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Acute pyelonephritis in pregnancy.

James B Hill1, Jeanne S Sheffield, Donald D McIntire

  • 1Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75390-9032, USA.

Obstetrics and Gynecology
|December 31, 2004
PubMed
Summary
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Acute pyelonephritis in pregnancy remains uncommon, with Escherichia coli as the primary pathogen. While maternal complications occur, poor obstetrical outcomes are rare, highlighting the importance of continued vigilance.

Area of Science:

  • Obstetrics and Gynecology
  • Infectious Diseases
  • Nephrology

Background:

  • Acute pyelonephritis is a serious kidney infection that can occur during pregnancy.
  • Routine prenatal screening for asymptomatic bacteriuria aims to reduce pyelonephritis incidence.
  • Understanding the epidemiology and outcomes of antepartum pyelonephritis is crucial for maternal and fetal health.

Purpose of the Study:

  • To determine the incidence of acute antepartum pyelonephritis.
  • To identify associated risk factors, common microbial pathogens, and obstetric complications.
  • To compare pregnancy outcomes in women with pyelonephritis to the general obstetric population.

Main Methods:

  • A 2-year longitudinal study collected data on pregnant women hospitalized with acute pyelonephritis.

Related Experiment Videos

  • All patients received intravenous antimicrobial treatment.
  • Pregnancy outcomes were compared with a control group from the general obstetric population.

    • Main Results:

    • The incidence of acute antepartum pyelonephritis was 1.4% (440 cases).
    • Pyelonephritis was associated with nulliparity and younger maternal age.
    • Escherichia coli was the predominant pathogen (70%), followed by gram-positive organisms (10%). Complications included anemia, septicemia, renal dysfunction, and pulmonary insufficiency.

    Conclusions:

    • The incidence of pyelonephritis remains low despite routine screening.
    • First-trimester pyelonephritis constitutes over 20% of antepartum cases.
    • While maternal complications persist, severe adverse obstetrical outcomes are infrequent.