Acute Pyelonephritis in Pregnancy: A Retrospective Descriptive Hospital Based-Study

Abstract

Introduction. Pyelonephritis is a common complication of pregnancy. It is also exacerbated by immunocompromised states and also the sickle cell gene. We reviewed this condition in Jamaican women. Method. We did a six year hospital database docket review. We found 102 confirmed cases. Results. Pyelonephritis was found in 0.7% of deliveries. The mean maternal age was 24 ± 5.83 years with 51% primiparity. Most (58.8%) occurred in the second trimester. The main symptoms were loin pain (96.2%) and abdominal pain (84.6%). It was more common on the right side in 67% of cases. On urinalysis, 81.4% had pyuria. The commonest organism was Escherichia coli, in 61% of cases. Patients given Antibiotics prior to admission had quicker resolution, P < 0.02. Haemoglobin S was found in 16% cases (general population 10%; P = 0.002). However diabetes was only found in 1.3% cases (1.5% expected). 61.3% had positive urine culture after treatment showed that 61.3% and 25% had recurrent pyelonephritis. Complications included 32% threatened preterm labour and 17% preterm delivery. About 6% of neonates had intrauterine growth restriction. There were no ICU admissions and no deaths. Conclusion. Early recognition and treatment of pyelonephritis result in good outcome. The condition is more prevalent in patients with the sickle cell gene and recurrence is high.

Acute Pyelonephritis in Pregnancy and the Outcomes in Pregnant Patients

“…Similarly, Dawkins et al reported flunk pain as the most common symptom in their study (6). In addition, the right side CVA tenderness was present in most patients (66.7%), the same as reported by Angel et al (14).…”

“…Nowadays, it is well established that pregnant women with pyelonephritis are at increased risk of sepsis, ARDS (acute respiratory distress syndrome) and ICU care requirement compared to non-pregnants with pyelonephritis. On the other hand, studies claimed that pyelonephritis absorbs a considerable proportion of healthcare budgets (12.4 million dollars per year) and causes excessive load of expenses (6,11,12). The advantages of early screening and treatment of asymptotic bacteriuria, especially in gestational period is an undeniable fact.…”

“…Asymptomatic UTI incidence does not increase in pregnant women in comparison to non-pregnants, but due to mentioned anatomical and physiological changes, the risk of clinical diseases increases in gestation and 30% -40% of untreated cases develop symptomatic infection such as pyelonephritis (6,8). However, bacteriuria eradication by antibacterial agents decreases symptomatic infection occurrence (6).…”

“…Normal perineal flora bacteria such as E. coli, Proteus and Klebsiella are the most important organisms leading to pyelonephritis during gestation (5). Infection usually ascends through bladder easily during gestation, since higher progesterone level causes additional urine stasis due to increased vesicoureteral reflux, decreased urethral peristaltism and bladder hypotonia (6,7). Asymptomatic UTI incidence does not increase in pregnant women in comparison to non-pregnants, but due to mentioned anatomical and physiological changes, the risk of clinical diseases increases in gestation and 30% -40% of untreated cases develop symptomatic infection such as pyelonephritis (6,8).…”

“…Infection usually ascends through bladder easily during gestation, since higher progesterone level causes additional urine stasis due to increased vesicoureteral reflux, decreased urethral peristaltism and bladder hypotonia (6,7). Asymptomatic UTI incidence does not increase in pregnant women in comparison to non-pregnants, but due to mentioned anatomical and physiological changes, the risk of clinical diseases increases in gestation and 30% -40% of untreated cases develop symptomatic infection such as pyelonephritis (6,8). However, bacteriuria eradication by antibacterial agents decreases symptomatic infection occurrence (6).…”