Acute cystitis in pregnancy
Introduction
Introduction to pregnancy with acute cystitis Acute cystitis (acutecystitis) can be developed in pregnant women from asymptomatic bacteriuria, but there is also the first urine culture is negative, the latter may be related to women's short urethra, close to the anus, not paying attention to the vulva hygiene and causing infection If there is an operation such as catheterization, it is more likely to occur. basic knowledge The proportion of illness: 0.001% Susceptible population: pregnant women Mode of infection: non-infectious Complications: postpartum urinary tract infection
Cause
Pregnancy with acute cystitis
(1) Causes of the disease
Cystitis and urethritis are collectively referred to as lower urinary tract infections, which can be divided into bacterial and non-bacterial infections. Escherichia coli is the most common pathogen, followed by Staphylococcus. The main routes of infection are:
1 ascending infections, such as male prostatitis, female paraurethral gland inflammation, various examinations and treatments through the urethra.
2 Downstream infections, such as infections secondary to the kidneys.
3 through lymphatic spread and direct spread, such as vaginitis, cervicitis and other adjacent organs when infection occurs.
(two) pathogenesis
In the lower urinary tract infection, bacterial ascending infection is the most common. After the bacteria enter the bladder, it does not cause urinary tract infection. Because the body has a series of defense ability against bacterial invasion, urination can remove bacteria in the bladder, as long as the urinary tract is smooth. The bladder emptying ability is normal, the bacteria are difficult to stay in the bladder; the urine has urinary mucin, which has the function of blocking the adhesion of bacteria to the bladder wall; the Tamm-Horsfall protein secreted by the renal tubule contains mannose residues and can be wrapped. E. coli pili, which prevents the contact between E. coli pili and urinary mucosal epithelium, so that the bacteria lose their chance of adhesion and excrete with the urine; in acute cystitis, the bladder epithelial cells can accelerate the shedding to accelerate the elimination of bacteria adhering to the bladder mucosa .
The occurrence of urinary tract infection depends on the quantity and virulence of the invading bacteria and the damage of the normal defense function of the body. For example, the pathogenicity of E. coli after entering the urinary tract is related to the antigenic characteristics of the strain, and it has been found to contain K antigen. The strain has anti-macrophage function and resistance to complement destruction, more common in acute pyelonephritis and some patients with cystitis, accounting for 38% of asymptomatic bacteriuria; and O antigen can cause bladder epithelial cells to fall off, reduce Normal peristalsis of the ureter accelerates inflammatory invasion of granulocytes, leading to tissue damage. 80% of E. coli causing urinary tract infection contains O antigen, and most of them are kidney infections; while E. coli H antigen has no effect.
Bacterial invasion of the urinary tract must first adhere to the mucosa of the urinary tract. There is a mannose residue on the surface of the urothelium, which may be a receptor for bacterial pili. Studies have shown that E. coli has 10 to 200 pili, and the surface of the bacteria is slender. It is a protein that secretes adhesin and acts as a hemagglutin-like protein. It recognizes receptors on the surface of epithelial cells, binds to mannose residues, and adheres to the surface of epithelial cells. The more pili of bacteria, the greater the adhesion. Among them, type I pili is called mannose-sensitive, which is closely related to lower urinary tract infection.
The normal bladder has the effect of eliminating bacteria, but when it causes urinary retention for any reason, a series of self-defense ability disappears, so patients with poor urine flow are more likely to have urinary tract infections, but so far there is no evidence that the body's own immunity is involved. The lower urinary tract infection caused the disease.
The pathological changes of acute cystitis are mainly mucosal congestion, flushing, swelling of epithelial cells, hyperemia of submucosal tissue, edema and leukocyte infiltration, which can completely disappear with the disappearance of bacteriuria in a short period of time. Only a few heavier cases have bladder mucosa. Spotted or flaky hemorrhage and mucosal ulceration.
Prevention
Pregnancy with acute cystitis prevention
Strengthen the health care during pregnancy and improve the health level; pay attention to the vulva cleansing, the toilet paper should be rubbed from the front direction after defecation, reduce the chance of intestinal bacterial contamination of the vaginal vestibule and urethra, clean the vulva every night; treat asymptomatic bacteriuria, do better Points help prevent acute cystitis.
Complication
Pregnancy with complications of acute cystitis Complications Postpartum urinary tract infection
Although there is no complication of acute cystitis, it can be caused by ascending infection, which quickly affects the upper urinary tract. 40% of patients with acute pyelonephritis during pregnancy have symptoms of lower urinary tract infection before onset.
Symptom
Pregnancy with acute symptoms of bladder inflammation Common symptoms Hematuria, frequent urination, low fever, turbidity, urinary urgency, pyuria, urinary frequency, urinary frequency after pregnancy
Cystitis is caused by ascending infection, accompanied by acute urethritis. The typical clinical manifestations of cystitis in adult women are frequent urination, urgency, dysuria and turbid urine. The frequency of urination is significantly increased, 1 or 2 times per hour. Even more frequent; urgency is that the urine can not help but immediately urinate, but the amount of urine is not much, each time the amount of urine is 10 ~ 100ml, frequent urination, urgency is more obvious, each time the amount of urine is less, frequent urination Urinary urgency is accompanied by dysuria, that is, burning pain in the bladder and urethra when urinating, frequent urination, urgency, and dysuria are collectively referred to as urinary tract irritation, which is caused by inflammation of the bladder triangle and posterior urethra, sometimes accompanied by There is bladder area discomfort, generally no obvious symptoms of systemic infection, only a few patients have low fever, urine cells often have white blood cells, occasionally hematuria, and even gross hematuria (if urinary red blood cell phase contrast microscopy, this hematuria is uniform red blood cell hematuria), The occurrence of cystitis is closely related to sexual life. After female sexual intercourse, bladder puncture and urine culture are used. Most of them can cultivate the same species as the parasitic urethra. Therefore, the urinary tract irritation of many patients occurs mostly. After delivery, such as cystitis without antibiotic therapy, also 30% of the sick can be 7 to 10 days of healing.
Examine
Examination of pregnancy with acute cystitis
There is often no protein in the urine, but there are a lot of white blood cells and bacteria. Red blood cells are often seen in urine sediments. Occasionally, hematuria can be seen by the naked eye. The culture of urine bacteria is often positive. The total number of single pathogens is often >105/ml, pathogens and asymptomatic bacteriuria. The same is true for patients with pyelonephritis, most of which are E. coli infections.
Diagnosis
Diagnosis and diagnosis of pregnancy complicated with acute cystitis
diagnosis
According to the medical history, hematuria, pyuria and urine culture a single pathogen >100,000 / ml, no difficulty in diagnosis.
Differential diagnosis
Acute pyelonephritis
Mainly manifested as urinary frequency, urgency, dysuria and other urinary tract irritation symptoms, urine test may have pus cells and red blood cells, but often accompanied by fever and other symptoms of systemic infection, low back pain and tenderness in the kidney area.
2. Trichomonas cystitis
Mainly manifested as urinary frequency, urgency, dysuria and other urinary tract irritation symptoms, but patients often have a history of unclean sexual intercourse, urethra has more secretions, and secretion examination can find trichomoniasis.
3. Interstitial cystitis
Mainly manifested as urinary frequency, urgency, dysuria and other urinary tract irritation, and pubic pain, pain and tenderness in the suprapubic bladder area is particularly obvious, increased in bladder filling, most routine urine examination, very few pus cells.
4. Glandular cystitis
Clinical manifestations of frequent urination, urgency, dysuria, dysuria and hematuria, B-ultrasound can be shown as non-specific signs of intravesical space-occupying lesions or thickening of the bladder wall. Cystoscopy and mucosal biopsy can help Identification.
5. Lower ureteral stones
Bladder irritation can also occur when the ureteral stones fall to the inter-wall segments. If the infection is combined, it is not easy to distinguish from cystitis. The KUB plain film and IVU can show the location of the stones and determine whether there is a combined obstruction.
6. Cystitis and urethral syndrome
The differential diagnosis is mainly positive for urine culture. The urethritis caused by Chlamydia trachomatis infection has similar symptoms, and the bacterial culture is repeatedly negative, but pyuria can be identified.
