The most common test during pregnancy is urinalysis. It is prescribed to everyone, without exception, and before each scheduled visit to an obstetrician-gynecologist. Why this particular study is done so often and what it can tell specialists, we will tell in this article.
Kinds
Urine analysis is a rather broad concept. This diagnostic method has been known for a long time and is popular in medicine. Examination of urine content allows the doctor to formulate a fairly accurate idea of the patient's well-being and the processes that take place in his body.
For pregnant women, timely diagnosis of even minor deviations is very important. That is why a simple and effortless urinalysis is recommended so often.
The growing uterus can squeeze internal organs, and the kidneys, bladder, ureters are the first to suffer. Prolonged pressure can lead to the development of severe lesions of the urinary system. According to the composition of urine, the doctor can conclude whether the kidneys, liver, pancreas of the expectant mother are working correctly, whether she has gestosis, diabetes mellitus, or an inflammatory process.
Urine studies are different. Without exception, expectant mothers are prescribed general (clinical) urine analysis. Sometimes there is a need to conduct an analysis according to Nechiporenko or Zimnitsky, sometimes there is a need to establish only individual parameters - the presence of sugar in the urine, the amount of uric acid. In the very early stages, a woman does hCG analysis. It can be carried out both in the laboratory and at home, for this there are pharmacy pregnancy tests. At least once during the period of bearing the baby, the woman is given a direction for bacterial culture of urine.
All these studies are carried out by different methods and have completely different goals. To understand why a referral for a particular study was written out in the consultation, you need to know what is the difference between the most common types of urine diagnostics.
General
This analysis gives a general idea of the quantitative composition of urine. The laboratory assistant sets the amount of liquid, its color, transparency, smell. Physicochemical research makes it possible to understand what is the density of urine and its acidity. Biochemical methods make it possible to find out which substances are present in the liquid. The list of "searched" includes proteins and enzymes. Under a microscope, a specialist calculates the contents of the sediment - epithelial cells, erythrocytes, if any, leukocytes, salts - urates and oxolates, as well as phosphates, if the urine is alkaline. Rent for research morning portion of urine.
According to Nechiporenko
The study is named after the scientist who first proposed this diagnostic method. It happened in the middle of the twentieth century. Since then, the simple and informative method has found widespread use. The analysis allows you to establish the level of leukocytes, erythrocytes and cylinders in the secreted fluid if an inflammatory process in the urinary system is suspected.
Not always, with diseases such as cystitis and pyelonephritis, it is possible to find the true number of these indicators in the general analysis. With symptoms and previously diagnosed diseases of the genitourinary system, the Nechiporenko test is prescribed for pregnant women in all cases. The study requires a morning portion of urine.
According to Zimnitsky
This method of laboratory diagnostics allows specialists to find out how well the kidneys concentrate urine, as well as establish the volume of daily urine output. Understanding exactly how much urine the patient's kidneys excrete per day, including at night, is necessary for the diagnosis of pathologies of the kidneys and cardiac activity.
Morning urine is not suitable for research. But after the first urination, it is recommended to collect urine in eight cans, every three hours. In this case, the expectant mother will have to calculate and write down how much fluid she consumed.
Bakseeding
This study is conducted not only in order to find out if the expectant mother has any infections or foci of inflammation, but also in order to establish the exact causative agent of these ailments and understand how to deal with it. So, with bacterial infection, laboratory assistants determine the type of bacteria and its resistance to various antibiotics. Used for diagnostics average portion of urine.
Decoding and reasons for deviations
A normal clinical test result for uncomplicated pregnancy looks like this:
What these or those indicators indicated in the table say, becomes clear if you know the assessment criteria.
The amount of urine
Normally, a woman should excrete about 75% of all the fluid she drinks. The rest of the moisture is used for intracellular nutrition. The daily urine rate is about 2 liters or slightly less. An increase in daily volume is called polyuria. In pregnant women, this may be due to the consumption of too much liquid, foods that have a natural diuretic effect.
In addition, the amount of urine may increase if a woman has suffered severe nervous stress, her swelling began to dissolve. Exceeding the daily allowance can be a sign of diabetes mellitus, as well as a consequence of an illness associated with an increase in temperature.
If the amount of urine decreases to half a liter, then this phenomenon is called "Oliguria". So the body begins to work in conditions of a lack of fluid, if a woman drinks little and sweats a lot. Oliguria is also characteristic of pregnant women with heart disease, kidney disease and acute liver failure.
Anuria - this is an almost complete absence of urine, if a pregnant woman secretes only 200 grams of this liquid per day. This is an indicator of acute renal failure, meningitis, severe toxic poisoning. Anuria can also occur if the stones block the urinary tract, or if a tumor forms in one of the areas.
Colour
The yellow color, which is considered completely normal, is given to urine by special pigments - urochromes. Bright yellow urine is observed with increasing concentration, specific gravity of all substances dissolved in it. This usually happens with dehydration, toxicosis associated with vomiting. Pale, light or almost clear urine may indicate the presence of diabetes mellitus or gestational diabetes, an increase in blood sugar and urine levels of the expectant mother.
The golden color of urine can change to orange if there is bilirubin in the urine, liver function is impaired, if there are blood diseases with massive breakdown of red blood cells. Pink urine can be a sign of an incipient disease of the urinary system, and the fluid secreted by the kidneys becomes red due to blood impurities characteristic of various injuries and inflammatory processes of the urinary tract, kidneys, ureters, and bladder.
Brown urine can accompany many diseases of the liver, gallbladder, pancreas, and infectious hepatitis. Greenish urine becomes when infected with Pseudomonas aeruginosa, white - when lymph or pus enters it, blue or blue - with an intense pyogenic process in the intestine with the formation of indigo pigment and with rare metabolic disorders associated with excessive accumulation of the protein tryptophan.
Both food products and drugs can stain urine in different colors.... So, beets and red food colors give the secreted liquid a red color, carrots, carrot juice, oranges and some multivitamin complexes - orange. Preservatives used to produce canned meat, cherries and blackberries - in pink, and folic acid, which all expectant mothers take while waiting for a baby - in brown. Red tints appear with a high dose of acetylsalicylic acid.
Only by the color of urine, no one will establish a diagnosis. If there is a deviation in this indicator, the rest of the parameters will be examined more carefully so that the reason for the change in shade becomes obvious.
Smell
Normal urine smells slightly like ammonia. In a healthy pregnant woman the liquid should not have a strong odor. If the urine sample smells bad, the technician will try to determine the nature of the smell and describe it.
So, the smell of acetone is characteristic of women in a state of ketonuria. An unpleasant smell of feces in the urine appears with a bacterial infection of the urinary tract, the causative agent of which is Escherichia coli. A strong smell of ammonia may indicate cystitis. Experienced laboratory assistants distinguish about a dozen more different nuances - the smell of rotten fish, rancid fishy smell, musty mouse smell, the smell of a swimming pool and sweaty feet. Each phenomenon has its own name.
A woman herself can pay attention to the fact that during pregnancy, even in the early stages, the smell of urine changes. This is due to the fact that the composition of urine also changes.
The new conditions in which the organism of the expectant mother works requires the mobilization of all possibilities, the hormonal background is changing. This cannot but affect the odor of the fluid excreted by the kidneys.
Specific gravity (relative density)
The density of substances dissolved in urine is a variable concept. During the day, the density of urine can change. It is higher in the morning and decreases in the evening. If the amount of liquid is small, then its density is usually higher. If the specific gravity is below normal, then we can talk about diabetes mellitus or kidney failure. The presence of sugar and protein in urine makes it denser.
Transparency
The norm is the absence in the urine of suspension, white flakes, visible sediment. Cloudy urine may indicate that the analysis was not collected correctly, as well as that there are protein, mucus, bacteria, fats or salts in the physiological fluid. To understand which of the above has clouded the fluid secreted by the kidneys, laboratory technicians heat the sample. If the reason is in the salts, then when heated, the urine becomes transparent.
If vinegar is added to the sample and the urine ceases to be cloudy, then the cause of the turbidity is in phosphates, better known as amorphous crystals. If the liquid becomes clear after adding hydrochloric acid, the reason is in oxalates. Fat in the urine is easily dissolved by the addition of alcohol, but if there is pus in the urine, then neither heating nor the addition of reagents, purity and transparency can be achieved.
Foam will form on each sample if shaken well. But with a poor analysis, it is persistent and does not disintegrate for a long time, and with liver diseases and increased bilirubin it is also yellow. Healthy urine foam is unstable, transparent, and quickly disappears.
Acidity
The acidity of urine depends on what the pregnant woman eats and drinks. For example, a large amount of plant foods, dairy products increase the pH. Acidity also increases with certain diseases, for example, with prolonged diarrhea, with dehydration, as well as with kidney failure and infectious diseases.
Protein
There should be no protein in urine, but a small amount, indicated in the table, is considered acceptable during pregnancy. The reason for the increase in the protein content in the secreted fluid can be pressure of the grown uterus on the renal veins and liver. A slight excess or traces of protein are found with a large amount of protein products in the diet of the expectant mother, as well as strong physical exertion.
Sugar
Glucose is essential for energy metabolism. Both the woman herself and her baby need it. Therefore, the body of a pregnant woman begins to accumulate glucose, which can be expressed in an excess of this indicator. But in the vast majority of cases an increase in sugar is an alarming sign indicating the presence of diabetes mellitus, about which the woman herself may not even guess, about the violation of the filtering function of the kidneys, about failures in the pancreas, which produces insulin.
Bilirubin
Only a few units of direct bilirubin in urine are considered normal. The wording "in the field of view" means that this is the number of molecules of a substance that is found during microscopic examination in the area of examination. If bilirubin is still found, then the doctor may suspect that the pregnant woman has liver problems or blood diseases in which red blood cells break down. It is during this process that bilirubin is produced, which enters the kidneys with the blood. Elevated bilirubin can be in hepatitis.
Leukocytes and erythrocytes
There should be no normal blood cells in urine. The acceptable value of leukocytes is only a few units in the field of view. An increase in this amount may indicate an infectious disease, inflammation. A significant excess of the norm of leukocytes indicates that serious inflammation develops in the body of the expectant mother, the urine itself is cloudy, foaming, has a putrid and very unpleasant odor.
Epithelium
Determination of epithelial cells in the secreted fluid allows you to establish in which part of the urinary tract there are problems. If the squamous epithelium is elevated, this indicates that inflammation or trauma has occurred in the bladder area. Cubic epithelium indicates that the ureters and pelvis are damaged. Renal indicates kidney damage.
According to Nechiporenko
A urine test according to Nechiporenko can be assigned to an expectant mother if the general analysis comes bad. This method will clarify some indicators that are important for the diagnosis. A direction can also be given with a good general analysis, if a woman has edema, complaints of painful urination, or previously had urinary tract diseases. Normally, the results should be as follows:
- leukocyte count - no more than 2000;
- the number of red blood cells - no more than 1000;
- content of cylinders - no more than 20.
The doctor should decipher the results of the test according to Nechiporenko. After all, it is important not only whether the three main parameters are changed upward, but also how the levels of these parameters agree with each other.
According to Zimnitsky
Since the secreted fluid is collected for such an analysis during the day, it is considered normal if the daily volume of urine output is higher than the night one, while the total amount of urine should not be less than 1.7-2 liters or 75% of the fluid drunk by a woman (calculations include and soups, and tea, and plain water.
In each of the jars, the density and acidity will be calculated. If in at least one of the portions the density is below the permissible threshold of 1012 g / liter, then you will need to visit a nephrologist to be sure to consult with him; ultrasound of the kidneys and bladder may also be recommended. A deviation is also considered a large range of density fluctuations at different times of the day, as well as an increase in nocturnal urine output.
Bakseeding
The presence of a bacterial infectious process in a woman's body can have dire consequences for the condition of her child. That is why it is important and necessary to diagnose urine for bacteria.
Deciphering such an analysis is not difficult, in the list next to the names of fungi and bacteria, the laboratory assistant puts "-" if none are found, or "+" if the bacteria is found.For the detected microbe, an additional test is carried out, the task of which is to determine to which type of antibiotic it is hypersensitive.
In general, urine is not sterile. But multiplying microbes in large numbers is an unfavorable diagnostic picture.
In the fluid secreted by the kidneys, staphylococcus and streptococcus, enterococcus (usually enterococcus faecalis), escherichia coli (Escherichia coli), Klebsiella (klebsiella pneumoniae) can be found.
All microbes and fungi are a great danger to the baby. The effect of Escherichia coli on the fetus may lie in the likelihood of intrauterine infection, which can result in meningitis and the death of the baby either in utero or shortly after birth. The placenta, of course, will by all means protect the baby from aggressive bacteria, while it itself will quickly age, scar, the blood supply of the small organism, its saturation with oxygen and nutrients will be disrupted.
If the bacterial culture of a pregnant woman's urine does not inspire optimism in her treating doctor, then, most likely, antibiotic treatment will be prescribed.
You should not be afraid of it, the doctor will certainly weigh all the risks and prescribe only those drugs that, with the correct treatment regimen and the right dosage, will not harm the baby.
How to pass correctly?
The general analysis should be taken after preliminary preparation. In order for the sample to be transparent, to have a normal color, spicy foods, salty foods, as well as all those that can give urine an abnormal color (beets, carrots, etc.) should be excluded from the diet per day.
If a woman takes a multivitamin complex recommended by a doctor for pregnant women, for a day it is better to refuse to take another vitamin, also do not take folic acid for about a day. For 12 hours it is worth limiting yourself in physical activity, and it is also better to abstain from sex.
In the morning on the day of delivery, a woman should wash herself without soap, and then collect the middle portion of morning urine in a clean and dry pharmacy jar. This means that the beginning and end of urination should be carried out in the toilet, and the middle part of the urine should be collected in a jar. It is important that vaginal discharge does not enter the sample, For this, a woman gently closes the vaginal opening with a small piece of cotton wool while collecting material.
A tightly closed container should be delivered to a consultation or clinic no later than two hours after collection, otherwise the disintegration process of some diagnostically important substances will begin in the urine, and the laboratory technicians will not receive a true result.
Analysis according to Nechiporenko, like general clinical analysis, requires adherence to a diet that excludes fatty, spicy and salty. It is important not to overheat the body before collecting the material - do not steam in the bath, do not go to the sauna, do not use heating pads, do not sunbathe, do not take a hot bath. Otherwise, the procedure for collecting liquid does not differ from similar actions in the general analysis. Morning urine is collected, its middle part. The jar should be taken to the laboratory within a maximum of 2 hours.
The analysis according to Zimnitsky is collected in 8 jars. Every 3 hours, except for the first morning portion. You don't need to collect it. Collection rules are the same, only the entire volume of urine should be collected in a jar, not just the middle part. Each jar or vial is signed, indicating the time and stored in the refrigerator until the end of collection of the last jar. After that, all eight containers and the amount of liquid drunk written separately on paper are taken to the laboratory.
Bacterial culture requires special accuracy and hygienic measures, because given the huge number of bacteria that surrounds us in everyday life, it is so easy to get false positive results. It is impossible to take household vials and bottles for urine; only sterile pharmaceutical containers for collecting analyzes should be used for this diagnostic method.
Before collection, you should definitely wash yourself, but you should not use soap. The entrance to the vagina must be closed with a cotton swab. For diagnosis, an average portion of morning urine is required. The amount of urine for any type of diagnosis should not be less than 150 ml, with the exception of the Zimnitsky test.
If several times in a row the analysis for bacterial culture gives a bad or paradoxical result, a woman can take urine with a catheter in a procedure room. The procedure is not very pleasant, it is a minus, but not long, and this is a definite plus. Important, that this method of sampling will provide the most accurate results.
For information on why urine tests are done during pregnancy, see the next video.
