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Pyelonephritis in pregnancy

Pyelonephritis in pregnancy – a kidney disease, inflammatory and infectious nature. In the first process involved interstitial tissue of the organ, and then the cups and pelvis.

According to statistics, during the carrying a child to lose more often exposed right kidney. Approximately 7% of women diagnosed bacteriuria, 1-4%, it causes pyelonephritis. In recent years there has been a trend towards increased frequency of pyelonephritis in pregnancy with destructive purulent lesion of the kidneys. The problem of pyelonephritis in pregnancy is of particular relevance in connection with risk of development of complications that threaten the life of the child and the mother.

The causative agent mainly gestational pyelonephritis is Escherichia coli, however, it may be Klebsiella, enterococci and Proteus. These representatives of enterobacteria cause disease in 70-80% of cases. Much less frequently the inflammation caused by staphylococci and Pseudomonas aeruginosa. In addition, there are known cases of development of gestational pyelonephritis pathogen was Candida, Ureaplasma, and Mycoplasma, and viruses and intracellular parasites. Often they appear in Association with bacteria and start the development of the disease.

Mainly gestational pyelonephritis occurs on the 22 – 28th week of pregnancy. Of the total number of pregnant pyelonephritis occurs in 1-4% of cases.

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The symptoms of pyelonephritis in pregnancy

The symptoms of pyelonephritis in pregnancy will depend on what the course has the disease: acute or chronic.

The acute phase has the following symptoms:

  • The condition of the pregnant woman deteriorates.
  • Increasing body temperature, it can rise to high levels.
  • There is a lethargy and weakness.
  • The woman complains of chills and headaches expressed.
  • The accession of nausea and vomiting. Vomiting is often multiple.
  • In the language detected by the plaque, the tongue dry.
  • The appetite disappears.
  • Causes marked pain that is localized on thethe side which is one of the kidney. Give pain in the hip, groin, all of this is happening against the background pulling pain the lumbar.
  • Often women complain of painful urination, you may experience feelings of incomplete emptying of the bladder, and gross hematuria.
  • If the disease is purulent, the temperature increases abruptly.
  • May increase symptoms of renal colic.

When pyelonephritis occurs in the first trimester of pregnancy, often dominated by symptoms of the inflammatory process with fever, chills and headaches. When pyelonephritis occurs at a later date, at the forefront of the local manifestations of the disease with severe pain.

If the disease is exacerbated during labor, the symptoms are mild and lost in the background of labor.

If the disease is in the chronic form, the symptoms are mild. Possible complaints of intermittent pain in the lower back aching or dull character. Pregnant women experience headaches (see also: Headache in pregnancy), lethargy, weakness, drowsiness. As a rule, women do not pay attention of the doctor for similar symptoms, relating them to its situation. Therefore, chronic disease is often detected only by laboratory tests.


Causes of pyelonephritis in pregnancy

The direct cause of pyelonephritis are bacteria and microbes that begin to proliferate in the tissues of the kidneys.

There are two ways of spreading of infection during pregnancy:

  • Hematogenous route from the existing focus of infection.
  • Urinogenous way way in the background of vesicoureteral reflux. Most often, this way the bacteria reach the kidneys. Already in the early stages of pregnancy in 80% of healthy women undergo a dysfunction of the urinary tract: decrease tone and peristalsis, develops hypotension, hypokinesia. Against this backdrop, some pregnant women have is the development of vesico-ureteral and renal pelvic reflux, pressure inside the pelvis of the kidney is increased, soaked with urine, germs and toxins. In the end, the woman begins to suffer from acute pyelonephritis.

Naturally, despite changes in the functioning of the urinary system in the gestational period, not every pregnantill with pyelonephritis.

The disease manifests under the influence of additional factors provocateurs, including:

  • A history of genitourinary infection before 20 weeks of pregnancy.
  • Anatomical abnormalities in the development of the kidney and urinary tract;
  • Nephrolithiasis.
  • Violation of rules of personal hygiene.
  • Fetal presentation.
  • Inflammation of the female genital organs.
  • Violations of urodynamics, which developed on the background of pregnancy.
  • The presence of extragenital diseases: diabetes mellitus and chronic tonsillitis.
  • Low socio-economic status of women.
  • Untreated bacteriuria who are asymptomatic, leads to the development of pyelonephritis in 20-40% of cases. Therefore, doctors believe bacteriuria a risk factor for development of gestational pyelonephritis in pregnancy.

In addition, by itself, a pregnancy is a predisposing factor to the development of disease:

  • As a result of exposure of the hormone progesterone, relaxes smooth muscles of all organs of the pregnant woman. In this regard, including the kidneys. The tone of the ureters is falling, their peristalsis is getting worse. Urine from the bladder in result bubble-ureteric reflux coming back up into the kidneys, which leads to an inflammatory process.
  • The growth of the fetus, the uterus increases in size. It puts pressure on the kidneys, the bladder, the ureters. As a result, the blood circulation in them is disturbed, the urine is excreted with a delay.
  • Do not forget about the reduction of immune forces of the body during pregnancy, which increases the risks of developing any diseases, including pyelonephritis.

The most common cause of inflammation of the kidneys becomes E. coli. Although it is possible the development of the disease in the result of the pathological activity of enterobacteria, gram-negative organisms, chlamydia, Mycoplasma, Trichomonas, fungi and viruses.

The consequences of pyelonephritis in pregnancy

Long course of the disease can lead to destruction of renal tissue, which causes the development of serious complications:

  • Anemia;
  • Sepsis;
  • Kidney failure;
  • Premature birth;
  • Hypertension.

The development of pyelonephritis during pregnancy isextremely undesirable and dangerous process.

Experts distinguish between three degrees of risk of pyelonephritis that can occur during pregnancy:

  • First degree characteristic of the acute inflammatory process that occur during pregnancy. However, the pregnancy and birth process to proceed without complications. Possible threats – anemia, induced abortion, toxaemia in the later stages occur with a frequency not exceeding the frequency in healthy pregnant women. However, there is a possibility of intrauterine infection of the fetus.
  • If a woman has chronic uncomplicated pyelonephritis, who was in the history before conception, doctors consider this condition as a second degree of risk. The risk of complications is increased by 20-50% compared to healthy women. In this case, increases the risk of spontaneous abortion, early preterm birth, hypoxia of the fetus, toxemia and perinatal mortality. However, if there is no toxemia, hypertension and kidney functionality is expressed not broken, pregnancy keep.

  • If the woman has pyelonephritis occurs on the background of hypertension, a chronic deficiency of the body develops pyelonephritis or a solitary kidney, the experts regard this condition as the third degree of risk. The pregnant woman is contraindicated. (see also: Causes and symptoms of kidney failure)


Diagnosis of pyelonephritis in pregnancy

Diagnosis of pyelonephritis is based on history, clinical signs, laboratory derived data. Recently doctors to identify the disease using MRI. It has high information content and is not contraindicated during pregnancy.

Recommend the following laboratory studies with pyelonephritis in pregnancy:

  • Perform a haemogram.
  • Implementation of the common urine test.
  • Performing analysis of urine on Nechiporenko.
  • Bacteriological examination of urine.
  • The execution of the tests of General.
  • Performing ultrasound of the kidneys. However, in chronic pyelonephritis it is uninformative.

Feature of the diagnosis of pregnancy is that not all techniques can be used to detect the disease. So it is recommended to abandonradiographic methods of investigation, cystochromoscopy, radionuclide methods of research.

It is important to differentiate pyelonephritis from appendicitis, acute cholecystitis, renal colic, rupture of cysts, toxoplasmosis. (see also: Toxoplasmosis — symptoms and causes)


Treatment of pyelonephritis in pregnancy

Priority to treatment of pregnant women with pyelonephritis are:

  • The elimination of the main symptoms of the disease.
  • Bringing laboratory parameters to normal.
  • The normalization of the functioning of the bladder and urinary system as a whole.
  • Selection of appropriate antibiotic therapy. This should definitely be taken into account gestational age, circumstances of the disease, its duration.
  • To prevent the development of recurrence of pyelonephritis.
  • To eliminate the risk of complications.

There are some basic principles of treatment of pyelonephritis in pregnancy, including:

  • The timely appointment of antimicrobial therapy, initially empirical and then, if necessary causal.
  • Conducting long-term therapy with herbal uroseptics.
  • If necessary, the restoration of normal passage of urine through catheterization, the nephrostomy or ureteral stenting.
  • The comprehensive therapy: infusion aimed at the removal of intoxication, sedative, symptomatic, etc.
  • Strict control of both the pregnant woman and the fetus. The prevention of hypoxia and malnutrition.
  • In the first trimester of pregnancy in order not to harm the embryo used exclusively natural or semi-synthetic penicillins or uroseptic of plant origin.
  • In the second and third trimester barrier function of the placenta is improving and possibly expanding the number of antibacterial drugs: in addition to penicillins can be prescribed cephalosporins, macrolides, nitrofurans.
  • The duration of antibiotic treatment ranges from a week to 10 days, depending on the severity of the disease.

Drug correction should be based on antibiotic therapy. It is chosen taking into account not only the antimicrobial activity but also with regard to its possible impact on the fetus. Starting therapy always comes down to empirical choice of drug, after which its abolition (results analyses).

Depending on the trimester of pregnancy,women will be assigned the following empirical preparations:

  • Inhibitorsdisease aminopenicillin – 1 trimester. This drugs such as: Amoxicillin, Ampicillin, Benzylpenicillin.
  • Cephalosporins and inhibitorsdisease aminopenicillin – 2 and 3 trimester. That drugs such as Cefuroxime, Cefoperazone, Erythromycin, Spiramycin, Ofloxacin.
  • In the postpartum period, the list of drugs above the stern, can be added to this antibacterial: Co-trimoxazole, norfloxacin, Pefloxacin, Meronem.

Non-drug therapy reduced to uroseptic treatment and can only be carried out in combination with reception of antibiotics. In this case, can be used such herbal preparations as Vitalizing, Kanefron, etc. Widely used plazmaferez subject of severe disease. In the postpartum period is possible in addition to plasmavores the assignment of a UFO.

Pregnant shown to drink plenty of water to comply with bed rest. Gestational pyelonephritis is not an indication for interruption of the process of gestation.

Symptomatic therapy is available in 2 and 3 trimesters. Antispasmodics are prescribed to improve urine flow, desintoxication therapy should be done if there are signs of intoxication. During this period, antibiotic scheme can be supplemented by reception Furagin, Uroculture, Nevigramon, 5-NOK.

The indication for surgery is abscess or carbuncle of the kidney.

Throughout the course of treatment is controlled by the state is not only pregnant, but the fetus, as due to the infectious process and enhanced immune response increases the risk of miscarriage. If such a risk exists, it is therapy aimed at maintaining a pregnancy.

If the treatment does not give positive effect, the woman shown early delivery. To give birth a woman needs without the use of the method of caesarean section, vaginally. In the process of labor are widely used antispasmodic.