A 31-year-old woman, gravida 1 para 0, at 28 weeks gestation comes to the office for an initial prenatal visit. The patient reports fatigue but otherwise feels well. She has no contractions, vaginal bleeding, or leakage of vaginal fluid. Fetal movement is normal. The patient had a vaginal yeast infection 6 weeks ago that she treated with an over-the-counter suppository. Her only other medication is a prenatal vitamin. She does not use tobacco, alcohol, or illicit drugs. Temperature is 37.2 C (99 F) and blood pressure is 100/70 mm Hg. BMI is 24 kg/m². Fetal heart rate is 155/min on Doppler ultrasound. Fundal height is appropriate for gestational age. A 1-hour, 50-g oral glucose challenge test reveals a blood glucose level of 120 mg/dL (normal: 100,000 colony-forming units/mL of Escherichia coli. If left untreated, this patient is at greatest risk for which of the following complications?

Question

A 31-year-old woman, gravida 1 para 0, at 28 weeks gestation comes to the office for an initial prenatal visit. The patient reports fatigue but otherwise feels well. She has no contractions, vaginal bleeding, or leakage of vaginal fluid. Fetal movement is normal. The patient had a vaginal yeast infection 6 weeks ago that she treated with an over-the-counter suppository. Her only other medication is a prenatal vitamin. She does not use tobacco, alcohol, or illicit drugs. Temperature is 37.2 C (99 F) and blood pressure is 100/70 mm Hg. BMI is 24 kg/m². Fetal heart rate is 155/min on Doppler ultrasound. Fundal height is appropriate for gestational age. A 1-hour, 50-g oral glucose challenge test reveals a blood glucose level of 120 mg/dL (normal: <140 mg/dL). A urine culture grows >100,000 colony-forming units/mL of Escherichia coli. If left untreated, this patient is at greatest risk for which of the following complications?

Quizplus · Accepted Answer

11ec25c8_da99_76d5_bc81_59285ba1f9de_MD0003_00 The patient has asymptomatic bacteriuria (ASB), the growth of ≥100,000 (10⁵) colony-forming units/mL of a single bacteria in a clean-catch urine specimen from a patient with no urinary tract infection symptoms (eg, dysuria, urinary frequency). In pregnancy, increased progesterone levels cause smooth muscle relaxation and ureteral dilation. Because of these physiologic changes, pregnant women with untreated ASB are at increased risk for acute pyelonephritis and subsequent complications, including acute respiratory distress syndrome and preterm labor and delivery. ⁵ Because of the risks of pyelonephritis in pregnancy, all women require urine culture screening for ASB at the initial prenatal visit. The most common associated pathogen is Escherichia coli, as in this patient. Pregnant women with ASB require antibiotic therapy; first-line antibiotics include cephalexin, amoxicillin-clavulanate, or nitrofurantoin. As a test of cure, a repeat urine culture is performed after antibiotic treatment due to the risk of persistent or recurrent bacteriuria. (Choice A) Abruptio placentae, the premature separation of the placenta from the uterus, typically presents with vaginal bleeding and is associated with preeclampsia, maternal abdominal trauma, or cocaine use, which are not seen in this patient. Abruptio placentae (Choice C) Amniotic fluid embolism causes acute cardiovascular collapse and most commonly occurs during labor or shortly after delivery, particularly with a cesarean or operative vaginal delivery. It is not associated with ASB. (Choice D) First-stage labor protraction may be due to inadequate uterine contractions, cephalopelvic disproportion, or fetal macrosomia. Although fetal macrosomia is associated with gestational diabetes mellitus, this patient's glucose challenge test is normal (<140 mg/dL), making this diagnosis less likely. (Choice E) Intraamniotic infection is caused by the ascent of normal vaginal flora into the uterus. Risk factors include prolonged membrane rupture and maternal group B Streptococcus colonization, not ASB with Escherichia coli. (Choice F) Oligohydramnios is associated with hypertension and placental insufficiency but not with ASB. Educational objective: Asymptomatic bacteriuria (ASB) is diagnosed when a clean-catch urine culture from an asymptomatic patient grows ≥100,000 colony-forming units/mL of a single bacteria. Because ASB during pregnancy increases the risk of acute pyelonephritis, all patients require urine culture screening at the initial prenatal visit and treatment as indicated. References: Asymptomatic bacteriuria in pregnancy. (http://www.ncbi.nlm.nih.gov/pubmed/17347050) Urinary tract infection and bacteriuria in pregnancy. (http://www.ncbi.nlm.nih.gov/pubmed/26475951)

A 31-Year-Old Woman, Gravida 1 Para 0, at 28 Weeks