Gestational pyelonephritis: the treatment, possible complications

Author of the article - an obstetrician Grigorieva Xenia S.

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Gestational pyelonephritis - is infectious and inflammatory disease arising in the period pregnancy and is characterized by pain in the lumbar region, fever with chills.

Gestational pyelonephritis occurs mainly during the second trimester of pregnancy, the frequency of its occurrence is 3-10%. Develops more often in women with an unfavorable flora in the vagina, cervix, urethra, or with chronic pyelonephritis in anamnesis.

Causes

Pyelonephritis may be primary and secondary. Last develops due nephritis, kidney stones, kidney abnormalities, disorders of the normal passage of urine from the kidneys (due to compression of the urinary tract gravid uterus).

Pyelonephritis is caused by bacteria, viruses, protozoa, fungi (E. coli, staphylococci, enterococci, streptococci, etc.).

Risk factors include:

• past history pyelonephritis;
• the presence of bacteria in urine analysis (bacteriuria);
• infectious and inflammatory diseases of the genital and urinary organs;
• urolithiasis disease;
• kidney malformations of the urinary tract.

Symptoms of gestational pyelonephritis

Pyelonephritis is an acute and chronic forms. Acute occurs in 2-10% of pregnant women, usually during the first pregnancy.

For acute pyelonephritis pregnant form is characterized by:

• common symptoms of intoxication (nausea, headache, weakness);
• increase in body temperature to 38 degrees accompanied by chills;
• pain in the lumbar region: a dull, constant, can be radiating to the groin, lower abdomen;
• increased sweating;
• pain in the muscles and joints;
• can be nausea and vomiting, not bringing relief;
• discomfort when urinating.

Chronic pyelonephritis form mainly occurs in childhood. Acute forms may be related to hormonal changes (puberty, pregnancy, delivery, etc.). The remission patients with chronic pyelonephritis feel good, sometimes there is a dull pain and malaise.

Against the background of pyelonephritis is characterized by the development of preeclampsiaMainly occurs in the second trimester. Combined gestoses more severe and poorly amenable to comprehensive treatment.

In the acute form of pyelonephritis shows treatment in a hospital under the supervision of doctors.

Diagnostics

In 70% of pregnant women with acute pyelonephritis in anamnesis revealed a urinary tract infection.

Diagnostic Methods

1. The clinical picture.
2. Anamnesis. The doctor will know whether other infectious diseases pyelonephritis and in the past.
3. Symptom Pasternatskogo (tapotement of loin in the kidneys).
4. Clinical and biochemical blood tests. Marked leukocytosis (leukocyte count above 12,0h10⁹l). In the biochemical analysis data without deviation, but they are needed for the differential diagnosis.
5. General urine analysis. The analysis notes leukocytes increase, The presence of bacteria and mucus.
6. Analysis of urine Nechiporenko (Collected midstream morning urine, 20-25 mL, first and last drops - in the toilet bowl). Revealed leukocytosis more than 4.0 x 10⁹ l in 1 mL of urine.
7. renal ultrasound.
8. kidney Doppler (ultrasound vessels).

differential diagnosis

Gestational pyelonephritis should be differentiated from these diseases:

• acute appendicitis;
• liver or renal colic;
• acute cholecystitis;
• urolithiasis disease;
• acute pancreatitis;
• perforated gastric ulcer or duodenal ulcer;
• other infectious diseases (influenza, food poisoning).

In gestational pyelonephritis frequently experience pain on the affected side at pokolachivanii the loins, e unlike other diseases. The main differential diagnostic criteria are the data obtained during the examination.

Treatment of pyelonephritis in pregnancy

For acute pain should call an ambulance. Treatment of pyelonephritis is engaged physician nephrologist, urologist, or therapist.

Treatment consists in the following:

1. Relief of symptoms (No-spa, Baralgin).
2. Recovery rates of laboratory data.
3. Restore functions of the urinary system.
4. The fight against disease pathogens. Antibiotic treatment (drugs selected depending on the gestational age, the severity and duration of the disease).
5. Prevention of complications.

Antibiotics in Pregnancy

Selection of antibiotics is carried out according to their susceptibility to pathogens.

In the first trimester are mainly used:

• Amoxycillin in combination with clavulanic acid.
• Ampicillin + Sulbactam.

In the second and third trimester apply: penicillins, cephalosporins second and third generation, but also macrolides. preparations:

• cefotaxime;
• ceftriaxone;
• Ampicillin + Sulbactam;
• Spiramycin.

The course of treatment is 10-14 days. Additionally for removing toxins from the body assigned albumin protein. When fetal malnutrition - Pentoxifylline with glucose. Also used diuretics (fees herbs, kidney tea, bearberry, cranberry juice) and antispasmodics.

Important! If pregnancy can not be used:

• fluoroquinolones (norfloxacin, ciprofloxacin);
• the first and third trimester - sulfonamide (Co-trimoxazole, Sulfadimidine);
• aminoglycosides is permissible to use only for health reasons (Streptomycin, Tobramycin).

In conjunction with drug therapy is assigned vitaminized diet (recommended for use watermelons, melons, cucumbers, grapes, pears, gooseberries, blackberries, beets, carrots, drink more liquid). Sleep is recommended on the healthy side.

With the ineffectiveness of medical treatment of ureteral catheterization is performed to restore normal urine excretion.

Indications for hospitalization:

• acute form of pyelonephritis;
• gestosis;
• threatening miscarriage or miscarriage;
• impaired renal function;
• signs of fetal malnutrition (slowing of physical development, the size of the discrepancy fetal gestational age).

delivery

With proper and timely treatment of births are in time through natural ways. If untreated pyelonephritis give birth in the hospital ward observational.

Cesarean section is performed only for obstetric indications.

After giving birth should undergo an examination in urological hospital.

Possible complications for mother and fetus

Statistics show that women who first became ill with acute pyelonephritis in the period of gestation of the child, subject to complications is much less than with the chronic form.

Possible complications:

• preeclampsia (edema, hypertension, "fly" to the eyes). One of the most common complications of pregnancy, especially in the chronic form (30-40%);
• anemia;
• threatened miscarriage or premature delivery (due to increased contractile function of the uterus). It occurs in 30% of pregnant women with pyelonephritis;
• fetal hypoxia;
• Fetal hypotrophy (20%);
• spread of infection, including the fetus.

Complications can be avoided, if not self-medicate and to fulfill all the prescribing physician. Necessary to monitor urine 2 times a month, from 22 to 28 weeks of pregnancy - weekly. And also need to be under the supervision of a nephrologist.

Contraindications for pregnancy:

• pyelonephritis combined with hypertension;
• pyelonephritis with a single kidney;
• glomerulonephritis (a kidney disease).

Forecast

The risk of complications can be minimized, if you observe all the recommendations of doctors, the exact dosing regimen, diet and so on. If the doctor suggests hospitalization, should not give up, we are talking not only about the health of pregnant women, but also children.

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Some studies in pregnancy

• Smears during pregnancy.
• Tests during pregnancy by trimester.
• Ultrasound during pregnancy.
• Urinalysis in pregnancy.
• Coagulation.
• Installing pessary.
• Glucose tolerance test.
• Homocysteine ​​in pregnancy.
• Amniocentesis.
• Anesthesia during childbirth.
• Fetal CTG (cardiotocography)
• Cordocentesis.
• Epidural anesthesia during childbirth.