I always feel like I have to urinate when I am four months pregnant.

For pregnant women, as the fetus develops, the uterus will gradually become larger, thereby compressing the bladder. Therefore, during this period, pregnant mothers will experience frequent urination. If you always feel the urge to urinate during the fourth month of pregnancy, pregnant mothers do not need to worry too much. As long as the prenatal check-up is normal, it is most likely caused by endocrine changes or pressure on the bladder.

(1) Asymptomatic bacteriuria The incidence of asymptomatic bacteriuria during pregnancy is as high as 4% to 7%, often occurring in the first month of pregnancy. Up to 40% of cases may progress to acute pyelonephritis. Therefore, it is recommended that urine culture tests should be performed on pregnant women routinely in early pregnancy to detect patients with asymptomatic bacteriuria in a timely manner. It is currently recommended that anti-infective treatment should be taken for such patients. It is recommended to give 3-5 days of antimicrobial treatment based on the results of the drug sensitivity test. One of the following options can be selected: ① Nitrofurantoin; ② Amoxicillin; ③ Amoxicillin/clavulanate potassium. Please come to the hospital for a urine culture review 1 week after stopping the medication, and then review it once a month until the end of the pregnancy. For patients with recurrent asymptomatic bacteriuria, antibiotic prophylaxis can be taken during pregnancy, taking nitrofurantoin or cephalexin every night at bedtime.

(2) For acute cystitis, it is recommended to give 3 to 5 days of antimicrobial treatment based on the results of urine culture and drug sensitivity test. If there is no time to wait for the results of drug sensitivity test, nitrofurantoin, amoxicillin, or second- or third-generation cephalosporins can be given. After treatment, urine culture test is required to understand the treatment effect. If acute cystitis recurs, it is recommended to take cefuroxime or nitrofurantoin orally before bedtime every day until the postpartum period to prevent recurrence.

(3) Acute pyelonephritis The incidence of acute pyelonephritis during pregnancy is 1% to 4%, and it often occurs in the late pregnancy. It is recommended to first give intravenous infusion of antimicrobial drugs based on the results of urine culture or blood culture and drug sensitivity test. If there is no time to wait for the results of drug sensitivity test, ceftriaxone, aztreonam, piperacillin + tazobactam, cefepime, or ampicillin can be selected for treatment. After the clinical symptoms are significantly improved, treatment can be switched to oral antibiotics. The total course of treatment is at least 14 days.