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Pus Cells In Urine During Pregnancy: Know Its Cause, Normal Range And Treatment


Pus cells are a type of dead white blood cell that collects as the body’s immune system reacts to an infection. At the location of the infection, these cells produce a whitish-yellow or yellowish-colored protein-rich fluid. This fluid is referred to as liquor puris. These pus cells may occasionally be found in your urine.

In this article, we will go over what pus cells are, why they are present in urine, what symptoms indicate the presence of pus cells in urine, the usual range of pus cells in the urine, and whether it is normal to detect the presence of pus cells in urine during pregnancy.

What Are Pus Cells

Pus cells are polymorphonuclear leukocytes (macrophages and neutrophils) that have died and are seen in pus. When combating an infection, the body frequently creates pus. The pus cells are the elements of the pus generated at the infection or injury site, together with infectious agents such as bacteria, cell debris, and tissue fluid.

Pus cells are neutrophils that have arrived at the site of infection as part of the immune system’s reaction to infectious pathogens. These neutrophils consume infectious foreign germs and kill them. Pus cells, on the other hand, gradually succumb to the process and form part of these viscous exudates.

These pus cells may occasionally be found in your urine. Pus cells in urine means that it could be Pyuria, a condition that occurs when white blood cells are identified in urine. Pyuria is classified as either sterile or non-sterile. Sterile pyuria is defined as the presence of pus cells in urine without the presence of bacteria, whereas non-sterile pyuria is caused by the presence of bacteria. In addition, the presence of a high number of pus cells in the urine during pregnancy indicates an infection.

Depending on the number of pus cells in the urine sample, the presence of pus cells in urine may or may not be deemed normal. Pus cells can be present in the urine sample of a healthy individual at extremely minute levels.

When pregnant, however, an increased amount of pus cells in urine means there may be a urinary tract infection (UTI).

Pus Cells In Urine Normal Range

A little amount of pus cells in the urine sample is normal. When examined under a high-power microscope, the normal pus cells in urine range varies slightly between males and females. The typical count of pus cells normal range in male urine samples is fewer than 4 cells/HPF, but the count of normal pus cells in urine in female urine samples is 5 to 7 cells/HPF. 

The presence of 8-10 pus cells, which is more than normal pus cells in urine, indicates a bacterial infection, which is typically diagnosed as a urinary tract infection (UTI). The doctors recommend that the urine be cultured in order to determine the most effective treatment of pus cells in urine can be provided. The increased quantity of pus cells in urine can be seen physically by changes in urine, such as the urine becoming thick and murky like pus. As a result, if you notice changes in the texture or color of your urine, you should see a doctor.

Causes of Elevated Pus Cells In Urine During Pregnancy

Pus cells in urine during pregnancy are frequently an indicator of an infection. Certain alterations in female anatomy may promote the development of infections. The urinary system changes physiologically and anatomically in pregnant women, resulting in the growth of bacteria that are either symptomatic or asymptomatic.

The uterus bears down on the urinary tract, which is placed beneath it, as the baby grows in the uterus and the uterus swells. The pressure on the bladder causes urine to linger in the bladder and inhibits its passage, allowing germs to thrive. The urethra begins to dilate (expand) at six weeks of pregnancy and continues to grow in size throughout the pregnancy. The broader route also makes it easier for microorganisms from outside to enter the bladder.

Furthermore, a physiological increase in plasma volume caused by the fetus in the womb during pregnancy results in a drop in urine concentration.

Certain pregnancy-related diseases can also lead to the formation of glucosuria in pregnant women, which is one of the major causes of bacterial growth in the urine. Asymptomatic bacteriuria, commonly known as the presence of bacteria in the urine and a significant urine culture, 105 bacteria/ml. However, the patient has no UTI symptoms and is so classified as having asymptomatic bacteriuria. However, the presence of pus cells in the urine during pregnancy suggests a UTI, and the physician recommends the treatment of pus cells in urine based on the clinical context.

It should be mentioned that asymptomatic bacteriuria is extremely common in pregnant women. It is estimated that roughly 30-40% of pregnant women with asymptomatic bacteriuria who are misdiagnosed and untreated are at risk of developing acute pyelonephritis in the late stages of pregnancy. During pregnancy, pyelonephritis is associated with a high rate of morbidity for both the mother and the growing fetus. As a result, clinicians advised that different routine pus cells in urine test or urine analyses be performed for early detection and treatment of bacteriuria. Even if the symptoms do not continue, this will aid in the resolution of any pregnancy issues.

Urinary Tract Infection During Pregnancy

The urinary tract consists of the kidneys, urinary bladder, ureters, and the urethra. Urinary tract infections are infections that arise in the urinary tract.

One of the most common illnesses among pregnant women is urinary tract infection (UTI) which can develop as a result of pus cells in urine range being elevated. When it develops during pregnancy, however, it is connected with serious problems for both the mother and the baby. As a result, the condition must be identified and treated as soon as possible and the treatment of pus cells in urine must start immediately.

Effect Of UTI During Pregnancy On Baby

Urinary tract infections during pregnancy can have serious consequences for both the mother and the baby. The mother could have asymptomatic bacteriuria or a symptomatic urinary tract infection, both of which can harm the baby.

Asymptomatic bacteriuria has been linked to an increased risk of fetal growth retardation, also known as intra-uterine growth retardation (IUGR), and low birth weight.

Symptomatic UTI has been linked to an increased risk of early rupture of membranes and pre-term labor.

Because of the high risk of difficulties in both the mother and the fetus from UTI, pregnant women should be frequently screened for the presence of bacteria (bacteriuria) in their urine. Complications of severe UTI in the mother include kidney dysfunction, pre-term childbirth, lung damage and respiratory distress syndrome, and, in rare cases, septic shock.

Symptoms of UTI during Pregnancy

The clinical characteristics of a urinary tract infection differ depending on whether the infection is in the lower urinary tract (bladder) or the kidney.

UTI of the bladder or the lower urinary tract (cystitis)

  • Burning pain during urination (dysuria) – this is the most crucial symptom predictive of UTI because the other symptoms are common in pregnant women and so may be non-specific.
  • Frequent urination
  • Urgency or the desire to pass urine quickly
  • Lower abdomen discomfort and pain
  • Urination frequently during the night (nocturia)
  • cloudy urine
  • occasionally connected with the discharge of blood in the urine (hematuria)

Infection of the kidneys or the upper urinary tract (pyelonephritis)

  • Fever with shivering chills
  • On examination, there is pain and soreness in the groin.
  • Appetite loss
  • Vomiting and nausea

Diagnosing UTI During Pregnancy

A history and physical examination are commonly used to make a diagnosis of UTI during pregnancy, which is subsequently confirmed by a urine analysis.

History and Physical Exam – A history of burning pain while urinating is often suggestive of a UTI.

Urine Tests

Urine Examination:  A positive nitrites test shows the presence of bacteria in the urine, which may necessitate other pus cells in urine test such as urine cultures.

Urine microscopy: entails centrifuging a urine sample and examining the sediment under a microscope for abnormal findings such as an increased number of leukocytes (white blood cells), red blood cells, and the presence of urinary casts. Increased leukocytes or pus cells in urine test, in the presence of red blood cells, implies urine infection. The presence of urine casts indicates renal involvement.

Urine culture and sensitivity:  To avoid contamination, the vaginal area should be cleaned and rubbed dry before delivering a urine sample for culture. A mid-stream sample should be taken, which entails allowing the first portion of urine to flow before collecting the sample in the culture container provided. It is recommended to collect the pee sample right after taking a shower or washing the genitalia (this avoids any contamination of the sample from skin flora).

The urine will be streaked on appropriate culture media and bacterial growth will be monitored. It usually takes 48 hours to report on this.

Blood tests : are typically not required for lower urinary infections; however, if kidney involvement is suspected, kidney function tests such as blood urea and serum creatinine are performed to examine kidney function.

Imaging Tests: In cases where kidney involvement is suspected, an ultrasound of the kidney may indicate enlarged kidneys (hydronephrosis) or the presence of urinary tract stones. If a kidney ultrasound is equivocal, a specialist test known as an intravenous urogram (IVU) may be undertaken, however, this comes with the danger of greater radiation to the fetus. To reduce radiation, a rapid three-film IVU can be performed. The actual dangers must be discussed with the mother. This test should not be considered during the first trimester. The obstruction of the urinary tract by a stone can cause urine stasis and UTI.

A plain CT of the Kidney, Ureter, and Bladder region may be preferred over the IVU because it is faster and does not require any contrast material to be injected; nevertheless, due to the radiation risk, this is best avoided.

MRI: may be utilized in the second or third trimester to rule out the renal blockage.

Treatment Of UTI During Pregnancy

To avoid difficulties for both the mother and the baby, it is critical to diagnose UTI during pregnancy as soon as possible.

Asymptomatic bacteriuria (ASB) treatment and Lower UTI (Cystitis)

The following treatments are available for asymptomatic bacteriuria and cystitis:

Administration of appropriate antibiotics – Following a urine culture and antibiotic sensitivity testing, the organism should be given antibiotics to which it is sensitive. Antibiotics that are regularly used for treatment of pus cells in urine during pregnancy include:

  • Cephalexin 500 mg four times a day
  • Ampicillin 500 mg four times a day
  • Fosfomycin

Resistance to Ampicillin and Amoxycillin is common in E. coli infections, and these drugs are not used. Another helpful medication in the treatment of simple UTIs caused by E. coli and Enterococci is fosfomycin, a phosphonic acid derivative.

Antibiotics to avoid during pregnancy –

  • 1st Trimester – Ciprofloxacin 
  • 3rd Trimester – Nitrofurantoin
  • 1st & 3rd Trimester – Sulphamethoxazole
  • 1st & 3rd Trimester of pregnancy – Trimethoprim

Fluid replacement – If the patient becomes dehydrated, IV fluid replacement may be required.

Follow-up urine culture – Because recurrent infections can develop, all pregnant women with UTI should have their pus cells in urine test on a regular basis.

Despite treatment, bacteriuria continues in some women due to a variety of factors such as diabetes, low immunity, sickle cell disease, or a history of recurrent UTI prior to pregnancy. Prophylactic antibiotics should be given to such women throughout their pregnancy to prevent difficulties for both the mother and the fetus.

Pyelonephritis Treatment

Pyelonephritis typically develops later in pregnancy, near the end of the second and third trimesters. Treatment includes hospitalization and

  • Intravenous antibiotics such as Cephalosporin and Gentamicin are administered.
  • Fluid replenishment via IV may be required but should be done with prudence.
  • Acetaminophen is used to treat fevers.
  • Metoclopramide and other antiemetics are used to treat nausea and vomiting.

It should be noted that the use of certain antibiotics during pregnancy is prohibited since they can harm the fetus. Tetracyclines, chloramphenicol, and trimethoprim are examples. Fluoroquinolones must be handled with extreme caution.

Prevention Of UTI During Pregnancy

It is critical to avoid fetal and maternal problems by preventing UTIs throughout pregnancy.

Bacterial testing of urine

All pregnant women should be routinely screened for the occurrence of clinically severe bacteriuria. Urine culture is the most reliable method of detecting the presence of bacteria in the urine. Routine urine culture and sensitivity testing are therefore advised during the first antenatal appointment and again during the third trimester.

If asymptomatic bacteriuria is discovered, the above-mentioned treatment measures must be followed.

Measures in general

Some general precautions taken on a regular basis may help to avoid or lessen the occurrence of UTIs.

  • Bathtubs should be avoided.
  • After using the restroom, wash your hands.
  • Using clean clothes, clean the genital area.
  • After passing pee or stools, wipe from front to back.
  • To avoid colonization from bar soap, use liquid soap.


The presence of pus cells in urine during pregnancy is a significant signal of urinary tract infection (UTI) and should not be ignored. If you get a burning feeling or an increased frequency of urination, you should undergo a pus cells in urine test right away. You will be better able to analyze your health state and make the appropriate decision at the right time now that you are aware of the pus cells normal range, the reasons why pus cells may be present in urine during pregnancy, and the symptoms when you should obtain a pee test.

Frequently Asked Questions

  • What are the effects of asymptomatic bacteriuria while pregnant?

Asymptomatic bacteriuria rarely causes major complications in nonpregnant women. In pregnant women, however, this infection can develop and cause acute urethritis, acute cystitis, and acute pyelonephritis. Bacteriuria can have a negative impact on pregnancy outcomes. Low birth weight and premature labor are two examples from a reliable source. Preterm labor is the leading cause of significant problems in newborn newborns, including death.

  • How can cranberry juice help with preventing UTIs?

According to research, drinking cranberry juice or taking cranberry pills may lower bacteria levels and deter new germs from colonizing the urinary system. (However, drinking cranberry juice will not treat an existing infection, so if you’re experiencing symptoms, you should see your physician immediately to acquire a prescription for antibiotics.)

  • Who is at risk of having a lot of pus cells in urine during pregnancy (urine infection)?

When you are pregnant, you may be more susceptible to getting an infection of the urine, including

  • A history of urinary tract infections (UTIs) or diabetes
  • Advancing age
  • Pregnancies in multiples
  • You may also be at risk if you have previously taken numerous antibiotics.


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