What is the recommended management for asymptomatic bacteriuria in pregnancy?

• A. Do nothing
• B. Reassess only if symptoms develop
• C. Treat with non-pregnancy-safe antibiotics
• D. Treat with pregnancy-safe antibiotics to prevent pyelonephritis; confirm with culture and treat even if asymptomatic

Answer: (D)

In pregnancy, bacteria in the urine without symptoms can still ascend and cause serious problems, like acute pyelonephritis, and are linked to adverse outcomes such as preterm birth. Because of these risks, asymptomatic bacteriuria should be identified and treated rather than ignored. The management is to confirm the infection with a urine culture and then use antibiotics that are safe in pregnancy to eradicate it. After completing treatment, a follow-up culture is usually done to ensure clearance. This approach helps prevent progression to kidney infection and protects both mother and baby. Using non-pregnancy-safe antibiotics or waiting for symptoms would miss a treatable condition that can worsen during pregnancy.