Evaluation of Current Screening Test for Asymptomatic Bacteriuria during Pregnancy at First Antenatal Visit in Rimal Health Center UNRWA ,Gaza 2007

Rasmiya Khamis Ghsoub
رسمية خميس غصوب
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Al-Quds University
Urinary tract infection is a common problem during pregnancy and if it is not diagnosed and treated properly, bad sequels could occur affecting the mothers and their outcome of pregnancy. The main objective of this study is to determine the prevalence of urinary tract infection (UTI) and asymptomatic bacteriuria (ASB) during pregnancy, as well as to evaluate the validity of current screening test (nitrite dipstick) at first antenatal visit. This is a cross sectional study conducted among pregnant women in Rimal Health Center which is a Primary Health Care Center; UNRWA in Gaza City. The total study population was 160 pregnant women attending antenatal care at first antenatal visit from 12th April 2007 to 25th July 2007. Midstream urine was collected and tested with culture, dipstick and microscopic examinations. Validity of tests was measured by sensitivity, specificity, positive predictive value and negative predictive value. Antibiotic sensitivity was also done. Thirty one out of 160women were identified positive urine culture with prevalence of 19.4%, 18/160 was asymptomatic (11.25%) while 13/160 was symptomatic (8.15%). Among the 31 culture positive, the commonest organism was staphylococcus aureus (29%), followed by E-coli (25.80%) and klebsiella (22.58%). Ciprofloxcine was shown as the 1st sensitive drug in all cultures (93.54%) followed by cefuroxim (83.87%) and co-amoxiclave and norfloxacine were equal (70.96%) while amoxicillin, co-trimoxazol and erythromycine had the lowest sensitivity. Maximum resistance was seen to co-trimoxazol (67.74%) followed by doxycycline (29.03%). Symptoms of UTI, weeks of gestation and the previous history of premature deliveries were statistically significant risk factors for the occurrence of ASB. Age, gravidity, parity, educational level, previous CS, history of urinary catheterization and previous history of UTI were not significant risk factors for this disease. Nitrite dipstick had low sensitivity (29%), high specificity (97.7%), with positive predictive value of 75% (PPV) and negative predictive value of 85% (NPV). Asymptomatic bacteriuria in pregnancy is a major public health problem and nitrite dipstick reagent is not sufficiently sensitive to be of use in screening of asymptomatic bacteriuria in pregnancy and many of patients would be missed for management. So, the researcher recommends the use of urine culture for screening of all pregnant women at first antenatal visit.