Urine screen for urinary tract infection (UTI), kidney disease
A symptomatic bacteriuria occurs in two percent to eight percent of pregnant women, and pyelonephritis occurs in one percent to two percent. Pyelonephritis is increased, owing to bacteriuria in the presence of stasis and dilation of the upper urinary tract in pregnancy. Group B streptococci and Pseudomonas species are infrequent causes of urinary tract infections in obstetric patients.
Screening should be carried out in early pregnancy in all pregnant women to detect and treat asymptomatic bacteriuria. Many women with significant bacteriuria are missed by selective screening. Selection of antimicrobial agents for treatment is based on susceptibility test results. Asymptomatic bacteriuria should be treated for 10-14 days. Single-dose therapy is accompanied by a higher failure rate in most studies. Assessment after treatment is important to detect recurrences and treatment failures. As cystitis is caused by the same organisms that produce asymptomatic bacteriuria, its treatment is the same as that for asymptomatic bacteriuria. In women with recurrent cystitis or recurrent bacteriuria, eradication of the organism and suppressive antibiotics are appropriate. The patient may develop recurrent bacteriuria even while on suppressive therapy. Thus it is necessary to check for bacteriuria at regular intervals, such as monthly throughout the pregnancy and at the postpartum visit.
Screening high risk individuals by culture should occur at the preconception and/or during the first pregnancy visit and in the third trimester. Screening low-risk women should probably be performed at the preconception or initial pregnancy visit.
Hepatitis B titer
All women should be screened for hepatitis B surface antigen at the preconception visit or during pregnancy. At the preconception or first pregnancy visit, women at high risk for acquiring hepatitis because of life-style or work situation should be screened for antibody status, and, if not immune, vaccination may be appropriate.
Women who are HBsAg negative but who have a history placing them at continuing high risk of HBV infection should be counseled about the advisability of vaccination. The adult dosage of 1 ml. Injected in the deltoid muscle; intramuscular injection in the buttocks is not as effective. A series of three doses is required; the second and third doses are given 1 and 6 months, respectively.
Household contacts and sexual partners of HBsAg-positive women identified through prenatal screening should be vaccinated, after testing to determine susceptibility to HBV infection when feasible. Hepatitis B vaccine should be given at the age-appropriate dose of those determined to be susceptible or judged likely to be susceptible to hepatitis B infection.
HIV testing should be offered to all women. Screening of individuals or populations at high risk is reasonable at the preconception or first pregnancy visit and again in the third trimester. Issues related to informed consent, confidentiality, counseling, support, and follow-up should be worked out in advance. The Department has established standards for both pre-test and post-test counseling (77 Ill. Adm. Code 697); these are available from the AIDS Activity Section,
Division of Infectious Diseases,
Office of Health Protection,
Illinois Department of Public Health,
525 West Jefferson Street,
Springfield, IL 62761.
The protection of confidentiality is essential to prevent these recommendations from being implemented in such a way as to pose additional barriers to early and continuous prenatal care.