Urinary tract infections and kidney stones in pregnancy Quiz: Ace Your Exams

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A 30-year-old woman, gravida 2, para 1, presents to the obstetrics clinic at 28 weeks’ gestation with two days of dysuria, urinary frequency, and urgency. There is no associated hematuria, vaginal bleeding, uterine contractions, or decreased fetal movement. Pregnancy to date has been uncomplicated. Her prior pregnancy was delivered via cesarean delivery at term for breech presentation. Temperature is 37.0ºC (98.6ºF), pulse is 84/min, respirations are 16/min, and blood pressure is 120/82 mmHg. The patient appears well, has no costovertebral tenderness, and no pooling on a speculum exam. Bedside testing for ruptured membranes is negative. Which of the following findings would warrant treatment with oral antibiotics?

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Hydronephrosis on renal ultrasound

Fever

A hyperechoic focus with posterior shadowing in the bladder on ultrasound

Nitrites on urinalysis

Red blood cells (RBCs) on urine microscopy