Pregnancy 1 trimester leukocytes in urine. What do elevated leukocytes mean in urine analysis in a pregnant woman?

Leukocytes are immune cells, white blood cells, which, when detected in urine, clearly indicate inflammatory processes. Any diseases and inflammations in the expectant mother during pregnancy can pose a danger to the fetus. Therefore, it is important to understand what health problems are indicated by leukocytes in urine during pregnancy and what actions should be taken.

What do white blood cells mean in OAM

Leukocytes are white blood cells that form in the bone marrow and perform a protective function in the body. Circulating in the blood, they easily penetrate the vascular wall and rush to the location of foreign bodies and foci of inflammation. When there are more leukocytes during pregnancy, this indicates the presence of a focus of inflammation and the penetration of bacteria, viruses and other foreign agents.

If leukocytes appear in the urine of a pregnant woman, especially in large numbers, then this fact almost always indicates an inflammatory reaction or malfunctioning of the urinary organs.

The rate of leukocytes in urine during pregnancy

The normal number of leukocytes in the general analysis of urine in pregnant women (as well as in non-pregnant women) is from 0 to 5 in the field of view. Some experts admit their increase to 10, considering the indicator as a variant of the norm, taking into account the pronounced antigenic load on immunity during pregnancy.

When there is an increase in leukocytes, a pregnant woman is recommended to have a general urine test again. This will ensure that the result was not mistaken.

A clearer picture of the number of leukocytes is given by a study according to Nechiporenko. It consists in determining the qualitative and quantitative elements in the urine sediment obtained by centrifugation. The norm of the content of leukocytes during pregnancy is no more than 2000 pieces in 1 ml.

With a large number of white blood cells in the urine (leukocyturia), when their number is 40 or more at the standard definition during pregnancy, pyelonephritis, cystitis, or a genital infection should be suspected. Such diseases can lead to irreparable consequences (cause miscarriage, disrupt the formation of organs in the fetus).

How to properly prepare and pass the analysis

To obtain the correct result during pregnancy, preliminary preparation should be carried out and during the collection, follow the rules:

1. Purchase a sterile collection container from your laboratory or pharmacy.
2. Do not eat foods the day before that can change the color of urine (beets, carrots).
3. Do not take diuretics and other drugs during the day - they seriously affect the result.
4. Before manipulation, thoroughly wash the genitals.
5. Collect only the morning portion. The first 1-2 seconds, you should urinate in the toilet, and then into the jar (you need an average portion). The last part is also not suitable for analysis.
6. After collecting, close the container with a lid.
7. Deliver urine to the laboratory within two hours.

If the expectant mother takes medications that are constantly needed, then before doing a urine test during pregnancy, she needs to consult with a specialist about the advisability of temporary cancellation.

What causes an increase in performance and how dangerous it is

A change in the number of leukocytes in the test results does not always indicate problems. Sometimes this is observed in violation of hygiene and other rules during collection, the use of dirty containers for storage, exceeding the delivery time to the laboratory. But most often the reason why leukocytes in urine increase during pregnancy is abnormalities.

Inflammation of the bladder or kidneys

Violations of the urinary system during gestation are often observed. A sign of inflammation in these diseases is not only an increased number of leukocytes in urine and blood:

• The woman feels frequent urge to go to the toilet "in a small way", but after that there is a feeling of overflow of the bladder.
• Pain in the lumbar region begins to bother, the temperature rises.
• Nausea, vomiting and lack of appetite are signs of pyelonephritis intoxication during pregnancy. But often women attribute such symptoms to toxicosis.

The course of pregnancy depends on the timely detection of pyelonephritis and cystitis. If the diseases pass in a sluggish form and are not detected symptomatically, then in the urine tests during the period of exacerbation there will be changes, including increased leukocytes. Diagnostics helps to prevent intoxication during pregnancy and the death of the child.

Stagnant urine

A large number of leukocytes during pregnancy appears due to stagnation of urine. Stagnation occurs due to the relaxing effect on smooth muscles of pregnancy hormones - progesterone and estradiol. Thanks to this, the tone of the uterus decreases, and the fetus can develop normally without the danger of miscarriage. But the same mechanism leads to a violation of the outflow of urine. Its stagnation is threatened by infections, the formation of sand and stones.

Thrush

Another reason why elevated leukocytes are detected in urine analysis during pregnancy is often thrush. It is caused by a fungal infection and proceeds heavily during gestation against the background of a decrease in the general resistance of the body. The woman has profuse watery-white discharge, itching of the vulva and labia, swelling and redness. Candidiasis can manifest itself against the background of other diseases and the intake of a number of medications (hormones, antibiotics).

Thrush causes inflammation, and against this background, many leukocytes are detected in the urine in the analysis of urine.

Urolithiasis disease

Stagnation contributes to the formation of sand and calculi in the kidneys. Deposits are also formed as a result of:

• decrease in physical activity, which is characteristic of pregnant women;
• metabolic disorders.

This phenomenon is especially often observed during pregnancy in women over 35 years old against the background of chronic inflammation of the genitourinary system. Signs may include an increased level of leukocytes in the urine during pregnancy, cloudiness and sediment.

If the stone begins to move, renal colic develops. An attack of pain is so strong that it can provoke a premature birth.

Colpitis, vaginitis

A common occurrence during pregnancy is inflammation of the vaginal mucosa. According to statistics, this deviation is observed in 75% of all women. Nonspecific vaginal inflammation develops as a result of immunity deficiency and changes in the acid-alkaline environment against the background of hormonal changes. Provoking factors:

• lack of hygiene;
• allergy to detergents and pads;
• synthetic fiber underwear;
• stress.

With colpitis and vaginitis, pregnant women have a high level of leukocytes, a lot of mucus in the urine. The woman suffers from itching and discharge, a violation of the general condition.

During pregnancy, it is recommended to regularly take tests so that at the first signs of illness, immediately take the necessary measures.

Sexual infections

Sexually transmitted infections are very dangerous for the expectant mother and fetus. These include: herpes, chlamydia, syphilis, HIV infection, cytomegalovirus. Infection can occur before or after conception. Often, the disease during pregnancy is mild and manifests itself as a large amount of leukocytes in the urine. Special methods of laboratory diagnostics help to recognize it - a blood test for PCR and ELISA.

Other reasons

There are other factors when leukocytes in the urine of a pregnant woman increase:

• tumors;
• glomerulonephritis;
• abscess, amyloidosis, renal tuberculosis;
• inflammation or suppuration of the cyst;
• allergy;
• appendicitis;
• nephropathy in diabetics;
• systemic disease (lupus, rheumatoid arthritis);
• severe intoxication or dehydration.

But the most formidable deviation that comes to light in the second half of pregnancy is gestosis, when there is a high probability of fetal death as a result of rejection. There is also a risk to a woman's life.

Acute intoxication is accompanied by the appearance of leukocyte protein in the urine and requires emergency care in a hospital setting.

What to do if leukocytes are elevated during pregnancy

With an increase in leukocytes, a second urine test should be done first and a possible error should be ruled out. If leukocytosis persists for 2-3 times, and there are other signs of pathology, additional methods are used to make a diagnosis.

Additional examinations

To clarify the pathology of the urinary tract is carried out:

• urine analysis according to Nechiporenko;
• three-glass test;
• Ultrasound of the kidneys and urea;
• vaginal smear;
• general and biochemical blood test;
• ultrasound diagnostics of the abdominal organs;
• tests for specific infections.

In some cases, you may need to consult a therapist, allergist, surgeon, nephrologist, additional tests and instrumental studies.

What treatment is needed

Treatment is aimed at eliminating the cause or reducing the provoking factor of the pathological condition:

1. Antibiotics are used to treat inflammation of the kidneys and bladder. They are prescribed only by a doctor.
2. To overcome urinary stagnation, it is recommended to drink liquid (1.5 liters or more per day), if there is no tendency to edema.

During pregnancy, the doctor regularly sends a woman for urine tests. Usually, the tests are organized in the antenatal clinic. It is unsafe to go to the clinic while carrying a child, since the likelihood of contact with infectious patients increases.

However, some expectant mothers are sure that they are being tested in vain. This carelessness is caused by a lack of understanding of the importance of timely monitoring of health indicators. They do not want to know what kind of reckoning awaits the baby in the future, and why all the responsibility falls on the mother.

In the analysis of urine, there are several indicators reflecting the state of internal organs, their functioning, which are especially important for a woman. One of them is the appearance of leukocytes in the urine during pregnancy.

Let's remind about leukocytes

Leukocytes are part of the blood cells. They provide human immunity. The leukocyte formula contains 5 types of cells. All of them are involved in the protection process:

• some directly kill microbes by “swallowing” them and dissolving them inside the cytoplasm;
• others - serve as "accumulators of memory" about the previously encountered infection and transmit it to new forming clones;
• still others - provide "leadership" in the attack on foreign agents;
• the fourth - control the course of the struggle and the timely activation of the mechanism for stopping the reaction.

Through the transfer of the transfer factor from the mother to the offspring, information about the previously encountered pathology is received, this is what we call hereditary immunity. By the content of leukocytes in the blood, the doctor judges the level of the woman's defenses, the ability of her body to independently reflect the attack of microbes.

Leukocytes, unlike other blood cells, are able to move not only through the vessels, but also to be sent to tissues where a problem is found

Thus, they enter the kidneys, bladder, ureteral walls, urethra, in order to limit the spread of pathogenic flora. They are excreted with urine, by its composition we can judge about:

• the presence of inflammation;
• severity;
• localization;
• the effectiveness of therapeutic measures.

For diagnosis and subsequent treatment, the identified combinations of an increased number of leukocytes with other abnormalities seem to be important:

• bacteria;
• protein in the urine;
• erythrocytes.

A moderate increase in leukocytes in urine is possible due to the reaction of the mother's body to the fetus, like a foreign body. Such changes are considered normal if they are not associated with Rh-conflict.

For a correct assessment of the number of detected cells of the leukocyte series, it is customary to compare them with the established norm.

What is considered the norm?

The rate of leukocytes in urine during pregnancy reflects not only the state of complete health, but also determines the nature (proportionality) of the inflammatory response.

For a woman without pathological changes in the urinary organs, it is permissible to detect up to three to six cells in the field of view during microscopy of urine sediment.

A level of 6–8 reflects an increase in the antigenic load on the maternal organism.

If an analysis is carried out according to the Nechiporenko method, then the calculation is based on the number of leukocytes in one ml of urine volume. Up to 2000 cells are considered normal.

An increase in leukocytes in the urine of pregnant women in excess of the norm indicates an inflammatory process in the urinary organs.

When one to one and a half dozen leukocytes are detected in the field of view, one can think of moderate inflammation (small leukocyturia). A level of 40 or more is considered high and indicates damage to the kidney tissue (pyelonephritis).

Leukocytes can get into the urine from the genitals if they are improperly collected for analysis, inflammation. Therefore, it is important for every woman to know the specifics of preparing for urine testing.

What should pregnant women remember about urinalysis?

Urine analysis for the first time is prescribed immediately when the pregnant woman appears to the obstetrician-gynecologist. This procedure is mandatory. The frequency of referrals depends on the gestational age:

• in the first three months, it is recommended to conduct an examination every 3-4 weeks (prescribed at each visit to the doctor);
• in the second trimester, it is done more often - every 2 weeks;
• in the third - weekly.

This schedule should be followed by healthy women. If they are included in the risk group, then the attending physician warns about the frequency of control studies.

If the collection rules are violated, many leukocytes are found in the urine. Therefore, the doctor prescribes a re-analysis and once again talks with the woman about the need to fulfill the requirements.

In a clinical laboratory, a complete study is carried out, starting with an assessment of transparency, color, specific gravity. Part of the urine is poured into a test tube and centrifuged. Then the sediment is applied to the glass with a pipette and examined under a microscope, counting the detected elements in the field of view.

Sometimes it is necessary to apply a special staining of the smear.

Rules for collecting urine for analysis

The day before urine collection, a woman should not overeat foods high in protein (meat dishes, cheese, cottage cheese), ascorbic acid (berries, fruits, citrus fruits). It is recommended that you stop taking certain medications with the permission of your doctor.

Prepare a glass container made of glass, rinse it well with soap and pour boiling water over it.

It is better to use standard containers that can be bought at the pharmacy, they are already sterile, so they do not need additional cleaning

Only morning urine obtained after a thorough toilet of the genitals is suitable for analysis. It is recommended to insert a tampon into the vagina before urinating.

A middle portion is collected, the initial urine is released, then the act of excretion is interrupted and about 20 ml of urine is collected in a sterile container.

The jar cannot be stored for a long time; the material must be delivered to the laboratory no later than one and a half hours after collection.

For what reasons can leukocytes increase during pregnancy?

Considering the causes of increased leukocytes in the urine, we will immediately exclude the disturbed collection and ingress of inflammatory elements from the vagina.

The most common cause of leukocyturia during pregnancy is inflammatory diseases of the kidneys (pyelonephritis) and the bladder (cystitis).

The pathogenesis of these disorders, in general, is more typical for the female body, since the urethra in women is short and wide, the anus is located nearby, which contributes to infection.

During pregnancy, stagnation in the bladder is added to the inflammation factors, followed by reflux (reverse reflux) of infected urine into the renal pelvis.

Stagnation is promoted by:

• The enlarged uterus compresses the bladder. This is especially true for thin women with a narrow pelvis.
• Altered hormonal balance causes ureteral atony.
• Insufficient physical activity in the third trimester interferes with urine flow due to decreased muscle tone.

Squeezing matters in the second half of pregnancy

The triggering mechanism of inflammation is always pathogenic microorganisms. This is confirmed by the detection of bacteria in the urine of pregnant women. This condition is called bacteriuria. In addition to the bacterial flora, the causative agents of infection can be fungi, viruses, cocci.

If a woman's partner suffers from a chronic or acute disease of the genital tract, then during pregnancy Trichomonas, chlamydia, and gonococci are found in the urine. They also cause inflammation and increase white blood cells in the urine.

The provoking factors of inflammation are:

• hypothermia;
• accompanying illnesses;
• disturbed nutrition;
• stressful situations (breakdown of immunity).

White blood cells and bacteria in the urine can increase without any clinical symptoms. This condition is called latent bacteriuria. It requires a mandatory examination and, perhaps, at the time of the analysis, it was possible to record the very initial period of inflammation.

Candidiasis (thrush) affects a pregnant woman more often in the last stages. In addition to the vagina, the bladder is involved in the inflammation. In the analysis of urine, not only a large number of leukocytes are detected, but also a fungus of the genus Candida.

By what symptoms can a woman guess about inflammation?

Increased leukocytes in urine during pregnancy in combination with bacteriuria are manifested in external signs, so a woman should independently observe the nature of urine. You need to worry if the color becomes dark, transparency is lost, a loose precipitate, flakes, and insoluble threads appear in the turbid liquid.

With cystitis, it manifests itself:

• frequent urination with cuts;
• pain over the pubis;
• itching and burning in the urethra.

Typical for pyelonephritis:

• dysuric phenomena;
• nausea, loss of appetite;
• back pain;
• temperature increase;
• chills.

Nausea is exacerbated by intoxication with pyelonephritis

The appearance of symptoms must be urgently reported to the doctor. You shouldn't try to cope with the infection yourself. It spreads rapidly.

What does the detection of leukocytes with erythrocytes in the analysis of a pregnant woman indicate?

Erythrocytes accompany leukocyturia in several conditions:

• One of the manifestations of a growing uterus, altered hormonal composition and compression of the vessels that feed the wall of the bladder, ureters, kidneys. It is considered as a physiological adaptation and does not require medical intervention if the number of red blood cells is small and the woman does not suffer from blood diseases that can cause internal bleeding.
• They appear with an infectious lesion of the mucous membrane of the bladder and pelvis, impaired filtration function of the kidneys. It is urgent to diagnose the pathology and carry out treatment in order to avoid serious consequences for the mother and child.
• The stones that form from the salts (especially oxalates) injure the mucous membrane with sharp angles. Paroxysmal pain occurs at the same time. In this case, erythrocytes indicate the addition of urolithiasis.

What to think about when detecting protein and leukocytes in urine during pregnancy?

With a good filtration function of the renal glomeruli, protein is not passed into the urine. Therefore, a healthy woman should not have it. After stress or physical exertion, its appearance is allowed in the form of "traces" or 0.033 g per liter.

During pregnancy, an increase in protein excretion is an extremely undesirable symptom. It indicates a lesion in the permeability of the glomerular membrane. It can be caused by inflammation or toxicosis. A particularly dangerous symptom is considered in late pregnancy, when toxicosis can lead to miscarriage or premature birth.

Consequences and complications of leukocyturia

If a high level of leukocytes in the urine confirms kidney pathology, then treatment should be started immediately. This will help the woman to communicate the pregnancy and avoid harm for the baby.

• The spreading inflammation can reach the degree of gangrene of the bladder (gangrenous form of cystitis). The bladder wall bursts. The contents are poured into the abdominal cavity with the formation of peritonitis.
• Chronic inflammation with persistent infection changes the acidity of urine, contributes to the formation of kidney stones, bladder. Their movement leads to severe bouts of pain. Even against the background of pregnancy, one has to decide on the issue of surgical intervention.
• Toxicosis leads to late gestosis with fetal death.
• High blood pressure (hypertension) is very difficult to treat, accompanied by malnutrition of the fetus, its death. Early disorders of cerebral and coronary circulation occur in the maternal organism.
• Eclampsia is characterized by the development of convulsive syndrome. At the same time, cerebral circulation and nutrition of the fetus through the vessels of the placenta suffer. The risk of having a child with a pathology or premature miscarriage is significantly increased.

If an increased content of leukocytes is detected in the general analysis of urine, the doctor is guided by their number. An unfavorable result (more than 10 cells) indicates inflammation, and with significant leukocyturia (up to 40) with bacteriuria, there is no doubt about the inflammation of the kidney tissue.

Additionally, tests are carried out to confirm the diagnosis:

• according to the Nechiporenko method (the number of leukocytes in one ml);
• according to the method of Zimnitsky (the filtration function of the kidneys is investigated by samples every 3 hours a day);
• a urine culture tank is assigned with the identification of a specific possible pathogen and its sensitivity to antibiotics.

According to the Zimnitsky method, eight samples are examined per day

The most acceptable and safe instrumental method for pregnant women is kidney ultrasound. In conclusion, with pyelonephritis, it is determined:

• changes in the size and location of the kidneys;
• expansion of the renal pelvis;
• changing the contours of the cups;
• heterogeneous consistency of the parenchyma, areas of scarring;
• wrinkling of the kidneys with glomerulonephritis;
• birth defects.

X-ray examination with the use of contrast agents is carried out only for health reasons for a woman, since it is harmful to the fetus.

How can a pregnant woman get rid of leukocytes in urine?

In choosing therapy, the doctor focuses on:

• the severity of the inflammation;
• gestational age;
• state of immunity;
• accompanying illnesses.

In a mild form, natural herbal remedies are used with a moderate diuretic and disinfectant properties in the form of a decoction:

• chamomile flowers;
• lingonberry leaves and berries;
• cranberry;
• black currant.

Achieved safe lavage of the urinary tract and the removal of pathogenic flora. For this purpose, a ready-made herbal preparation - Kanefron is also recommended.

Usually, a pregnant woman is placed in the pathology department at the perinatal center, where, in addition to treatment, bed rest is provided, high-quality nutrition, taking into account the diet

To limit the overall effect on the mother's body, local procedures are used in the form of instillations of special disinfectant solutions into the bladder.

With severe inflammation, drugs are used that have the least toxic effect on the fetus. Here we have to take into account the fact that inaction is much more harmful to the mother and child.

The detection of leukocytes in urine during pregnancy should be regarded as a warning about a possible pathology, a call for examination. Timely diagnosis of diseases and careful therapy allow every mother to give birth to a healthy baby.

A woman, from the moment she finds out about pregnancy and until the very birth, must take a large number of various tests, including urinalysis. Many are very unhappy with this fact and believe that such control is not necessary at all. Only dissatisfaction is caused rather by a lack of information, which can lead to an undetected disease.

Any change in the condition or analyzes of a pregnant woman should be alarming. If the doctor found leukocytes in the urine during pregnancy, you should not ignore the additional examination and the doctor's recommendations to pass various tests. Leukocytes in the urine of a pregnant woman may be the first bell, signaling the onset or presence of a dangerous disease.

What it is?

The blood cells contain leukocytes - white blood cells that form human immunity. The leukocyte formula contains 5 different cells, each of which takes part in the protective process. Some cells dissolve, as if "swallowing" microbes, others are like "flash drives" memorizing information about infections that they have already encountered, others dominate the attack on foreign agents that enter the body, the latter keep the attack under control and its timely completion.

Leukocytes are special blood cells that are able to move not only through the vessels, but also, unlike others, to get into tissues and organs where there are “enemy invaders”.

In addition, leukocytes transmit hereditary immunity, this happens through the transfer of a transfer factor from mother to child. By the level of leukocytes in the blood, the doctor can determine how high a woman's immunity is, and whether he is able to cope with microbes.

White cells are the same leukocytes

When microbes spread in the kidneys, bladder, urethra and ureters, leukocytes are sent there, and then excreted in the urine. By the composition of urine, you can determine:

• is there inflammation in the body;
• how serious and extensive it is;
• where is it localized;
• whether the medications the person is taking help.

To correctly diagnose, the doctor looks not only at the presence of leukocytes, but also at their combination with bacteria, erythrocytes or protein in urine analysis. In pregnant women, there may be a slight increase in white blood cells due to the reaction of the mother's body to a foreign body (for which the body takes the fetus). This condition is completely normal and does not require any additional intervention.

The norm of leukocytes in the urine of a pregnant woman

Normally, in pregnant women without problems with the urinary system, 3-6 cells can be detected by microscopy of the sediment.

When 6-8 cells are found on the woman's body, the antigenic load increases.

When a urine test according to Nechiporenko is taken, it is calculated on the number of leukocytes in one milliliter of urine. Normally, in this case, there can be up to 2000 cells.

An increase in leukocytes above normal indicates inflammation of the urinary system. If 1-15 leukocytes are detected, we can talk about a small leukocyturia (slight inflammation), from 15 to 40 leukocytes - an average degree of inflammation. An indicator above 40 leukocytes can indicate serious inflammation, up to pyelonephritis.

Be careful, an increased number of leukocytes may indicate improper collection of urine for analysis (ingestion from the genitals).

How to properly collect urine for analysis of a pregnant woman

A pregnant woman has to pass urine for analysis quite often. In the first trimester, once a month, in the second, about every two weeks, and in the third trimester, almost every week.

How to properly collect urine for analysis?

• before the day of the test, you should not abuse protein products;
• fruits, berries, citrus fruits are also not worth eating in large quantities;
• coordinate the intake of medications with the doctor;
• prepare a glass container, rinse it well or purchase a special sterile jar for analysis at the pharmacy;
• in the morning, conduct a thorough toilet of the genitals;
• insert a tampon before urinating;
• the initial portion of urine must be released, interrupt urination, bring a jar, draw the middle portion into a jar, release the remainder;
• within an hour, you need to deliver the analysis to the laboratory.

It is best to take tests in a pharmacy jar (it is sterile and does not require processing)

If you follow all the rules of preparation, the results of the analysis should show the state of the urinary system of the pregnant woman as accurately as possible.

Symptoms indicating an increase in white blood cells

An increase in leukocytes in the urine of a pregnant woman may be accompanied by some symptoms. For example, the color of the liquid, instead of transparent, becomes dark, cloudy, a precipitate in the form of flakes or insoluble filaments may appear. Other troubling symptoms:

• frequent urination, accompanied by cramps;
• pain above the pubis;
• nausea, loss of appetite;
• itching and burning in the urethra;
• dysuric phenomena;
• increased body temperature;
• back pain.

If any of the listed symptoms a pregnant woman finds in herself, she urgently needs to consult a doctor and tell about her complaints. Do not self-medicate, this can lead to irreversible consequences!

Causes of high leukocytes

Excluding improper collection of urine, several main causes of leukocyturia can be distinguished.

During pregnancy, stagnation occurs in the bladder, sometimes accompanied by a reverse reflux (reflux) of infected urine into the renal pelvis. Congestion can be due to:

• squeezing the bladder with an enlarging uterus;
• a change in hormonal balance causes a lack of ureteral tone;
• due to a decrease in muscle tone (due to low physical activity in the last trimester), the outflow of urine is impaired.

Sexually transmitted diseases in a woman or her partner can cause an increase in white blood cells in a woman's urine. In addition, pathogenic flora can develop due to fungi, viruses, etc. But the main cause is usually two diseases - pyelonephritis and cystitis during pregnancy.

Pyelonephritis

During pregnancy, women in 7% of cases develop such an unpleasant and dangerous disease as pyelonephritis, or gestational pyelonephritis. Pyelonephritis is a kidney disease, during which the kidney tissue becomes inflamed first, and subsequently, the calyces and pelvis may also be affected. Usually this disease develops at the end of the second - third trimester of pregnancy, when the uterus is already large enough and squeezes adjacent organs, including the ureters. In this case, urine cannot pass through them normally, and inflammation begins. Another reason may be a change in the level of hormones, which affects the peristalsis of the ureters, and as a result, the deterioration of urine excretion. As a result, urine stagnates in the pelvis, and forms an excellent environment for the development of pathogenic microflora.

The difference between a healthy kidney and a kidney affected by pyelonephritis

The reasons for the development of pyelonephritis.

The main causes of gestational pyelonephritis are low immunity, hypothermia, a sedentary lifestyle and the occurrence of cystitis or pyelonephritis earlier.

Signs of the disease

Pyelonephritis can be acute and chronic. In the acute form, a woman may experience increased headaches and muscle pain, vomiting and lack of appetite, chills, weakness, fever, lower back pains are pronounced on one or both sides (depending on whether one kidney is inflamed or both).

In the chronic form, aching pain in the lower back can be observed, usually dull, they can either arise or stop. Headaches and weakness are also present.

Treatment

Acute pyelonephritis is usually treated in a hospital, with the use of antibiotics, and specific therapy (from the adoption of a special position by a pregnant woman, nephrostomy and decapsulation, to removal of the kidney).

In chronic pyelonephritis and relatively normal tests, a hospital stay is not required, and the woman is given general recommendations regarding lifestyle and diet, and some drugs are prescribed to prevent deterioration of the condition.

With moderate or high severity of the disease and poorly responding to treatment of pyelonephritis, the possibility of maintaining pregnancy may be called into question. In some cases, there is a high probability of death of the mother and child, so in no case should the advice of doctors be disregarded. And if the first symptoms are found, a visit to a gynecologist is mandatory.

Cystitis

Cystitis during pregnancy is found in about 10% of pregnant women. The risk increases if a woman has already had this disease.

Cystitis is an inflammation of the lining of the bladder and a malfunction that is caused by microorganisms and several other factors.

It looks like cystitis - inflammation of the mucous membrane of the bladder

The reasons for the development of cystitis

Cystitis is infectious, medicinal, allergic thermal. Infectious cystitis is caused by various bacteria. The main causative agent of such cystitis is Escherichia coli. Usually, this type of cystitis occurs precisely in women due to the structure of the genitals (where the urethra is located close to the anus).

Medicinal cystitis occurs due to certain drugs, the altered substances of which are excreted in the urine, thereby irritating the mucous membrane of the bladder.

Allergic cystitis occurs in people who are hypersensitive to certain substances such as bubble baths, hygiene sprays, condoms, and certain foods.

Thermal cystitis occurs due to hypothermia or exposure to hot liquids on the mucous membrane of the bladder.

Signs of the disease

A disease such as cystitis is usually accompanied by a number of unpleasant symptoms:

• strong and frequent urge to urinate;
• frequent discharge of small amounts of urine;
• blood in the urine;
• burning sensation while urinating;
• discharge of urine with an unpleasant odor;
• cloudy urine or sediment;
• pressure in the lower abdomen and discomfort in the pelvic region;
• increased body temperature.

Cloudy urine is a sign of inflammation

Treatment

Treatment for cystitis depends on the reason for it. With infectious cystitis, antibiotic therapy is performed. But you need to carefully approach the choice of antibiotic, since some of them adversely affect the fetus. Other types of cystitis depend on its form. Applicable:

• anticholinergics;
• pain relievers;
• special preparations for cystitis;

Regardless of the type of cystitis, the doctor advise you to stay in bed and drink enough fluids.

What does an increase in leukocytes in the urine of pregnant women lead to?

If leukocyturia is a sign of kidney disease, treatment must be carried out immediately, otherwise it can lead to the following consequences:

• Toxicosis can lead to late gestosis and fetal death;
• Inflammation can cause gangrene of the bladder, the wall of which breaks and the contents are poured into the abdominal cavity, peritonitis occurs;
• Chronic inflammation contributes to the formation of stones in the bladder and kidneys. Because of the severe pain, sometimes the question of surgical intervention is raised even during pregnancy;
• Hypertension is accompanied by a lack of nutrition of the fetus and its death, as well as disorders of the cerebral and coronary circulation of the mother;
• Eclampsia develops convulsive syndrome, the fetus does not receive enough nutrition and oxygen, which increases the risk of having a child with pathology or premature birth.

Additional examination

To confirm the diagnosis, the woman will be assigned to pass a series of tests that will help determine the severity of the disease. In addition to a general blood and urine test, you will need to pass a urine test according to Zinitsky and Nechiporenko, bacteriological urine culture, undergo an ultrasound of the kidneys, a consultation with a nephrologist, and possibly a chromocystoscopy or ureteral catheterization.

In rare cases, an X-ray study with contrast is prescribed, it is safe for a woman, but it can harm the fetus.

Pregnancy is a very important period in the life of every woman, and you need to be especially careful about yourself at this time. Register with the antenatal clinic on time, take all the tests, follow the recommendations of your doctor, eat right, walk more, watch out for colds, and at the slightest sign of any illness, be sure to visit the doctor, and then the pregnancy will go smoothly, and you will not have any complications bother.

Elevated leukocytes in urine during pregnancy indicate the development of urinary tract infections (UTIs). It should be noted that UTIs are one of the most common complications of pregnancy. This is due to such physiological changes in the body of a pregnant woman as stretching of the ureter (after the sixth week of pregnancy), an increase in the size of the MP (bladder) and a significant decrease in its tone. Due to this, vesicoureteral reflux is formed, which creates a favorable background for the development of often recurrent inflammatory processes in the urogenital tract of a pregnant woman.

In addition, about seventy percent of pregnant women develop glucosuria, as well as increased levels of progestins and estrogens in the urine. This contributes to the rapid multiplication of bacteria in the urine, as well as their further invasion in the epithelium of the genitourinary tract.

In this regard, a general urinalysis is included in the list of mandatory regular examinations performed during pregnancy. It allows you to identify inflammation in the genitourinary tract, from the urethra to the kidneys.

Normally, leukocyte cells in the urine are absent or are in the amount of two or three in the field of view. For women, the maximum allowed content is up to five per field of view.

Norm: leukocytes in urine during pregnancy does not differ from standard indicators (up to five in the field of view). The rate of the 3rd trimester is also similar.

When conducting a urine analysis according to Nechiporenko, in 1 ml of urine sediment (after centrifugation), up to 2000 leukocytes are allowed.

An increased content of leukocytes in the urine is called leukocyturia. She may be:

• weak or insignificant (less than forty leukocyte cells in the field of view);
• moderately expressed (from fifty to one hundred leukocytes);
• pronounced.

With an increase in the content of leukocytes more than two hundred in the field of view, the diagnosis is made - pyuria. With the development of pyuria, pus is excreted in the urine. Such urine has a putrid, pungent odor and a cloudy yellowish-green color.

Increased leukocytes in urine during pregnancy

It should be noted that a single urine test does not make a diagnosis. If there are many leukocytes in the urine, the analysis must be repeated with a more thorough toilet of the external genital organs, to exclude false results.

If elevated leukocytes are re-identified, women are recommended to be examined by a gynecologist in order to exclude inflammatory processes such as vulvovaginitis and bacterial vaginitis.

A general blood test and ultrasound examination of the pelvic organs and kidneys are also performed.

The analysis of urine should be supplemented by its culture for sterility (detection of bacteriuria).

The spectrum of microorganisms that cause UTIs

In most cases, inflammation of the bladder, kidneys, urethra, etc., is associated with Escherichia coli, Proteus, Klebsiella. Less commonly, UTIs are caused by staphylococci, enterobacter bacteria, and streptococci.

In sexually transmitted infections, the greatest role is played by gonococci, Trichomonas and chlamydia.

Leukocytes in urine during pregnancy are increased: causes

Many leukocytes in urine during pregnancy may indicate the presence of:

• stones in the ureters;
• pyelonephritis;
• pyelitis;
• cystitis;
• urethritis;
• asymptomatic leukocyturia and bacteriuria in pregnant women;
• glomerulonephritis (combined with hematuria and / or proteinuria);
• capillary glomerulosclerosis;
• disseminated lupus erythematosus;
• urinary allergy (extremely rare);
• malignant arterial hypertension;
• renal tuberculosis;
• toxicosis (especially dangerous are increased leukocytes in the urine during late pregnancy, combined with proteinuria);
• sexually transmitted diseases;
• gynecological inflammations (bartholinitis, vaginitis and vulvovaginitis, adnexitis, etc.).

It should be noted that with a pronounced alkaline reaction of urine, leukocytes are destroyed, therefore, an increase in leukocytes in urine analysis may be absent even in the presence of severe inflammation. In this regard, when conducting a study, it is imperative to pay attention to the pH of urine.

Pyuria in pregnant women can be caused by:

• pyelonephritis and pyelitis;
• gynecological inflammatory processes;
• carbuncle or kidney abscess in the breakthrough stage (when pus is excreted in the urine);
• a breakthrough into the urinary tract of purulent inflammatory processes from the OMT (pelvic organs);
• chronic inflammation of the bladder;
• bladder cancer;
• thrombosis of the veins of the kidneys (in rare cases, increased leukocytes in the urine during pregnancy in late stages can be caused by thrombosis of the renal veins due to hypercoagulation);
• toxic shock;
• severe toxicosis (sterile pyuria is possible).

What symptoms accompany an increase in leukocytes in urine?

Leukocyturia in urine tests means the presence of inflammatory processes in the MP (genitourinary system). In most cases, the cause of an increase in leukocytes during pregnancy is:

• acute or chronic cystitis;
• pyelonephritis;
• asymptomatic bacteriuria.

Inflammation of the bladder (cystitis)

The disease is manifested by discomfort and pain in the lower abdomen (the maximum pain is observed above the pubis), frequent false urge to urinate, burning and cramps during urination. With a severe course of the inflammatory process, fever, chills, and the appearance of streaks of blood in the urine are possible.

Pyelonephritis

Pyelonephritis is an inflammatory process that affects the kidneys. In this case, inflammation affects the interstitium, tubules and the calyx-pelvis system.

Symptoms of the disease, as a rule, develop acutely, with fever, fever and chills, tachycardia, pallor of the skin. Patients complain of lower back pain (more intense on the affected side), pain in muscles and joints, nausea (vomiting is possible, which does not bring relief).

There may also be an increased urge to urinate, pain and discomfort when urinating. The urine is cloudy with an unpleasant odor. Visible mucus and blood streaks may appear.

In the absence of timely treatment, pyelonephritis during pregnancy is accompanied by a high risk of developing urosepsis, intrauterine fetal death or premature birth.

Asymptomatic bacteriuria in pregnant women

This term means persistent bacterial colonization of the urinary tract of a pregnant woman, without clinical symptoms of the inflammatory process.

It should be noted that despite the absence of clinical manifestations, such bacteriuria is not a harmless condition that does not require treatment, since it significantly increases the risk of developing cystitis and pyelonephritis.

In addition, urinary tract infections during pregnancy can cause IUGR (intrauterine fetal growth retardation), premature baby birth (prematurity), congenital anomalies (with infections in early pregnancy), and also lead to intrauterine fetal infection, intrauterine death and spontaneous abortion, infection during childbirth, the development of postpartum sepsis.

Urethritis during pregnancy

The onset of an inflammatory process in the urethra is accompanied by the appearance of burning and pain during urination, frequent false urge to urinate, difficulty urinating (due to edema). Discharge of pus, mucus and blood streaks is also possible.

If symptoms of urethritis are detected, an examination for STDs (sexually transmitted diseases) should be carried out, since the main causative agents of urethritis are gonococci, Trichomonas, chlamydia.

Vulvitis and vaginitis

The main symptoms are vaginal discomfort, burning, and dryness. The appearance of mucopurulent or muco-bloody discharge with an unpleasant odor from the vagina is possible. Pulling and aching pains in the lower abdomen and in the lower back may also be noted.

Adnexitis

The inflammatory process in the ovaries is accompanied by fever, fever, chills, nausea, bloating, severe pain in the lower abdomen (sometimes pain radiates to the lower back or leg), the appearance of mucopurulent or purulent vaginal discharge, pain during urination. On palpation, the appendages of the uterus are sharply painful.

Bartholinitis

The inflammatory process in the glands of the vestibule of the vagina is accompanied by severe pain sensations, aggravated by walking or sitting, an increase in the gland in size and swelling of the labia majora on the side of the lesion. There is also severe dryness and burning sensation in the vagina, discomfort when urinating.

When the abscess of the Bartholin gland breaks through, pus is discharged. At the stage of abscess formation, there is an increase in body temperature and intense throbbing pain in the labia majora.

Late toxicosis (gestosis) of pregnancy

One of the most formidable complications of late pregnancy is preeclampsia and eclampsia. With the development of these conditions, in urine analyzes there will be not only sterile leukocyturia, but also significant proteinuria.

The clinical symptoms of late gestosis are:

• increased blood pressure;
• the appearance of edema;
• persistent and severe headaches;
• visual impairment;
• nausea and vomiting;
• loss of consciousness;
• flashing flies and colored spots in front of the eyes;
• tremor of the limbs;
• convulsions.

If these symptoms are detected and preeclampsia is suspected, the pregnant woman is immediately hospitalized. The development of eclampsia can cause disseminated intravascular coagulation, bleeding, placental abruption, fetal death and pregnancy.

Urolithiasis disease

In some cases, an increase in leukocyte and erythrocyte cells in the analysis of urine may indicate urolithiasis. Symptoms include lower back pain and severe urinary discomfort (if sand is present).

Vivid clinical symptoms are characteristic of the development of renal colic. In this case, there is a sharp, intense and excruciating pain in the lower back, abdomen, along the ureter, etc. Pain can radiate to the leg. Patients are sharply restless, screaming, rushing about in pain. Possible vomiting by a fountain.

What to do if high leukocytes are detected in urine analysis?

The main criterion for the diagnosis of urinary tract infection is the combination of leukocyturia with bacteriuria. Also, the presence of clinical symptoms will testify in favor of the inflammatory process:

• back pain;
• dysuric disorders;
• temperature rise, etc.

In the analysis of blood, accelerated ESR, leukocytosis and neutrophilia may be noted. An increase in acute phase proteins (C-reactive protein) is also characteristic. However, such changes are characteristic of severe inflammation (pyelonephritis) in uncomplicated cystitis or urethritis; there may not be any changes in the blood test.

In the presence of minor and periodic leukocyturia, it is not always possible to detect it using a routine urinalysis. To obtain more reliable results, special quantitative analyzes are performed (Addis-Kakovsky and Amburzhe test).

To exclude gynecological inflammation, smears are taken from the vagina for their further microscopy.

An examination by a gynecologist, examination for STIs is mandatory, and an ultrasound examination of the pelvic organs and kidneys is performed.

Treatment

In the presence of uncomplicated urinary tract infections, fosfomycin (for example, Monural®) is prescribed. Due to the wide spectrum of action, covering the entire spectrum of UTI pathogens, a short course of treatment (1 or, if necessary, 2 days), as well as the absence of undesirable effects on the fetus, Monural ® is the drug of choice for the treatment of asymptomatic bacteriuria and uncomplicated cystitis in pregnant women.

For pyelonephritis, aminopenicillins and second- and third-generation cephalosporins may be prescribed.

All treatment should be strictly supervised by a physician. Self-medication and changing the prescribed dosages are unacceptable and can cause significant harm to the unborn child and pregnant woman.

• erythrocytes (0-1 in the field of view);
• leukocytes (0-3 in FOV).

1. Squamous epithelium.
2. Salt in small amounts.

The body of pregnant women bears a double load, working immediately for the expectant mother and baby. So, the excretory system removes metabolic products from both the mother and the child. This, as well as a change in hormonal levels, causes an expansion of the urethra, as a result of which the risk of stagnation and infection of urine increases.

One of the components of urine that is important in urine analysis is white blood cells.

Leukocytes are formed elements of blood and lymph. They are heterogeneous in their structure and role. They do not have a pronounced color, which is why you can often find a variant of the name "white blood cells". They have the ability to penetrate the walls of the capillaries. The main function of these cells is protective, but it has some differences for different types of leukocytes.

A significant level of these cellular elements in the analysis of urine or blood is almost always an indicator of the inflammatory process in the body. It occurs with various pathological phenomena:

• infections of the genitourinary apparatus;
• decreased kidney function;
• allergic reactions;
• organ inflammation;
• diseases of viral etiology.

Separately, it should be noted pyelonephritis - an acute inflammation of the renal pelvis and parenchyma, common among pregnant women. Its direct cause is an ascending urinary tract infection.

Elevated leukocytes (more than 7 in the field of view of the microscope) may indicate not only diseases, but also banal non-observance of the rules of personal hygiene.

But you need to know that a moderate number of such cells in gynecological smears and urine of women is permissible. This is due to the anatomical and physiological features of the structure of the genital organs and is only a constituent part of the healthy microflora of the vagina.

White cell levels naturally rise during pregnancy. The principle of the defensive function of the leukocyte is such that it absorbs and digests the harmful organism. This process is called phagocytosis. And the protective mechanisms in the body of a woman carrying a child are activated. During this period, physiological is observed in urine and blood, i.e. natural leukocytosis.

Special attention should be paid to cases of high white blood cell count after the 37th week of pregnancy. For a more accurate assessment, a urine test using the Nechiporenko method may be prescribed.

Treatment

The therapy will be directed at the disease that caused the leukocytosis. Assistance to pregnant women is assigned according to the deadline:

1. Natural diuretics are suitable for minor infections. These include herbal teas, decoctions, herbal preparations. Both independently and in the collections are used: lingonberry, chamomile, orthosiphon, birch leaves and buds, cornflower, field horsetail.
2. More complex cases require the use of antibiotics. These are drugs of the groups: penicillins, cephalosporins, sulfonamides and nitrofurans. The doctor selects drugs individually, based on the degree of safety for the expectant mother and fetus.

After the end of the course of therapy indicated by the specialist, urine analysis is repeated. By a decrease or complete normalization of the level of white cells, one can judge about recovery. If leukocytes are still elevated, additional examinations are prescribed, therapy is corrected.

Prophylaxis

Prevention of diseases that cause an increase in the level of white cells involves strict adherence to personal hygiene:

• thorough hand washing;
• separate towels for the body and genitals;
• using only warm running water;
• refusal from bar soap and washcloths for intimate hygiene; this will prevent the breeding of bacteria;
• taking a shower instead of a bath.

Preventive analysis, detection of the cause of increased urine leukocytes will help to stop inflammatory processes in a timely manner, which is extremely necessary for the safe course of pregnancy.

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