Management of Abdominal Pain with Burning Micturition in Pregnancy

Initial Assessment and Diagnosis

For pregnant women with abdominal pain and dysuria, a urinary tract infection (UTI) should be suspected and treated promptly with appropriate antibiotics to prevent complications such as pyelonephritis, preterm birth, and low birth weight, as recommended by the American College of Obstetricians and Gynecologists 1
Obtain a clean-catch midstream urine specimen for urinalysis and culture before starting antibiotics, as suggested by the Infectious Diseases Society of America 1
Significant bacteriuria is defined as ≥10^5 colony-forming units per mL of a single uropathogen, according to the Centers for Disease Control and Prevention 2
Ultrasound should be the first imaging modality if additional imaging is needed to rule out other causes of abdominal pain, as recommended by the American College of Radiology 3, 4

Begin empiric antibiotic therapy while awaiting culture results, as recommended by the American College of Obstetricians and Gynecologists 1
First-line options include Nitrofurantoin, Amoxicillin-clavulanate, and Cephalexin, as suggested by the Infectious Diseases Society of America 5
Avoid fluoroquinolones and tetracyclines during pregnancy due to potential adverse effects on fetal development, as recommended by the American College of Obstetricians and Gynecologists 5

All pregnant women should be screened for asymptomatic bacteriuria at the first prenatal visit, as recommended by the American College of Obstetricians and Gynecologists 1, 2
Even asymptomatic bacteriuria requires treatment in pregnancy, as 20-35% of untreated cases can progress to pyelonephritis, according to the Centers for Disease Control and Prevention 1
Group B Streptococcus in urine at any colony count requires treatment during pregnancy, as recommended by the American College of Obstetricians and Gynecologists 2

Ultrasound is the first-line imaging modality for pregnant women with abdominal pain, as recommended by the American College of Radiology 3, 4
For inconclusive ultrasound findings, MRI without contrast is preferred over CT to avoid radiation exposure, as suggested by the American College of Radiology 3, 4

Delaying treatment of confirmed bacteriuria in pregnant women, as warned by the American College of Obstetricians and Gynecologists 1, 2
Using single-dose therapy, which has lower efficacy than short-course regimens, as noted by the Infectious Diseases Society of America 5
Failing to consider other causes of abdominal pain in pregnancy such as appendicitis, cholecystitis, or urolithiasis, as cautioned by the American College of Radiology 3, 6