The Definition and the Significance of Decreased Fetal Movements

Abstract

Asymptomatic urinary tract infection occurs in approximately 5 per cent of pregnant women. If bacteriuria is detected in the first trimester and is not eradicated, about 25 per cent of these women will develop acute pyelonephritis during the third trimester or the puerperium. Several reports indicate that single-dose antibacterial therapy, applied at the asymptomatic stage, may be effective in such cases. Two investigators used single-dose combination therapy in four different regimens for treating women with bacteriuria of pregnancy. The most successful of these was a single dose of streptomycin and sulfametopyrazine, which resulted in a 77 per cent cure rate among the 47 women treated. Both drugs, however, are considered hazardous to mother and infant. Another team treated 25 pregnant women with a single intramuscular dose of cephaloridine (2 gm) and cured 13 (52 per cent) of the patients. The sole criterion for cure was the eradication of the original infecting organism. Involvement of the renal parenchyma was detected by measuring strength of the antibody directed against the O-antigen of the infecting organism. If there was involvement of the parenchyma, the strength was usually 1:320 or greater, whereas a strength of 1:160 or less suggested the absence of renal involvement. This test was undertaken in 19 of the 25 pregnant women. Of those with an antibody strength suggesting kidney involvement, only 1 of 10 was cured, as compared with 8 of the 9 in whom the antibody strength indicated that the infection was confined to the bladder. The investigators concluded that the response to a single dose of cephaloridine appeared to be a good indicator of whether the infection involved the kidney. They suggested that, although cephaloridine was known to be bactericidal, this effect was not as rapid as that obtained with some other antibiotics, such as the aminoglycosides. Furthermore, complete sterilization of the bacterial population does not occur, and a few “persisters” remain. Improved results might have been obtained if the patients had been instructed to increase their fluid intake and empty their bladders at frequent intervals in order to wash out the bacteria. A second dose of cephaloridine on the following day might also have produced better results. The present author and his co-workers studied the effects of treating 12 pregnant women with asymptomatic bacteriuria with a single 100-mg oral dose of nitrofurantoin. Six of the 12 patients were cured (sterile urine 7 days after cessation of treatment). The six women were shown subsequently to have radiologically normal urinary tracts. Of the six patients who remained infected, three had radiological defects, namely, renal calculus, pelviureteric obstruction, or unilateral reflux nephropathy.