Lower UTI in pregnancy — assessment and treatment

PLAB 2 & PRES 3 · obs-gyn · medium · 8 minutes

Candidate brief

You are a doctor in a GP practice. Ms Sophie Ryan, 29, is 24 weeks pregnant and has developed pain when passing urine and urinary frequency. Assess her symptoms, exclude complications, explain the likely diagnosis and agree an appropriate management plan. No physical examination is required, but verbalise any assessments or investigations you would perform.

What examiners look for

Urinary symptoms during pregnancy require clinical assessment and urine culture. Do not rely on dipstick testing alone. Distinguish lower UTI from pyelonephritis. Fever, rigors, flank pain, vomiting or systemic illness require urgent hospital assessment. Also check for obstetric warning signs, including contractions, vaginal bleeding, leaking fluid and reduced fetal movements. Pregnant patients with symptomatic lower UTI should receive an immediate pregnancy-appropriate antibiotic while culture results are awaited. At 24 weeks, nitrofurantoin is usually suitable when renal function is adequate and there is no contraindication. Avoid it near term; HSE specifies after 36+0 weeks. Use amoxicillin only when culture confirms that the organism is susceptible. Review all culture results and change treatment when required. Explain adherence, adverse effects, hydration, follow-up and when urgent reassessment is needed. If group B streptococcus is identified in urine, communicate the result to the maternity team because it may affect treatment and antibiotic planning during labour.

Guideline references

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