Acute Pyelonephritis in Pregnancy and the Outcomes in Pregnant Patients

Abstract

Background: Urinary tract infections are the most common bacterial infections during pregnancy. Although asymptomatic bacteriuria is the most prevalent form of infection, acute pyelonephritis is the most serious complication, which occurs in 1% -2% of all pregnancies as the leading cause of septic shock in pregnancy and related to increased risk of cerebral palsy. Objectives: This study was performed regarding various results of previous studies and lack of a similar study to evaluate the prevalence of acute pyelonephritis and its outcomes in pregnant women admitted to Taleghani hospital, Tabriz, Iran. Patients and Methods: All pregnant women admitted with acute pyelonephritis from March 2010 to October 2011 to Taleghani hospital, were enrolled in this study. Antibiotic therapy, urine cultures one or two weeks after treatment and late consequences such as pregnancy outcome, newborn birth weight and Apgar score were evaluated. Results: The mean age was 23 ± 4.88 years. Of 60 patients, 40 (66%) were nulliparous and 19 (31.7%) multiparous. The mean gestational age was 25.73 ± 7.42 weeks. Most of patients (65%) had been diagnosed in the second trimester of pregnancy. Regarding urine culture studies, 42 (70%) had positive and 18 (30%) negative results. The predominant pathogen was E. coli isolated from 33 (78.6%) cultures, Klebsiella from 8 (19%) and negative coagulase staphylococcus from one (2.4%). None of the infants had low birth weight and 4 of them had preterm delivery (less than 37 weeks). The frequency of acute pyelonephritis was 0.46% in total deliveries. Conclusions: Similar to previous studies, most cases diagnosed in the second trimester of gestation, which necessitates more investigation in this field, since timely diagnosis and treatment have a significant role in preventing known complications of the disease.

Is routine urine dip stick testing justified in asymptomatic women in early pregnancy?

“…97.5% of pyelonephritis is diagnosed in the second or third trimester and as such an additional screening point in the first trimester seems unjustified. 18 If screening for ASB in early pregnancy is to be performed, a safe, reliable and acceptable test should be available. Urinalysis is non-invasive and considered acceptable by patients.…”

The Impact of Inflammation on the In Vivo Activity of the Renal Transporters OAT1/3 in Pregnant Women Diagnosed with Acute Pyelonephritis

“…Pregnant women are affected by diseases, such as infections, diabetes, and gestational hypertension. For example, urinary tract infections (UTIs) are the most common bacterial infections during pregnancy [13]. UTIs are defined as the presence and replication of bacteria in the urinary tract, leading to tissue damage in the urinary system.…”

“…UTIs are defined as the presence and replication of bacteria in the urinary tract, leading to tissue damage in the urinary system. Acute pyelonephritis stands out among severe cases of UTIs, caused mainly by the intestinal flora Gram-negative bacteria Escherichia coli, but also by the bacteria of the Enterobacter and Proteus and the Gram-positive bacteria of the genus Streptococcus group B [13,14]. Despite a relatively low prevalence during pregnancy (1-2%), acute pyelonephritis is one of the most common causes of prenatal hospitalization, which can lead to maternal-fetal death and is the primary cause of septic shock in pregnant women [13].…”

Evaluation of Three- and Five-Year Disease-Free Survival in Patients With Cervical Cancer With Spinal Cord Metastasis Under Treatment With External Radiotherapy + Brachytherapy

“…It is clear; however, that combination therapy is the best strategy to treat advanced cervical cancer with metastasis to the spinal cord. In this regard, combined use of external radiotherapy (with external beams), brachytherapy, and chemotherapy can result in plausible outcomes (12)(13)(14).…”

“…It is clear; however, that combination therapy is the best strategy to treat advanced cervical cancer with metastasis to the spinal cord. In this regard, combined use of external radiotherapy (with external beams), brachytherapy, and chemotherapy can result in plausible outcomes (12)(13)(14).In developing countries, treatment of cervical cancer with metastasis to the spinal cord is generally associated with failure and reduced patient survival due to the lack of appropriate facilities. oncologists are using a variety of methods to prolong patient survival.…”