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Urinary pathology in pregnancy

Currie, Jane Louise Danielle; (2021) Urinary pathology in pregnancy. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Urinary tract infection (UTI) in pregnancy is associated with pyelonephritis and preterm birth (PTB). However, modern evidence questions these associations. UTI in pregnancy research lacks clinical outcomes. I questioned the gold standard UTI diagnosis and examined the underlying assumptions. Alternative tests for urinary pathology were developed to research chronic UTI. I applied them to pregnancy; either for the first time (Artemis LUTS inventory, urinary adenosine triphosphate (ATP), urinary lactoferrin, fluorescent microscopy for bacteria-associated epithelial cells and uroplakin-3-stained epithelial cells) or in novel settings (quality-of-life assessment, fresh unspun microscopy for cell counts, enhanced sediment culture with identification of microbial isolates to species level, urinary IL-6 and IL-8). In the "Abdominal pain" study I recruited women with abdominal pain (n=50), gestation-matched against women with other acute problems (n=58) and attending routine appointments (n=51). In the "PTB study" I studied women with high risk of preterm birth owing to previous preterm birth (n=37), gestation-matched against women with other preterm birth risk factors (n=30) and low risk women (n=13). In the MSU-CSU study I compared mid-stream urine (MSU) samples against catheter specimen urine (CSU) samples in women undergoing catheterisation for elective caesarean (n=32) or cervical cerclage (n=2). I used parallel methods to enable pooling of MSU results to study relationships between tests and compare against outcomes (n=273). There were minimal between-group differences in Abdominal pain and PTB studies. MSU and CSU samples were markedly different, which may reflect different sampling of the urinary sediment rather than contamination. There was a high prevalence and range of urinary pathology across settings, for all alternative tests; these detected more pathology than standard culture. However, the significance for outcomes is not clear. Findings provide further evidence to challenge assumptions underlying UTI in pregnancy diagnosis, to encourage a more thoughtful approach clinically, and to demand outcome-focussed future research.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Urinary pathology in pregnancy
Event: UCL (University College London)
Language: English
Additional information: Copyright © The Author 2021. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health > Maternal and Fetal Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/10130409
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