Urinary Tract Infections (UTI) and Bacterial Vaginosis (BV) | Birth Injury Practice Areas
Urinary tract infections (UTIs) and bacterial vaginosis (BV) are two common bacterial infections that can occur during pregnancy. A UTI is an infection of the body’s urinary system (which can involve the bladder, kidneys and/or the tracts that connect these systems) while BV is an infection of the vagina due to an imbalance of naturally occurring flora. Both urinary tract infections and bacterial vaginosis (when left untreated) can cause serious permanent birth injuries and obstetrical complications (including premature birth, sepsis, meningitis, hypoxic ischemic encephalopathy (HIE) and cerebral palsy. Because these infections don’t show symptoms in the mother, standard procedure dictates that physicians should screen pregnant women for infection and treat them with appropriate antibiotics (determined using a susceptibility test) if they find signs of infection. UTIs and bacterial vaginosis can be recurring, so doctors must use a repeat urine culture to make sure the infections have been completely treated. In the worst of cases, kidney infections can cause maternal sepsis, preterm labor and premature delivery.
During pregnancy, changing hormones can leave expectant mothers predisposed to infection. Urinary tract infections (UTIs) and bacterial vaginosis (BV) are two of the most common complications an expectant mother may experience during pregnancy. Mismanaged, undiagnosed or left untreated, both infections can result in dangerous, permanent birth injuries, complications and newborn health problems. Throughout this page, our Detroit, Michigan birth injury attorneys will discuss everything you need to know about urinary tract infections, bacterial vaginosis, medical malpractice and birth injuries. Should you have any legal questions or case inquiries, please contact our team here.
What Are Urinary Tract Infections (UTIs)?
A urinary tract infection (UTI) is an infection in the body’s urinary system, which includes the kidneys, ureter (the tube that carries urine from the kidneys to the bladder), the bladder and the urethra (the short tube that carries urine from the bladder to outside the body). UTIs can take the form of lower track infections (bladder infections) or upper tract infections (kidney infections or pyelonephritis), with pregnant women at an increased risk for infections between weeks 6 and 24. Untreated UTIs can cause dangerous and permanent birth injuries and obstetrical complications including intrauterine infection, premature birth, brain damage and neonatal infection.
What Is Bacterial Vaginosis (BV)?
Bacterial vaginosis (BV) is an infection of the vagina caused by bacteria. Specifically, BV is caused by an imbalance of naturally occurring bacterial flora. Bacterial vaginosis is the most common vaginal infection in women of childbearing age, affecting approximately 1 in 5 women at some point during pregnancy. If bacterial vaginosis and urinary tract infections are misdiagnosed or mismanaged during pregnancy, the baby can become infected and develop sepsis, meningitis, brain damage and conditions such as hypoxic ischemic encephalopathy (HIE) and cerebral palsy.
Untreated Urinary Tract Infections (UTI) and Bacterial Vaginosis (BV) During Pregnancy Can Cause Neonatal Brain Damage
Bacterial vaginosis and urinary tract infections must be promptly and properly treated in pregnant women. Both infections are associated with increased risk of premature rupture of the membranes (PROM), preterm birth (which can lead to brain damage and cerebral palsy), low birth weight, sepsis, meningitis and perinatal death. Because urinary tract infections often have no symptoms, it is standard practice for physicians to screen all pregnant women for the infection, particularly in women with a history of preterm birth. A few studies show a connection between BV and second-trimester miscarriage, and it is standard practice to treat all pregnant women who have BV symptoms.
Causes of Urinary Tract Infections (UTI)
- Changes in Uterine Size: Urinary tract infections are more common during pregnancy because of changes in the urinary tract. Because the uterus sits above the bladder, its growth during pregnancy can block drainage of urine from the bladder, thereby causing infection.
- E. Coli: E. coli causes roughly of 80–85 percent of urinary tract infections. E. coli can be transmitted to the urethra from the bowel. After entering the bladder, E. Coli are able to attach to the bladder wall and form a biofilm that resists the body’s immune response.
- Staphylococcus (Staph Infections): Staphylococcus, or staph infections, cause roughly 5 to 10 percent of urinary tract infections. Staph infections usually occur secondary to blood borne infections.
- Group B Streptococcal (GBS) is a specific type of staph infection and is known to cause about 5% of UTI cases.
- Viral and Fungal Infections: Some UTIs are caused by viral or fungal infections. Bacteria usually cause UTIs by entering the bladder through the urethra, but infection may occur through the blood or lymph. Bacteria can enter the urinary tract by way of sexual intercourse, catheters, stool or partial blockage of a urinary passage.
Causes of Bacterial Vaginosis (BV)
Normally, the vagina contains several microorganisms that prevent other vaginal microorganisms from multiplying to a level where they cause imbalance and health problems. One of these microorganisms is Lactobacilli. The microorganisms involved in bacterial vaginosis are very diverse, and a change in the normal bacterial flora, including the reduction of Lactobacilli, allows more resistant bacteria to start to predominate and multiply. Antibiotics or a pH imbalance can cause a reduction in Lactobacilli. Douching is one of the most direct causes of BV.
Risk Factors for Urinary Tract Infections (UTI)
- Bladder infection
- Urinary catheterization
- Spermicide use
- Sexual activity (in young women)
- Family history
Risk Factors for Bacterial Vaginosis (BV)
- New or multiple sex partners
- History of BV
Signs and Symptoms of Urinary Tract Infections (UTI)
The most common symptoms of a bladder infection are burning with urination, having to urinate frequently, the absence of vaginal discharge and significant pain. Symptoms of a urinary tract infection range from mild to severe, and in healthy women, last an average of six days. Some women experience pain in the pubic bone or lower back. In addition to the classic symptoms of a bladder infection, women with a kidney infection may experience flank pain, fever or nausea and vomiting. Rarely, the urine may appear bloody or contain visible pyuria.
Symptoms of a urinary tract infection include the following:
- Pain or burning during urination
- A feeling of urgency during urination
- Blood or mucus in the urine
- More frequent urination
- Cramps or pain in lower abdomen
- Pain during sexual intercourse
- Chills, fever or sweats
- Leaking of urine (incontinence)
- Waking up from sleep to urinate
- Change in amount of urine
- Cloudy urine
- Pain, pressure, or tenderness in the area of the bladder
- Back pain, chills, fever, nausea and vomiting may occur if bacteria spreads to the kidneys
Signs and Symptoms of Bacterial Vaginosis (BV)
The chief symptom of bacterial vaginosis is abnormal vaginal discharge. The signs and symptoms of BV include the following:
- An abnormal homogenous, milky or creamy discharge
- Fishy or amine odor
- Mild itching
Diagnosing Urinary Tract Infections (UTI)
Urine cultures can detect urinary tract infections throughout a woman’s pregnancy. The American College of Obstetrics and Gynecology recommends that a urine culture be obtained at the first prenatal visit. A repeat urine culture should be obtained during the third trimester because the urine of treated patients may not remain sterile throughout the entire pregnancy. The recommendation of the U.S. Preventative Services Task Force is to obtain a urine culture between 12 and 16 weeks of gestation. Urine cultures are preferred to the office-based screening tests, such as a urinalysis and dipstick testing, which lack sufficient sensitivity and specificity.
Diagnosing Bacterial Vaginosis (BV)
For diagnosis of bacterial vaginosis, the presence of three of the following criteria are necessary:
- Homogenous, milky or creamy discharge
- Presence of true clue cells on microscopic exam
- pH of secretions above 4.5
- Fishy or amine odor with or without addition of 10 percent KOH
The CDC has noted that some specialists recommend screening and treatment during the first prenatal visit of women who had a previous premature infant. Additionally, these guidelines recommend follow up examinations one month after initial screening and treatment.
Treatment for Urinary Tract Infections (UTI)
Antibiotics administered throughout a pregnancy safely treat urinary tract infections. Antibiotic courses must be safe to both the mother and the baby, and the choice of antibiotic should address the most common infecting organism (for example, gram-negative gastrointestinal organisms). Historically, ampicillin has been the drug of choice, but in recent years, E. coli has become increasingly resistant to ampicillin and other antibiotics, such as sulfamethaxazole / trimethoprim (SXT) and ceftriaxone. Thus, it is imperative that antibiotic susceptibility testing be performed to determine which antibiotics will work to treat a specific woman’s infection. A repeat urine culture for test of cure should be performed. Urinary tract infections have a high rate of recurrence in pregnant women, so close monitoring with frequent urine cultures subsequent to the initial diagnosis and treatment is essential. It also is imperative to change to a more sensitive antibiotic if a woman’s infection is not cured by the treatment or the infecting bacteria is resistant to the antibiotic(s) given. In complicated cases, a longer course or intravenous antibiotics may be needed, and if symptoms haven’t improved, further diagnostic testing is necessary. Some common antibiotics, such as fluoroquinolones and tetracyclines, should not be prescribed during pregnancy due to their possible toxic effects on the baby. However, use of fluoroquinolones for resistant microorganisms is appropriate.
Some pregnant women with urinary tract infections do not present symptoms of infection. Because untreated UTIs can cause dangerous, permanent birth injuries, it is critical that physicians detect and treat UTIs in asymptomatic women. By screening for and aggressively treating pregnant women with asymptomatic bacteriuria, it is possible to significantly decrease the annual incidence of kidney infection during pregnancy. Research shows that treatment of pregnant women with aysmptomatic bacteriuria has been shown to decrease the incidence of preterm birth and low birth weight infants.
A kidney infection (pyelonephritis) is a serious illness that can progress to maternal sepsis, preterm labor and premature delivery. Early, aggressive treatment is important in preventing these complications. Hospitalization is indicated for women who are exhibiting signs of sepsis, who are vomiting and unable to stay hydrated and who are having contractions. Treatment with oral cephalexin or intravenous cephalothin (Keflin) have high success rates, and both are equally successful in preventing low birth weight and preterm deliveries. Antibiotic therapy may be initiated before obtaining the results of urine culture and sensitivity. Several antibiotic regimens may be used, including IV cefazolin (Ancef), IV gentamycin plus ampicillin, or intramuscular ceftriaxone. Treatment of a kidney infection should continue until the woman’s fever is gone. Most women respond to hydration and prompt antibiotic treatment within 24 to 48 hours. The most common reason for initial treatment failure is resistance of the infecting organism to the antibiotic. If fever continues, or other signs of systemic illness remain after antibiotic therapy, the possibility of a structural or anatomic abnormality should be examined. Persistent infection may be caused by urolithiasis, congenital kidney abnormalities or a kidney abscess.
Treatment for Bacterial Vaginosis (BV)
Antibiotics such as Metronidazole or Clindamycin are effective treatments for BV in pregnant women. However, there is a high rate of recurrence. Some research shows a high rate of resistance to Metronidazole, which can lead to the recurrence of a bacterial vaginosis case. In cases of recurrent BV, Clindamycin therapy often has a better clinical efficacy. A test for a cure should be performed after treatment. A one-time dose of Metronidazole is no longer recommended by the CDC due to low efficacy. Intravaginal clindamycin cream should be used in pregnant women only during the first 20 weeks.
Complications and Side Effects of Mismanaged Urinary Tract Infections (UTI)
Mismanaged urinary tract infections can cause several dangerous side effects and complications. The following birth injuries, obstetrical complications and neonatal health problems can result from a mismanaged UTI.
- Intrauterine growth restriction (IUGR)
- Low birth weight
- Premature rupture of the membranes (PROM)
- Preterm birth
- Cerebral palsy
- Preeclampsia and other hypertensive (high blood pressure) disorders of pregnancy
- Perinatal death
Complications and Side Effects of Mismanaged Bacterial Vaginosis (BV)
Mismanaged cases of bacterial vaginosis can cause dangerous side effects and complications. The following birth injuries, obstetrical complications and neonatal health problems can result from a mismanaged case of BV.
- Pelvic inflammatory disease (PID)
- Premature rupture of the membranes (PROM)
- Preterm birth
- Cerebral palsy
- Low birth weight
- Perinatal death
Medical Malpractice, Urinary Tract Infections (UTI) and Bacterial Vaginosis (BV)
Grounds for a Medical Malpractice Case
Due to the potentially devastating complications associated with UTIs and BV, it is imperative that the infections be accurately and promptly treated in all pregnant women. When a pregnant woman is not properly tested for UTIs or BV, and when standards for treating the conditions are not followed, it is medical negligence. If this negligence leads to injury in the baby or mother, it is medical malpractice.
Listed below are issues that may constitute negligence:
- Failure to screen a pregnant woman for urinary tract infections
- Failure to perform a bacterial vaginosis screening on a woman who has symptoms of or risk factors for BV
- Failure to perform antibiotic susceptibility testing for UTIs
- Failure to perform a test for cure after treating urinary tract infections and bacterial vaginosis
- Failure to use appropriate antibiotics and/or failure to switch to a more sensitive antibiotic when necessary
- Utilization of antibiotics that are harmful to the mother or fetus
Legal Help for Mismanaged Urinary Tract Infections (UTIs) and Bacterial Vaginosis (BV)
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Video: Our Birth Injury Attorneys
Award winning lawyers Jesse Reiter & Rebecca Walsh discuss the many causes of birth injuries, which include urinary tract infections & bacterial vaginosis.
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