Nursery to Toddler

Handbook of Routine Urinalysis $24.42 This practical handbook contains everything its user needs to know when performing routine urinalyses. Comprehensive in scope, the book discusses the formation of urine, its constituents and properties in both health and disease, the origin of these constituents, and the principles of urinalysis. Explanations of abnormal test results are provided together with several procedures that can be used as alternative or confirmatory tests.

The Pregnancy Test $3.95 Ordinarily, I’m a fan of pink–lovely color, does smashing things for the complexion. But not when it’s the bright, glaring stripe staring back at me on the pregnancy test. Then, pink is the color of major oops, of morning sickness, of boyfriends who seemed decent but now are part of some Jerk Witness Protection Program. Still, I’ve got a few things going for me–bitter humor, a divine right to eat till I’m the size of Marlon Brando, and good friends who’ve managed to get me a job interview with one Damien Sharpton: in need of a personal assistant, and some say, a good, swift kick in the arse. If you want to make a lasting impression, by all means, toss your cookies in your future boss’s wastebasket, which is located directly between his excruciatingly sexy legs. Apparently, Mr. Gorgeous-But-Unbearably-Anti-Social must like personal assistants who violate his trash can, because I got the job. And if I can avoid him via text messaging for the next seven months of health insurance, everything will be just fine. Except that he’s just asked–no, insisted–that I go with him on a business trip to the Caribbean. Gulp, Ordinarily, this would be cause for celebration. Ordinarily, I’d shave my legs, pack my bikini, revel in day-glo drinks and my seething lust for Mr. Swarthy-And-Secretive. But there’s nothing ordinary about this situation…which means it could be absolutely extraordinary.

Pregnancy $10.46 Pregnancy

Clearblue Easy Pregnancy Test – Twin Pack $9.99 Pregnancy test with +/- results. Results 5 days sooner. Clearblue Easy can be used as early as 4 days before you expect your period. That’s 5 days sooner than waiting until you miss your period to test. The amount of pregnancy hormone increases rapidly in early pregnancy. In clinical testing with early pregnancy samples, Clearblue Easy gave the following results: 1 Day before the expected period 87% women giving a pregnant result. 2 Days before the expected period 84% women giving a pregnant result. 3 Days before the expected period 74% women giving a pregnant result. 4 Days before the expected period 53% women giving a pregnant result). + = pregnant. – = not pregnant. No test is more accurate. Over 99% accurate (99% accurate at detecting typical pregnancy hormone levels. Note that hormone levels vary. See insert) from the day of your expected period. Changes color to let you know it’s working. Made in China.

Canine Pregnancy Test Kit (5 tests) $125.95 Rapid immunomigration test for detection of the hormone relaxin in canine blood. Can be used at 22 days gestation or after. A small blood sample must be obtained from the dog. 5 tests in each kit. * Early detection of planned or unplanned pregnancy. * Detection of pregnancy before or after abortion treatment. * Early detection of false pregnancy. * Diagnose fetal resorption or spontaneous abortion. * No refrigeration required. About the product: The Witness Relaxin kit is intended to determine pregnancy in the bitch, as well as to distinguish between pseudopregancy and gestation. The kit measures relaxin levels in plasma and serum samples. The presence of significant amounts of this hormone is a reliable indicator of pregancy. Relaxin can be detected in biological samples soon after implantation of the fertilized egg, which occurs about 22-27 days after mating (26-31 days post-LH surge).

Clearblue Easy Digital Pregnancy Test – 2 Count $9.69 The Clearblue Easy Digital Pregnancy Test is over 99% accurate at detecting typical pregnancy hormone levels (note that hormone levels vary – see insert) from the day of your expected period. Clearblue Easy can be used as early as 4 days before you expect your period. That’s 5 days sooner than waiting until you miss your period to test.This package includes 2 test sticks and 1 English/Spanish Insert.1. Take the test: simply hold the stick pointing downwards in your urine stream for 5 seconds only.2. Wait: an hour glass symbol will flash to show you the test is working.3. Read your result: within 3 minutes your result will be displayed in words.Read instructions before use. English and Spanish instructions inside.Store at 36&def;F-86°F. Do not freeze. For in-vitro diagnostic use only (not for internal use).

WITNESS RELAXIN [Canine / Feline Pregnancy Test] $132.22 Relaxin can be detected in biological samples soon after implantation of the fertilized egg, which occurs 20-31 days post-LH surge, or approximately 16-33 days post-mating. ? Early detection of planned or unplanned pregnancy ? Detection of pregnancy befor

pregnancy test urinalysis

Urine samples Photo Mugs Urine samples. Two sample tubes containingspecimens of urine. The samples will undergoroutine tests known as urinalysis. Analysis candiagnose bladder and kidney disorders, moresystemic disorders such as diabetes, andpregnancy. Urine testing may also be used todetect illegal drugs. CROWN COPYRIGHT UNDER LICENCE FROM THE HEALTH a SAFETY LABORATORY a CONTROLLER OF HER MAJESTYS STATIONERY OFFICE….

Rapid Response 10 Parameter (10SG) Urinalysis Reagent Test Strips, 100 Strips/Bottle $12.70 Urinalysis Reagent Strips provide tests for glucose, bilirubin, ketone, specific gravity, blood, pH, protein, urobilinogen nitrite, and leukocytes…

Phion Diagnostic pH Test Strips …

Rapid Response Urine Dipstick 10SG 10 parameter – Urinalysis Reagent Strips Bottle of 100 – Rapid $13.00 The BTNX Urinalysis product Urinalysis Reagent Strips provide tests for the following: Glucose, Bilirubin, Ketone, Specific Gravity, Blood, pH, Protein, Urobilinogen, Nitrite and Leukocytes. Urinalysis strips are useful in the preliminary screening for diabetes, liver diseases, haemolytic diseases, urogenital, and kidney disorders. Upon immersing the test strip in the specimen, comparison betwee…

Are We Having A Boy or A Girl (Intelligender Test)

UTI in pregnancy

Pathophysiology

Remarkable changes occur in the structure and function of the urinary tract during pregnancy. Blood-volume expansion is accompanied by increases in the glomerular filtration rate (GFR) and urinary output. The ureters undergo tonic relaxation because of the mass production of hormones, particularly progesterone. This loss in tone, along with the increased urinary tract volume, results in urinary stasis, which, in turn, can lead to dilatation of the ureters and the calyceal pelves. Urinary stasis and the presence of vesicoureteral reflux predispose some women to upper tract UTIs and acute pyelonephritis.

Frequency

United States

The frequency of asymptomatic bacteriuria occurs in 2-7% of pregnancies, similar to the nonpregnant population. However, up to 40% of these may progress to symptomatic upper tract UTI or pyelonephritis, significantly more than in nonpregnant women.4Several factors are associated with an increased frequency in various patient populations. Indigent patients have a 5-fold increased incidence of bacteriuria compared with that of nonindigent patients. The risk is doubled in women with sickle cell trait. Other risk factors for bacteriuria include diabetes mellitus, neurogenic bladder retention, and a history of previous urinary tract infections.

Mortality/Morbidity

Untreated upper tract UTIs are associated with low birth weight, prematurity, premature labor, hypertension, preeclampsia, maternal anemia, and amnionitis.5A retrospective population-based study by Mazor-Dray et al showed that urinary tract infection during pregnancy is independently associated with intrauterine growth restriction, preeclampsia, preterm delivery, and cesarean delivery.6

Race

When socioeconomic status is controlled, no significance difference among the races seems to exist.

Sex

Urinary tract infections (UTIs) are 14 times more frequent in women than in men. This difference is attributed to several factors: (1) the urethra is shorter in women; (2) in women, the lower third of the urethra is continually contaminated with pathogens from the vagina and the rectum; (3) women tend not to empty their bladders as completely as men; and (4) exposure of the urogenital system to bacteria during intercourse.

Clinical

History

The presentation varies depending on whether the patient has asymptomatic bacteriuria, a lower tract UTI (cystitis), or an upper tract UTI (pyelonephritis).

• Pregnant women with asymptomatic bacteriuria usually are diagnosed incidentally on routine urinalysis and urine culture.
• Burning with urination (dysuria) is the most significant symptom in pregnant women with symptomatic cystitis.
• The usual complaints of increased frequency, nocturia, and suprapubic pressure are not particularly helpful, because most pregnant women experience these as a result of increased pressure from the growing uterus.
• Symptoms of pyelonephritis include the following:
  • Fever (Often, the temperature is very high.)
  • Chills
  • Nausea and vomiting
  • Costovertebral angle (CVA) or flank pain

Physical

A thorough physical examination is recommended, with particular attention to the abdomen.

• CVA tenderness may be present.
• Suprapubic tenderness may be present.
• The fetal heart rate should be noted.
• Pelvic examination is strongly recommended in all patients (with the exception of the third-trimester patient with bleeding) to rule out vaginitis or cervicitis.

Causes

• Escherichia coli (most common, in as many as 70% of cases)
• Group B Streptococcus (10%)
• Klebsiella or Enterobacter species (3%)
• Proteus species (2%)3

Differential Diagnoses

Cervicitis
Renal Calculi
Sexually transmitted infection (GC, NGU, HSV, trichomoniasis)
Urethritis
Vaginitis

Other Problems to Be Considered

Pyelonephritis

Workup

Laboratory Studies

• In all pregnant patients, a urine specimen should be carefully collected for urinalysis and culturing during the first prenatal visit or at 12-16 weeks’ gestation.
  • These tests help to identify patients with asymptomatic bacteriuria as well as those with other specific complaints.
  • For urine collection, a midstream clean catch is adequate, provided the patient is given careful instructions.
  • Catheterization is indicated if the patient is unable to void, too ill, extremely obese, or bedridden.
  • Two consecutive voided specimens with isolation of the same bacterial strain (100,000 CFU/mL) or a single catheterized specimen (100 CFU/mL) is diagnostic.7,2
  • Counts of less than 100,000 CFU/mL, with 2 or more organisms, usually indicate a contamination rather than an infection.
  • The leukocyte esterase test of the urine can be used as a screening examination for pyuria, although this test may be unreliable in patients with low-level pyuria (5-20 WBCs per high-power field).
• Patients with pyelonephritis often have WBC casts.
• Urine culturing should be performed in cases of suspected acute pyelonephritis, patients requiring hospitalization, and patients with a history of recent instrumentation or repeated infections.
• CBC, electrolyte, blood urea nitrogen (BUN), and creatinine tests should be ordered at the physician’s discretion, although the results do not aid in the diagnosis or change treatment unless they are markedly abnormal.

Imaging Studies

• Unless anatomic abnormalities or renal disease is suspected, routine imaging studies are not necessary.
• In cases of persistent symptoms, persistent infection, or suspected urolithiasis, renal ultrasonography may be helpful.

Treatment

Emergency Department Care

Because of the dangers of maternal and fetal complications, care in the ED should be focused on identifying and treating patients with asymptomatic and symptomatic bacteriuria. Treatment of asymptomatic bacteriuria in pregnant patients is important because of the increased risk of urinary tract infection (UTI) and its associated sequelae.8ED care may involve the following:

• Administration of appropriate antibiotics
• Administration of fluid if the patient is dehydrated
• Strongly consider admission if there is any indication of renal involvement

Consultations

An obstetrician may be consulted.

Medication

Antibiotic therapy for urinary tract infection should be initiated after all necessary cultures are obtained. If significant nausea or pain is present, appropriate medication may be indicated. Treatment of all symptomatic and asymptomatic patients with bacteriuria is important.

Antibiotics

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. Empiric coverage for E coli and Klebsiella, Proteus, and Enterobacter species should be provided.3

Penicillins and cephalosporins are safe for use during pregnancy. Ceftriaxone should be withheld close to parturition due to the possibility of neonatal kernicterus secondary to bilirubin displacement. Trimethoprim is a folic acid antagonist and should be avoided, especially during the first trimester. Fluoroquinolones and tetracyclines are known teratogens and are contraindicated in pregnancy.

Amoxicillin (Amoxil, Polymox, Trimox)

Asymptomatic bacteriuria (ASB): 500 mg PO tid for 3 d
Acute cystitis: 250-500 mg PO q8h for 10 d
Acute pyelonephritis: 1-2 g PO q6h plus gentamicin, 1 mg/kg PO q8h

Nitrofurantoin (Macrobid, Furadantin)

ASB or cystitis: 100 mg PO bid for 5-7 d
Recurrent infections: 100 mg PO q6h for 21 d

Trimethoprim and sulfamethoxazole (Bactrim, Septra)

ASB or cystitis: 160/800 mg PO q12h for 10 d
Pyelonephritis: 160/800 mg PO q12h

Cephalexin (Keflex)

ASB: 250 mg PO q6h for 3 d
Cystitis: 250-500 mg PO q6h for 10 d

Ceftriaxone (Rocephin)

Acute pyelonephritis: 1-2 g IV q24h

 

Follow up

Outpatient Care

• Appropriate antibiotics may be required for UTIs during pregnancy.
• Advise the patient to maintain adequate fluid intake.
• The obstetrician who is providing prenatal care should perform follow-up within 1 week for repeat urinalysis.
• Patients should be instructed to return to the ED if symptoms or fever worsens or if they are unable to tolerate oral medications for any reason.

Prognosis

• The prognosis of urinary tract infection (UTI) in pregnancy is good with appropriate therapy.

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