infect the community with 80% of the
infection in the urinary tract. These microorganisms
increase the pregnant women risks such as premature
labor and spontaneous abortion which need firm vigilance
because of its great prevalence [1,4].
Maternal markers are considered medically diagnose
for UTIs throughout pregnancy. It is important to
determine symptoms that are the core problem during
pregnancy some of them might be present, such as urinary
occurrence and dysuria. Urgency urination may be present
but at a lower scale, affecting approximately 1% to 5% of
pregnant women. However, such indicators may also be
present in cystitis and pyelonephritis by urethral irritation
of the epithelium or as irradiated aching of a higher
urinary tract infection process . Also the presence of a
microorganism that causes UTI per milliliter of urine at
least 100,000 in asymptomatic pregnant women, or as
over 100 organisms/ml. of urine associated with pus
cells on urine (>5 WBC/HPF) in asymptomatic women
throughout pregnancy .
Urinary tract infection in pregnancy is divided into
asymptomatic (ASB) and symptomatic bacteriuria groups.
Asymptomatic bacteriuria it is defined as the continued
presence of bacteria in the urinary system of women who
have no symptoms [1,2]. While the second group that
characterized by urinary tract infection in the lower part of
the urinary system like (acute Cystitis) or upper tract
(acute pyelonephritis) infections. Cystitis is characterized
by the presence of bacteriuria with bladder mucosal
invasion, however pyelonephritis is presence of
bacteriuria linked with the inflammatory process of the
American Journal of Nursing Research 318
kidney parenchyma and pelvis named is symptomatic
urinary tract infections .
The prevalence of acute pyelonephritis is significantly
developed in pregnant women with asymptomatic bacteriuria
that ranged between 20 to 30%, if not treating during
pregnancy will progress to acute pyelonephritis that
considered a complication is leading to septic shock
in the majority severe cases. So that, the initial
antenatal urine culture is routinely performed, to decrease
the occurrence of this dangerous pathology [1,8].
Pyelonephritis arises in 20-40% of pregnant women and
has a relapse immediately in 23% post-natal period .
Although symptoms are greatest markers of UTI through
pregnancy, special treatment has to be focused for
asymptomatic cases .
The frequency of UTIs in pregnancy are thoroughly
linked with the socio-economic status of the women,
predisposing factors like, repeated UTIs, diabetes mellitus,
structural defects of the urinary system, etc. Among the
pathogenic agents, E. coli registers for the largest of UTIs,
subsequent by Enterobacter and Klebsiella. Enterococci
and Proteus species source uncomplicated inflammation
in the bladder and pyelonephritis. Candida species are a
major reason of fungal UTIs mainly in immunecompromised
patients and in patients with catheters for a
long period . Penicillin, Amoxicillin, celtaxidime,
norfl,aoacin, and cefoxitin are the greatest important and
competent antibiotics for the cure and impede the majority
of the UTI bacteria .
The nurse has an important role for prevention, early
detection and treatment of urinary tract infection during
pregnancy. The prenatal assessment to detect the women
and fetus at risk should do by the nurse to improve the
antenatal outcome by providing the proper care. Also,
nursing intervention can assists in the effective treatment
of lower urinary tract infection (LUTS) and prevent the
involvement of upper urinary tract. Moreover, the nurse
has experience and knowledge about the proper referral
and suitable patient teaching to prevent the recurrence of
1.1. The Significance of the Study
Urinary tract infections are commonly spread and
constitute a serious maternal and fetal risk. They are
considered the costly medical complications of pregnancy,
occurring in nearly 20% of all pregnancies and responsible
for 10% of all admissions to the hospital during pregnancy
[2,3,4]. E. coli released the active endotoxin component of
(lipid A) into the maternal circulation. Endotoxin-induced
damage includes changes in cardiovascular output and
lessened peripheral vascular resistance and precipitates a
surge response of pro-inflammatory histamine, cytokines,
and bradykinins. This may lead to the more serious
complications such as; disseminated intravascular coagulation,
septic shock, respiratory insufficiency, and adult respiratory
distress syndrome . UTI is one of the most important
and potentially preventable causes of early preterm birth,
low birth weight, and higher neonatal mortality and
In Egypt, the prevalence of urinary tract infection has
been reported about 29% in Ismailia city, nearly 30.29%
in Suez governorate, and in Zagazig governorate reached
22% to 35%. Urinary tract infections are responsible for
the mortality of approximately 150 million annually,
worldwide [2,18,19]. Therefore, women during pregnancy
should be evaluated for predisposing factor and
assessed for the causative organism and markers of
infection throughout their regular schedule follow-up. The
examination of urine for the presence of bacteria and the
appropriate antibiotic treatment should be determined for
maternal and fetal health safety. The sensitivity for the
drug should be put into thought with their adverse reaction
related to pregnancy .
UTI is an avoidable disease that could be simply
limited through health instruction to pregnant women
about its etiology, nature, predisposing factors and women
high risk and preventive methods . So, this study aims
to identify maternal markers for detecting urinary tract
infection among pregnant women in port said City, Egypt.
1.2. The Aim of the Study
This study aimed to identify the maternal markers for
detecting urinary tract infection among pregnant women
in port said City, Egypt.
1.3. Research Questions
1- What are the maternal markers for detecting urinary
tract infection among pregnant women in PortSaid city?
2- What are the possible predisposing risk factors for
urinary tract infection during pregnancy in Port Siad city?
3- What are the causative bacteria isolated from the
urine culture among pregnant women?
محتويات مواقع أعضاء هيئة التدريس بما فيها من نصوص وملفات وصور وأبحاث وأية مواد أخرى هي مسئولية عضو هيئة التدريس بالكامل بصفته صاحب الموقع وبما له من صلاحية مطلقة في الإضافة والحذف، وتخلي الجامعة مسئوليتها عن محتويات تلك المواقع.
جميع الحقوق محفوظة © عمادة تقنية المعلومات والتعليم عن بعد 2018م ــ 1440هـ.