Clinical findings predictive of maternal adverse outcomes with pyelonephritis

Stephens, Angela; Baker, Andrea; Chauhan, Suneet P.; Sibai, Baha M.

doi:10.1016/j.ajogmf.2021.100558

Cited by 3 publications

(3 citation statements)

References 27 publications

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“…Complete blood count may show leukocytosis, bandemia, thrombocytopenia, or anemia. Abnormalities in multiple cell lines are highly correlated with adverse outcomes, such as the need for intensive care unit admission (48). A common presentation that should prompt timely initiation of antibiotic treatment is abnormal urinalysis, fever, flank pain, and CVA tenderness.…”

Section: Pyelonephritis Diagnosismentioning

confidence: 99%

“…When only some of these symptoms are present (for example, fever and UTI but no CVA tenderness or UTI and CVA tenderness but no fever), clinical suspicion for early or evolving pyelonephritis should be high. Clinicians must remain vigilant for worsening clinical symptoms until a diagnosis of pyelonephritis can be excluded (48). Pyelonephritis may also present with more serious sequelae, such as preterm contractions or labor, as well as sepsis, acute renal insufficiency, and ARDS (16,48,49).…”

Section: Pyelonephritis Diagnosismentioning

confidence: 99%

“…Clinicians must remain vigilant for worsening clinical symptoms until a diagnosis of pyelonephritis can be excluded (48). Pyelonephritis may also present with more serious sequelae, such as preterm contractions or labor, as well as sepsis, acute renal insufficiency, and ARDS (16,48,49). The differential diagnosis of these symptoms in pregnancy can also include nephrolithiasis, renal abscess, urosepsis without pyelonephritis, and chorioamnionitis.…”

Section: Pyelonephritis Diagnosismentioning

confidence: 99%

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Urinary Tract Infections in Pregnant Individuals

2023

Obstetrics &Amp; Gynecology

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SUMMARY Urinary tract infection (UTI) is one of the more common perinatal complications, affecting approximately 8% of pregnancies (1, 2). These infections represent a spectrum, from asymptomatic bacteriuria, to symptomatic acute cystitis, to the most serious, pyelonephritis. The presence of UTIs has been associated with adverse pregnancy outcomes, including increased rates of preterm delivery and low birth weight. Screening for and treating asymptomatic bacteriuria have been shown in multiple studies to reduce the incidence of pyelonephritis in pregnancy (3–5). Given the frequency at which UTIs are encountered in pregnancy, the ability to recognize, diagnose, and treat them is essential for those providing care to pregnant individuals. This Clinical Consensus document was developed using an established protocol in conjunction with the authors listed.

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Section: Pyelonephritis Diagnosismentioning

confidence: 99%

Section: Pyelonephritis Diagnosismentioning

confidence: 99%

Section: Pyelonephritis Diagnosismentioning

confidence: 99%

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Urinary Tract Infections in Pregnant Individuals

2023

Obstetrics &Amp; Gynecology

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Complicated Urinary Tract Infections

Augustin

2023

Acute Abdomen During Pregnancy

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Defining the Limits of Postpartum Leukocytosis: A Retrospective Cohort Study

Hartup,

Guarisco,

Song

et al. 2024

Reprod. Med.

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There are established reference ranges for many laboratory values during pregnancy. Fewer studies exist regarding the expected white blood cell (WBC) count after delivery. The aim of this study was to determine appropriate postpartum leukocytosis in a diverse patient cohort. Patients who delivered a live fetus at 37 weeks or later were retrospectively identified. Complete blood counts collected on hospital admission and postpartum day one were used to quantify the change in WBC count associated with delivery. A total of 2245 patients were included; of these patients, 1476 delivered vaginally and 769 delivered via cesarean section. The average change in WBC count was 2.99 × 103/mm3. A WBC count of 20.19 × 103/mm3 defined the 95th percentile. The average rise in WBC count was 3.31 × 103/mm3 after vaginal delivery and 2.34 × 103/mm3 after cesarean section (p < 0.001). Patients with chorioamnionitis or endometritis had an average postpartum WBC rise of 7.38 × 103/mm3 compared to 2.99 × 103/mm3 in controls (p < 0.001). There was no difference in WBC count rise with comorbid asthma, diabetes, or chronic hypertension. A greater WBC count rise was found in patients with pregnancy-induced hypertension. This study provides reference values for the average rise in WBC count after delivery and the 95th percentile postpartum WBC count in a diverse, medically complex patient population with and without delivery complications. Our findings further highlight maternal medical comorbidities that may contribute to the degree of postpartum leukocytosis.

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Clinical findings predictive of maternal adverse outcomes with pyelonephritis

Cited by 3 publications

References 27 publications

Urinary Tract Infections in Pregnant Individuals

Urinary Tract Infections in Pregnant Individuals

Complicated Urinary Tract Infections

Defining the Limits of Postpartum Leukocytosis: A Retrospective Cohort Study

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