An elevated number of pus cells in urine during pregnancy may indicate an infection.
“Don’t be alarmed! Urine infections in women are common (24%) during pregnancy because of multiple physiological changes,” informs Dr. Anita Sabherwal Anand, Consultant Obstetrician – Gynecologist at Sitaram Bhartia Hospital in Delhi.
What causes pus cells in urine?
Pus cells are actually white blood cells or leukocytes that fight off infections. White blood cells are normally shed in the urine. An examination of a urine sample under microscope may reveal no pus cells or a few pus cells in the field of the slide examined (normal range is 0-5 pus cells/hpf). The presence of many pus cells in urine during pregnancy needs to be examined further.
How much pus cells in urine is normal?
If present, the normal range of pus cells in urine is 0-5/hpf (when seen under a microscope in high power).
If your doctor suspects a urine infection, you may be advised to get a urine culture done.
“Through a urine culture we can identify which type of organism or bacteria is causing the infection. We allow the bacteria to grow over a few days in a laboratory and determine its response to different antibiotics.”
What may cause an increased number of pus cells in the urine during pregnancy?
Certain changes in the female anatomy may encourage infections to develop.
“As the baby grows in the uterus and the uterus expands, it bears down on the urinary tract which is located below it, “ elaborates Dr. Anita.
The urinary tract consists of the upper tract (kidneys and the ureter) and the lower tract (the bladder and the urethra).
The pressure on the bladder causes the urine to remain in the bladder and restricts its flow, which enables the growth of the bacteria.
Bacteria may also thrive in the presence of pregnancy hormones and glucose in the urine.
The urethra begins to expand at six weeks of pregnancy (urethral dilation) and continues to increase in size as the pregnancy progresses. The wider passage also helps the bacteria from outside to reach the bladder easily.
What are the symptoms of a urine infection in pregnancy?
You may experience
- Pain or a stinging sensation while passing urine
- An urge to pass urine frequently
- Pelvic pain or pain in the lower back
- Fever occasionally
- Nausea or loss of appetite occasionally
You may notice urine that appears opaque and has a reddish streak.
How is a urine infection in pregnancy diagnosed?
“High number of pus cells in urine during pregnancy may be found during a routine urine test, even if sometimes you do not display any symptoms,” informs Dr Anita.
“Expecting mothers are screened for Urinary Tract Infections (UTIs) at the first visit around 6 to 10 weeks and a second time between the 20th to 24th week of pregnancy.
A urine test is also advised when you complain of any symptoms.
UTIs are usually diagnosed between the 6th and 24th week of pregnancy.
Who is at risk of developing many pus cells in urine during pregnancy (urine infection)?
You may be more prone to developing urine infection during pregnancy in certain situations such as
- A history of UTIs or diabetes
- Older age
- Multiple pregnancies
You may also be at risk if you have taken multiple antibiotics in the past.
High doses and prolonged use of antibiotics taken for other infections can reduce the presence of good bacteria (Lactobacillus) in the vagina, that do not allow the growth of harmful bacteria like E.coli.
At 8 weeks pregnant, Vinitha Nair, began to feel a burning sensation every time she emptied her bladder. Aware that it required immediate attention, she consulted her gynecologist. She was then advised to get a urine test.
“The test revealed 25-30/hpf pus cells in urine during pregnancy, “ says Dr Anita.
Vinitha was then suggested a urine culture to confirm the presence of a urine infection.
The expecting mother was afraid that it may harm her baby and expressed her concern.
Does urine infection in pregnancy affect the baby?
“A UTI can harm the mother and baby, particularly if severe, unless it is treated in time.”
“It may even spread to the kidneys in the upper urinary tract leading to complications.”
Urine infections may also lead to
- Premature birth
- High blood pressure
- Intrauterine growth retardation (IUGR)
- High fever after delivery
Tense though she was, she felt lighter when the doctor reassured her she had done the right thing by not ignoring her symptoms and seeking medical help in time.
How do you treat urine infection in pregnancy?
Your gynecologist will advise antibiotics based on the results of your urine culture.
If the infection has spread to other parts of the urinary tract, you may be recommended stronger medication for a longer duration.
Based on her positive urine culture, Vinitha was prescribed an antibiotics course for 4 days.
She was keen to know tips to lower pus cells in urine during pregnancy.
What is good for urine infection when pregnant?
Some good practices to follow with a urine infection during pregnancy are:
- Increasing water intake: Drink atleast 6-8 glasses of water a day as this eliminates toxins from the body and reduces the recurrence of infections.
- Passing urine frequently: Empty your bladder whenever you feel the need and try not to restrain yourself. You should also pass urine before and after intercourse and avoid intercourse when you have a UTI.
- Cleaning private parts with only soap and water: Avoid using body washes, sprays or other feminine products as these could disturb the balance of microorganisms in the vagina.
Each of these practices also helps prevent infection or high pus cells in urine during pregnancy.
Vinitha asked the doctor whether there were any home remedies that may help prevent urine infections from returning.
Home remedies for increased pus cells in urine during pregnancy include:
- Vitamin C rich foods like Kiwis and Oranges can be eaten as these may help increase the acidity in the urine which in turn may help prevent bacterial infections.
- Unsweetened cranberry juice: Although more research is needed to prove its benefits, unsweetened cranberry juice is an anti-oxidant and may prevent infections. It can safely be consumed during pregnancy.
- Probiotics or good bacteria like Lactobacillus may help prevent urinary infections in women. Probiotics can be found in probiotic curd and other dairy products like Kefir and cheese.
When Vinitha followed up with the doctor after completing her antibiotics course, she felt better and no longer experienced painful urination.
She kept a strict vigil on her fluid intake and knew she should alert her gynecologist in case any symptoms reappeared.
“Thankfully the rest of my pregnancy was uneventful. I am glad I didn’t brush off my symptoms and averted any complications by treating the urine infection early,” says Vinitha in a visit after her delivery.
If you have any questions regarding infection and number of pus cells in urine during pregnancy, leave us a comment below.
Q&A: Elevated Pus Cells in Urine During Pregnancy
Answered by Dr Anita Sabherwal Anand, with 20+ years of experience as an Obstetrician-Gynecologist.
Q.Is it normal to have pus cells in 3-4 urine?
A.The normal range of pus cells in urine is 0-5/hpf , however up to 10 pus cells may be present without any definite infection. If you have any symptoms of a urine infection, you should get a urine culture done.
Q.I am 6 weeks pregnant and my urine test reports mention 8-10/hpf pus cells in urine during pregnancy. What should I do?
A.You should do a urine culture to understand whether you have a urine infection. While you wait for the culture report (which takes 2-3 days), you should increase your fluid intake and clean your private parts after each urination.
Q.My sister has 50-60/hpf pus cells in urine during pregnancy. What should she do?
A.Your sister should be in regular contact with her gynecologist. The high number of pus cells seems to indicate an infection but this can be verified through a urine culture. She should speak to her doctor to understand what other tests to do depending on how her pregnancy is progressing.
Q.I was told I have 30-40 /hpf pus cells in urine during pregnancy. I am in the 9th month. Is this dangerous?
A.You should contact your gynecologist as soon as possible. You may be advised a urine culture to identify which type of organisms are causing the infection and the best medication to treat it.
You may also be prescribed a blood culture, especially if you have high fever, to assess the spread of the infection.
This article has been written with Dr. Anita Sabherwal Anand, Consultant, Obstetrician-Gynecologist at Sitaram Bhartia Hospital in South Delhi.
MBBS, Lady Hardinge Medical College, University of Delhi (1992); MD (Obstetrics & Gynaecology), Lady Hardinge Medical College, University of Delhi (1997); DNB Secondary (Obstetrics & Gynaecology), National Board of Medical Education, New Delhi (1999)
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