URINARY TRACT INFECTIONS
A 23-year-old primigravida at 31 weeks’ gestation comes to the birthing
unit with complaints of flank pain, nausea, vomiting, and shaking chills for
the past 12 h. She has been diagnosed with sickle cell trait. On examination
her temperature is 39.4 C (103 F), pulse 125 beats/min, and respirations 30
breaths/min. Her skin is grossly diaphoretic and she has exquisite right
costovertebral angle tenderness. Electronic fetal monitoring shows baseline
pulse 170/min with reactivity. Uterine contractions are noted every 10 min.
Urinary tract infections (UTI) may involve the lower tract (including the
bladder or urethra) or upper tract (including the kidney). The most common
organisms are gram-negative enteric bacteria with Escherichia coli the most
frequent.