Due to the specific features of the anatomy of the female body, it is the fair half who usually encounters pyelonephritis - women suffer from it on average 5 times more often than men. During pregnancy, the disease is detected in approximately 10% of all cases of extragenital diseases.
It is important to diagnose pyelonephritis in a timely manner and begin treatment. What are the risks of developing an infection? Deterioration in the well-being of the expectant mother, a possible negative impact on the health of the growing baby.
Pyelonephritis in pregnant women: what to look for?
01.07.2020
Unfortunately, pyelonephritis is the most common disease that can accompany expectant mothers during pregnancy. This is not only due to hormonal imbalances, but also to the presence of infectious diseases in the pregnant woman’s body, such as furunculosis, tonsillitis , teeth with caries , and compression by the uterus . As a result of the fact that the uterus increases in size, the ureters expand and bend, the cavities of the pelvis increase, and as a result, blood circulation is impaired. Poor circulation allows infection from the urethra and bladder to enter the renal pelvis, which can lead to the formation of stones that can damage the urinary tract. During pregnancy, dysuria may appear, which can aggravate the infectious process in the kidneys .
The causative agent of acute pyelonephritis can be Escherichia coli.
Types of pyelonephritis:
- acute pyelonephritis ;
- chronic pyelonephritis .
Most often, pyelonephritis at 22-28 weeks of pregnancy, when hormonal levels are at their peak. During this period, pregnant women should be very careful about their health, take the necessary tests , and monitor their condition.
Acute pyelonephritis begins with body temperature rising to 38-40°C, trembling appears, a headache begins, aches in the joints of the limbs, pain in the lower abdomen , back , radiating to the leg, groin area. cystitis may occur . A positive Pasternatsky symptom is observed.
There are 3 forms of acute pyelonephritis:
- interstitial form;
- serous form;
- purulent. Here you should pay attention to the appearance of tachycardia, nausea , vomiting and a drop in blood pressure.
Chronic pyelonephritis can appear in childhood. Exacerbations occur 1-2 times a year, or even less often. The main reasons for this are adolescence, pregnancy, and childbirth . In pregnant women, as a rule, changes in tests , but the disease itself is asymptomatic.
Pregnant women with acute and chronic pyelonephritis should be prescribed urine tests , which must be taken every week, and an ultrasound of the kidneys and bladder to avoid possible complications. If a woman suffers from pyelonephritis with high blood pressure or pyelonephritis of one kidney , pregnancy is usually contraindicated in this case. Due to the fact that the pregnant woman’s condition may worsen and there will be a risk to the life of the pregnant woman and her baby.
Hospitalization of a pregnant woman is indicated if complications arise and examinations reveal fetal hypoxia. In the hospital kidney examinations are carried out therapy is subsequently prescribed .
Prevention of complications
- Measure blood pressure regularly
- Monitor changes in pregnant women's body weight
- Monitor the tone of the uterus and the condition of the fetus
Therapy of pyelonephritis
Nowadays, herbal preparations are often used to treat urinary tract diseases. It has a fairly wide spectrum of action. This drug is also quite hypoallergenic. Doctors prescribe it to pregnant women for prevention when toxicosis appears in the later stages and in case of kidney , for the treatment of urolithiasis .
If the situation is more serious, then treatment may be prescribed depending on the stage of pregnancy, the form and degree of the disease. Then antibiotics are administered. In the first trimester, drugs are used that do not affect the fetus - ampicillin, oxacillin. In the second trimester, the list of antibiotics increases because the barrier function of the placenta increases. It is not allowed to treat with tetracycline drugs. Aminoglycosides are prescribed with caution. The dose of the antibiotic is calculated depending on the overall functional capacity of the kidneys and the relative density of the urine .
Childbirth in pregnant women with pyelonephritis should be carried out naturally. A cesarean section is only permissible under strict medical prescriptions via the extraperitoneal route, in order to avoid problems in the postoperative stage.
Thus, we can summarize that in case of pyelonephritis , prevention and regular testing to monitor the condition of the pregnant woman. If there are any deviations from the norm or if the woman feels unwell, the necessary course of treatment should be carried out.
Published in Pregnancy, pregnancy management, Urological diseases Premium Clinic
Diagnosis of pyelonephritis during pregnancy
Laboratory tests help confirm the presence of the disease, which include:
- Blood analysis
. Anemia, lymphopenia, faster ESR and other features are determined. - Biochemistry of blood
. The doctor evaluates the level of nitrogen and creatinine, ALT and AST, and the volume of bilirubin. - General urine analysis , urine analysis according to Nechiporenko
. Reveals increased levels of red blood cells, white blood cells and other features characteristic of inflammatory processes. - Urine according to Zimnitsky
. The volume, specific gravity and density of urine are determined. Based on the test results, the doctor evaluates the patient's kidneys' ability to collect and remove urine from the body. - Bacteriological culture of urine
. The analysis identifies a specific infectious agent. As a result, the doctor can assess susceptibility to antibiotics.
In addition to tests, additional diagnostics are periodically used, for example, ultrasound of the kidneys. During the examination, the doctor evaluates the pyelocaliceal system and can promptly detect an abscess and inflammatory processes.
To normalize the outflow of urine, catheterization of the ureters and chromocystoscopy can be used.
Signs and symptoms of pyelonephritis in women
Acute inflammation in the kidneys - pyelonephritis - affects the underlying tissue located on the inner surface of the kidneys. The development of this disease can be caused by bacteria that are present even in the body of a healthy person. For the time being, they do not manifest themselves in any way, but due to decreased immunity (this condition is often observed during pregnancy), these microbes become a serious problem. Pathogenic microbes are responsible for the development of most diseases, including pyelonephritis.
Diagnosed chronic pyelonephritis puts the entire pregnancy at risk. Its owners belong to the second risk group. In case of complications of the disease with renal failure and hypertension, a woman is allowed to become pregnant only if the manifestations of the disease are steadily weakened or if at least one kidney is functioning steadily.
Acute inflammation in the kidneys can manifest itself with the following symptoms.
- Body temperature rises to 38-39 oC.
- Chills.
- Headache.
- Nausea leading to vomiting (extremely rare).
- Nagging pain in the back.
- Painful urination.
In some cases, there is a slight rise in temperature. If a low temperature (for example, 37.5 °C) is combined with symptoms such as nagging pain in the lumbar region and a feeling of pain when urinating, you should not delay a visit to the doctor. Early diagnosis of the disease guarantees a successful treatment outcome.
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Pregnancy with diabetes
According to modern epidemiological data, more than 2 million patients with diabetes mellitus are registered in Russia, but their real number may reach 8 million people. At the same time, approximately half are women of reproductive age1. Sooner or later, every obstetrician-gynecologist has to face all the difficulties of the reproductive period in this group of patients.
The reform of domestic health care rightly strives to provide highly specialized care in large inpatient departments of multidisciplinary hospitals. Here, next to the obstetrician-gynecologist, there are professional endocrinologists, cardiologists, vascular surgeons, and rheumatologists. Pregnant women with complex extragenital pathology require comprehensive monitoring. When it comes to diabetes, this is the golden rule.
Risks to mother and fetus
Pregnancy with diabetes can only be planned. If we are really interested in the end result. It is important that both the expectant mother and the attending physician understand: pregnancy in a patient with diabetes carries risks for both the woman and the fetus.
