Asymptomatic bacteriuria and urinary tract infection in pregnancy

Urine tests (at each visit from the 4th to the 9th month)

• Urine dipstick (leucocytes, nitrites)
• Urine microscopy and culture if dipstick positive (leucocytes or nitrites)if neededDipstick positive for leucocytes or nitrites in a woman without a risk factor: urine microscopy and culture confirms or not the colonisation ^[2,3].
• Urine microscopy and culture straight away, from the 1st visit then every month from the 4th to the 9th month, instead of the dipstick (history of urinary tract infection, diabetes, uropathy)if neededHistory of urinary tract infection, diabetes or underlying uropathy: urine microscopy and culture at the first visit then at the visits of the 4th to 9th months ^[2,3].

Urine tests (before any antibiotic therapy)

• Urine microscopy and culture with susceptibility testing
• Start empirical treatment without waiting for the result.

Urgently, without delaying referral

• Urine microscopy and culture (urgently, before the antibiotic)
• FBC
• CRP
• Serum creatinine
• Blood cultures (if signs of severity or atypical presentation)if neededSevere pyelonephritis (sepsis, shock, obstruction to drain) or atypical picture, for example isolated fever with a positive dipstick, to exclude bacteraemia of another origin (listeriosis in particular) ^[2].
• Urinary tract ultrasound (within 24 h if signs of severity or severe pain) and obstetric opinion in all cases.

8 to 10 days after the end of the antibiotic

• Repeat urine microscopy and culture

Then every month until delivery

• Monthly urine microscopy and culture