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Treatment of pyelonephritis during pregnancy. Pyelonephritis is an insidious disease during pregnancy

The urinary system does a lot more work during pregnancy. According to statistics, 15–20% of young girls suffer from pyelonephritis. Obstetricians claim that this disease significantly complicates the physiological course of childbirth, and also negatively affects the postpartum period.

Causes of the disease

Pyelonephritis is a nonspecific kidney disease with dominant local infectious and inflammatory damage to tubulointerstitial tissue, that is, the tissue of the kidneys itself, caused by a urinary tract infection that enters the kidneys by hematogenous, lymphogenous or ascending routes. Inflammation is concentrated primarily in the pyelocaliceal system.

The development of chronic pyelonephritis is facilitated by premature cessation of treatment and underestimation of the patient’s condition during the period of acute pyelonephritis. The diagnosis is confirmed if there have been more than two exacerbations in the last six months. Basically, this condition is accompanied by leukocyturia and bacteriuria. In this case, all structures of the kidney are damaged (interstitial tissue, tubules, glomeruli, vessels).

The likelihood of developing the disease is highest in the second trimester of pregnancy.

The following factors contribute to the exacerbation of the disease:

decreased immunity;
changes in kidney function (the pelvis and cups expand, facilitating the accumulation of urine, which leads to inflammation);
an increase in the size of the uterus and dilation of the ovarian veins, which interfere with the normal outflow of urine;
urodynamic disturbances (urolithiasis, diabetes mellitus);
constant stress;
overwork;
hypovitaminosis;
hormonal changes in the body;
eating disorders;
active reproduction of pathogenic microorganisms.

Symptoms and diagnosis

It should be noted that the disease can go unnoticed for a long time, which is typical for a period of remission. However, during an exacerbation the following symptoms appear:

increased fatigue and weakness;
lack of appetite;
heat;
aching dull pain in the lumbar region, which can radiate (give) to the perineum, buttocks;

There is a pattern: the more intense the damage to the kidney tissue by the inflammatory process, the brighter the clinical picture of the disease will be.

anemia, pale face;

change in the color and odor of urine. It becomes cloudy, sometimes with a reddish tint and an unpleasant, pungent odor;

frequent and painful urination.

At the same time, we must not forget that there may be no visible signs of the disease, but a urine test will show characteristic changes. It is the increased number of leukocytes, bacteria and protein that indicates an exacerbation of the process.

For a more accurate diagnosis, urine tests are performed according to Zemnitsky and Nechiporenko.

Thanks to an ultrasound examination of the urinary system, you can see a complete picture of the condition of the kidneys, ureters, and bladder

A general blood test can reveal leukocytosis, increased ESR, low levels of hemoglobin and red blood cells. Biochemical blood test - increased creatinine and urea.
To establish the causative agent of pyelonephritis and its susceptibility to antibiotics, it is necessary to conduct a bacteriological examination of urine.
Thanks to an ultrasound examination of the urinary system, you can see a complete picture of the condition of the kidneys, ureters, and bladder. With the disease, the kidney will increase in size and its structure will change.
If the passage of urine is impaired, chromocystoscopy and catheterization of the ureters are used for diagnosis.

Depending on the condition of the pregnant woman and her fetus, the obstetrician-gynecologist, together with the nephrologist, determines a further list of diagnostic tests and upcoming treatment.

Impact of the disease on pregnancy

In order for your pregnancy to proceed well and a healthy baby to be born, you need to listen to your body and consult a doctor at the first signs of deterioration in your health. Timely detection and treatment will help avoid severe complications of this kidney pathology. Therefore, regular visits to the obstetrician-gynecologist and testing are of great importance.

Doctors classify mothers who have been diagnosed with pyelonephritis as a high-risk group, which is quite logical, since newborn babies, as a result of infection, can be born with both harmless conjunctivitis and severe infectious lesions of internal organs. In addition, subsequent to intrauterine hypoxia, the child may be developmentally delayed and have low weight.

Very often, exacerbation of chronic pyelonephritis during pregnancy threatens its termination.

Possible consequences

If no measures have been taken to treat pyelonephritis, complications such as:

late gestosis;
spontaneous termination of pregnancy;
intrauterine infection of the fetus;
premature birth;
acute renal failure;
septicemia;
abscess;
kidney phlegmon;
septicopyemia;
bacterial shock.

HCG test result for pyelonephritis

In some kidney diseases, including inflammatory ones (pyelonephritis, glomerulonephritis), the hCG test result may be false negative. The reason is an insufficient amount of human chorionic gonadotropin (reduced production, penetration into urine), as a result of which the test simply may not detect it.

Treatment

Treatment of pyelonephritis is one of those issues that doctors solve immediately. Therapy for pregnant women should be extremely gentle, but at the same time effective.

Doctor's note: Under no circumstances should you self-medicate! The lives of mother and child depend on it.

First of all, pregnant women are recommended to sleep on the side opposite the diseased kidney (not on the back). The foot end of the bed is raised. This will reduce the pressure of the uterus on the ureters. During severe intoxication, pain and high temperature, bed rest is recommended.

The knee-elbow position must be held for 7-15 minutes up to 10 times a day

Up to ten times a day, it is necessary to take and maintain this position for 7–15 minutes.

The daily amount of fluid drunk should be two to three liters, depending on blood pressure and predisposition to edema. You can drink mineral water (Essentuki No. 20).

Diuretic preparations and infusions are strictly contraindicated. Only lingonberry and cranberry fruit drinks, compotes, and teas are allowed to be consumed.

Depending on the causative agent of the disease, the appropriate antibiotic is selected, taking into account side effects, contraindications, and the benefit/risk ratio for the mother and her child. As a rule, the most suitable drugs in this case are penicillin drugs: Amoxiclav, Ampicillin, Oxacillin. In the second trimester, you can use cephalosporins (Ceftriaxone, Cefazolin), macrolides (Azithromycin, Josamycin).

If severe intoxication is necessary, detoxification therapy is carried out, which is based on the use of protein solutions, rheopolyglucin, and hemodez.

Additionally, pregnant women are prescribed antispasmodics (Beralgin, No-shpu), antiallergic drugs (Suprastin, Diazolin) and vitamins C, B, PP.

Diet

The first thing to do is exclude fried, fatty, spicy foods from the diet. Broths made from mushrooms and fish are prohibited, as they contain many extractive substances that can provoke an exacerbation of the disease.

The menu is enriched with:

dietary products made from flour (pasta, day-old black bread);
vegetables and fruits;
dairy products;
juices, fruit drinks.

The attending physician can prescribe alkaline mineral waters in courses with a specific dose depending on individual needs.

Meat and fish dishes must be boiled.

Eating foods that have a slight laxative effect, such as beets and prunes, will reduce the risk of constipation.

As for the use of salt, it all depends on the complexity of the process. Basically, salt is excluded in case of severe pyelonephritis.

Gallery of approved products

Vegetables

Pregnancy is an important stage in the life of every woman, which lasts 9 months and ends with the birth of a long-awaited baby. Unfortunately, bearing offspring also serves as a stress factor for the body, as a result of which many chronic diseases that are dormant are exacerbated. The first signs of pyelonephritis during pregnancy are not known to everyone: this explains the low appeal to a specialist. To protect yourself and your baby from possible complications and negative consequences, you need to undergo regular tests and monitor your health throughout your pregnancy.

What is pyelonephritis during pregnancy?

Pyelonephritis is an inflammatory disease of the renal pyelocaliceal apparatus, which is caused by bacteria and can occur at any stage of pregnancy. The disease can be both acute (newly occurring and lasting from two to five days) and chronic (with constantly alternating phases of exacerbation and remission). The main triad of symptoms consists of increased blood pressure, lower back pain and the appearance of protein with bloody impurities in the urine.

Knowledge of the anatomy of the kidneys will help to understand the causes of pyelonephritis.

A normal kidney consists of several small cups united into larger pelvises, from which urine is directed through the ureter to the bladder. This structure provides better filtration of all fluid in the body. During pregnancy, the enlarged uterus puts slight pressure on the organs of the urinary system, thus causing congestion. This creates optimal conditions for the growth and development of pathogenic microflora.

Causes of the disease

Pyelonephritis is a disease that is caused primarily by bacterial pathogens. The most frequently encountered representatives include:

staphylococcus;
streptococcus;
Proteus;
Pseudomonas aeruginosa;
Klebsiella;
coli;
enterococcus;
some types of protozoa.

And it is also necessary to take into account external and internal factors that increase the risk of developing inflammatory processes in the body. This:

recent operations;
traumatic injuries of the abdominal organs and retroperitoneal space;
sedentary lifestyle;
frequent changes in climate zones;
the presence of chronic diseases (HIV, hepatitis, syphilis, tuberculosis, diabetes mellitus, hypertension, endocrine pathologies);
abnormalities in the development of the genitourinary system (absence of the ureter, double kidneys, underdevelopment of the bladder);
reverse reflux of urine into the pyelocaliceal system;
unprotected sexual intercourse with a large number of sexual partners;
violation of the rules of sanitary culture and personal hygiene;
low awareness of one's own health.

The causative agent of pyelonephritis enters the body of women in three ways: through the blood, lymphatic fluid and urethra. The first type of transmission is most common, and the source of infection can be located in any part of the body.

For example, untreated caries or a festering scratch can become a direct cause of the development of pyelonephritis.

After penetration into the human body, the bacterium settles in the lymph nodes, where its first cycle of reproduction begins, which ends with migration into the bloodstream. With the flow of fluid, it reaches the renal system, affecting the pelvis and calyces. At this point, active processes of cell damage and death begin, which is accompanied by swelling of the organ, causing the first pain syndrome. The kidneys perform their function much worse, swelling and signs of uremic intoxication of the body develop: nausea, vomiting, general weakness and sleep disturbances. At a later stage, connective tissue grows in place of dead cells - this is how acute or chronic renal failure develops, which can cause the death of the patient and the fetus.

Symptomatic manifestations of pyelonephritis during pregnancy

All general and local signs of pyelonephritis quite often add up to a picture that allows one to suspect a diagnosis. The typical form of the disease begins with intoxication, which is then accompanied by symptoms of renal damage, but in cases of complicated pyelonephritis, everything can be completely opposite.

In his clinical practice, the author of this article came across a case where a pregnant woman complained of the child’s hyperactivity during the urination process. The baby began to kick strongly, causing significant discomfort. This forced the girl to visit a doctor, as a result of which she was diagnosed with bilateral pyelonephritis.

Lower back pain is a common symptom of pyelonephritis

Local manifestations of the disease include:

nagging pain in the lumbar region;
redness and cloudiness of urine, the appearance of clots and foreign impurities in it;
urination disorders: urine retention, pain, burning and itching, urine droplets;
increased blood pressure;
the appearance of swelling in the facial area.

Swelling of the face indicates the accumulation of fluid in the body

Generalized signs of kidney inflammation:

weakness, lethargy, severe fatigue;
headaches and dizziness;
appetite disorders;
poor sleep;
temperature increase;
apathy and depression;
irritability;
fatigue in the evening;
decreased performance;
low endurance.

Table: characteristics of symptoms of pyelonephritis at different stages of pregnancy

Comparative clinical sign	First trimester (weeks 1–13)	Second trimester (weeks 14–27)	Third trimester (28 to 40 weeks)
Temperature increase	up to 37–38 degrees	38–39 degrees	up to 40 degrees
The appearance of protein and blood in the urine	up to 1 gram per liter	1–3 grams per liter	more than 3 grams per liter
A rise in blood pressure above normal by 20–30 mmHg	practically uncharacteristic	occurs in 40–60% of all patients	the majority of patients (up to 90%) suffer from hypertensive crises and periodic loss of consciousness
Urinary disorders	inability to completely empty the bladder, feeling of fullness	discomfort during urination associated with impaired urine flow	false urges, itching and burning in the urethra
Pain syndrome	localized in the kidney area, increases with stress and physical activity	in the umbilical region with a return to the groin and upper thigh	felt evenly over the entire surface of the back below the edge of the shoulder blades, may radiate to the navel

Diagnosis methods

The first doctor a woman will turn to with her complaints is an obstetrician-gynecologist. He subsequently redirects the patient to a nephrologist. The specialist begins work with farrowing: the patient is required to describe in as much detail as possible the time when the first symptoms appeared and their characteristics, and describe the previous treatment. If the disease existed before pregnancy, it is necessary to clarify the timing of the last exacerbation and its duration.

It is believed that the tendency to develop kidney diseases is inherited. Women whose immediate family members have suffered from pyelonephritis are twenty percent more likely to develop the condition.

After finishing the conversation and clarifying the main complaints, the doctor proceeds to the examination. The pregnant woman is asked to undress to the waist and is carefully examined. The development of inflammatory pathology in the body is indicated by:

pallor and dryness of the skin and mucous membranes;
seizures in the mouth area;
bruises under the eyes;
swelling of the neck and face;
whitish coating on the tongue.

Another specific method for diagnosing pyelonephritis is checking Pasternatsky’s symptom. To do this, the doctor places the palm of one hand on the lower edge of the costal arch on the back, and then strikes it with the fist of the other hand. With the development of the inflammatory process in the kidneys, the pain intensifies and migrates in the opposite direction.

What diseases are most often confused with?

Pyelonephritis is a fairly common disease from the group of renal pathologies that occur in most of the population. They have extremely similar clinical symptoms, which makes diagnosis much more difficult. Many patients unconsciously ignore their complaints or seek help from a completely different specialist who cannot correctly understand and read the clinical signs.

Most often, pyelonephritis in pregnant women is differentiated with the following ailments:

cystitis;
urethritis;
glomerulonephritis;
kidney cyst;
malignant and benign diseases of the pelvic organs and retroperitoneal space;
ectopic pregnancy;
miscarriage;
symptomatic arterial hypertension and hypertension;
eclampsia and preeclampsia;
diabetic, paraneoplastic, toxic, drug-induced, alcoholic nephropathy;
overdose of medications or drugs;
tuberculosis of the genitourinary system;
urolithiasis.

Laboratory tests for pyelonephritis

To obtain as much information as possible about the health status of a pregnant woman, it is necessary to regularly evaluate all tests. To do this, blood is donated and several types of urine tests are taken. After a couple of days, the doctor receives all the results, based on which it can be concluded that the pyelocaliceal system is damaged.

Blood in the urine is a serious sign of the development of the disease

Most often prescribed:

A complete blood count is a standard screening test that is performed on all patients entering the clinic for further examination. With pyelonephritis, pronounced inflammatory changes are observed: an increase in leukocytes, lymphocytes, neutrophils, macrophages, erythrocyte sedimentation rate and C-reactive protein. Anemia with low hemoglobin and platelets may also occur.
Urinalysis according to Nechiporenko is carried out when examining the first morning portion of urine. It is thoroughly mixed with a glass rod and placed in special chambers, where the same cellular elements are counted under a microscope. During pyelonephritis, there is always an increase in leukocytes from two thousand, red blood cells - more than a thousand, and cylinders - more than twenty units.
A general analysis of urine evaluates primarily physical properties. Normal urine has a straw-yellow color, moderate density and transparency. The inflammatory process is manifested by the appearance of blood or even clots, cloudiness of urine, and the formation of a crystalline sediment. It is also possible to detect the presence of pathogenic microorganisms in this way.
Bacteriological culture of urine. After microscopy of the urine sediment, it is transferred to various nutrient media using a cotton swab. After a few days, the level of bacterial growth is assessed. This makes it possible to detect which pathogen is causing the infection, as well as select specific treatment.

Instrumental studies for the disease

Thanks to the achievements of modern medicine, it becomes possible to assess the condition of the kidneys without resorting to invasive surgical methods. Instrumental examination methods cannot replace laboratory ones, but are an excellent addition to confirming the diagnosis of pyelonephritis. Unfortunately, their use during pregnancy is also limited. The most commonly used methods are:

The main methods of treating pyelonephritis during pregnancy

Treatment of inflammatory diseases in the pelvicalyceal system is a rather lengthy and labor-intensive process, which is largely complicated by the fact that most standard medications are prohibited from being taken during pregnancy. Strong emphasis is placed on traditional medicine and herbal medicine. Changing your eating style and drinking regime also has a beneficial effect on a woman’s health.

Important principles of treatment for pyelonephritis during pregnancy:

reduction of pain syndrome;
normalization of blood pressure;
stimulation of immune system cell activity;
removing excess fluid from the body;
restoration of water-salt and acid-base balance;
no negative effect on the fetus;
destruction of the bacterial pathogen that provoked the infection.

Medications to treat illness

During pregnancy, the mother's body perceives many substances as foreign components. They can also seriously affect the development of a small person, disrupting the maturation of his organs and tissues. Most often, the nervous, endocrine, and respiratory systems suffer from the use of medications, and external deformities and deformations of the facial skull also appear.

In the practice of the author of this article, there were clinical cases where women independently prescribed and discontinued antimicrobial drugs. Unfortunately, in the vast majority of cases, children were born with serious impairments of hearing, vision, and smell; there was a deep cleft palate or non-closure of holes in the atrial septum, which led to disruption of normal blood flow.

The best way to combat the causative agents of pyelonephritis are antibiotics: they kill pathogenic microflora, preventing further reproduction and development of the microbe in the body's cells. When using these groups of drugs there is no toxic effect on the baby:

Penicillinins: Benzylpenicillin sodium and potassium salt, Bicillin-1, Bicillin-5, Oxacillin, Ampicillin, Ampiox, Flemoxin, Dicloxacillin, Azlocillin.
Cephalosporins: Cephalexin, Cefazolin, Cefaclor, Cefuroxime, Cefpirome, Cefepime, Cephobid, Rocefin, Fortum, Claforan, Ceclor, Vercef, Keflex, Zinnat, Zinacef.
Macrolides: Erythromycin, Roxithromycin, Clarithromycin, Midecamycin, Macropen, Klacid, Rulide, Oleandomycin phosphate, Lincomycin.

Other groups of drugs used to treat the disease:

Herbal remedies that gently remove excess fluid, toxins and waste from the body. These include Canephron, Cyston, Phytolysin, and pharmaceutically prepared kidney preparations.
Antihypertensive drugs are used to reduce arterial hypertension and reduce blood pressure to normal levels. In obstetrics and gynecology, Verapamil, Diltiazem, Labetalol, Norvasc, Captopril, Enalapril are used.
Stimulants of the immune system help activate the body's internal reserves and direct the forces of cells to fight the infectious agent. The most commonly used are Timalin, Timogen, Taktivin, Cycloferon and human immunoglobulin preparations.
Diuretics should include Urea, Mannitol, Triamterene, Indapamide, as well as any mineral waters and fruit and vegetable juices.

Photo gallery: antibiotics and other drugs used to treat pyelonephritis

Ampicillin is well tolerated during pregnancy Ceftriaxone must be dissolved in novocaine Erythromycin helps remove microorganisms Canephron has anti-inflammatory, antispasmodic, antiseptic and diuretic effects
Captopril is used to treat arterial hypertension. Indapamide removes excess water from the body and lowers blood pressure.

The nutritional culture of pregnant women is a separate science, the basics of which must be learned at school for expectant mothers. It is worth noting that if the renal pyelocaliceal system is inflamed, you will have to give up your usual eating style. All dishes must be baked, boiled or stewed: fried, smoked and dried delicacies must be excluded from the diet. The number of meals during the day is at least five: breakfast, lunch, dinner, several hearty and healthy snacks. It is also necessary to maintain a drinking regime, drinking at least two liters of clean water per day.

Possible breakfast options:

porridge with water or milk (rice, oatmeal, rolled oatmeal, buckwheat, millet) with the addition of berries, honey or nuts;
cottage cheese of at least five percent fat content with sour cream;
plain yogurt and bread with cheese and butter.

soup (pea, chicken, mushroom, solyanka, borscht, cabbage soup, cream, cheese, puree) with several slices of whole grain bread;
stewed vegetables in their own juice;
fish, meat plate.

What to eat for dinner:

durum pasta with goulash;
boiled potatoes with chicken breast;
baked vegetables or turkey stew;
salmon with buckwheat porridge.

yogurt, cottage cheese, kefir, fermented baked milk;
fresh fruits;
nuts;
muesli;
bitter chocolate.

What is strictly prohibited to consume during pyelonephritis:

chips, crackers;
fast food;
carbonated drinks;
any alcohol;
semi-finished products;
custard noodles;
industrial sweets;
black coffee.

Fast food is bad for your metabolism Coffee increases your blood pressure Chips contain a lot of salt

Traditional medicine as an aid

It has long been known that natural recipes are used by women all over the world in order to alleviate their current condition and not harm the baby. Many people deliberately refuse to take traditional medications, completely replacing them with various teas and decoctions. This behavior is not correct, since all traditional medicine helps only to get rid of clinical symptoms, but is practically unable to affect the life cycle of the bacterium that causes pyelonephritis.

The main advantages of natural remedies:

cheapness;
ease of preparation and use;
the ability to assemble the ingredients yourself;
minimal harm to the health of mother and child;
good effect from use.

The disadvantages include:

the possibility of allergic reactions;
individual intolerance during pregnancy;
rapid loss of effect upon cessation of use.

Traditional medicine recipes that help cope with the manifestations of pyelonephritis during pregnancy:

Take three large carrots and two beets and use a juicer to make juice. Dilute 200 ml of juice with 100 ml of hot water and drink on an empty stomach. Beets and carrots not only contain a large amount of vitamins, but also have a pronounced stimulating effect on the immune system of the human body, forcing it to fight bacteria. This juice must be consumed within two months.
Brew three sachets of chamomile in a half-liter mug of boiling water. After cooling, drink the solution in small sips. The procedure is best carried out at a time when you do not plan to be away from home for a long time: chamomile has a mild diuretic effect, removes harmful toxic substances and waste from the body.
Place 200 grams of crushed burdock leaves in a saucepan with a liter of hot water and cook over low heat, stirring clockwise. Once the liquid has cooled, divide it into three equal portions to drink throughout the day. Burdock leaves do an excellent job of treating inflammatory processes.

Photo gallery: traditional medicine for pyelonephritis

Beets and carrots contain many beneficial substances Chamomile stimulates urination Burdock relieves inflammation

Video: competent therapy for kidney inflammation during pregnancy

Prognosis and possible complications of the disease

Pyelonephritis is a rather serious infectious disease, the improper treatment of which negatively affects the health of both mother and child. This is why most pregnant women are treated in a hospital setting rather than at home. This makes it possible to reduce the percentage of maternal and infant mortality by two to three times.

If necessary, patients are issued sick leave for up to fifteen days. The decision to extend it is made by a medical commission.

Disability is assigned only to patients with chronic pyelonephritis that has existed for a long time. The first group is for people with severe renal failure who cannot exist without monthly dialysis procedures - blood purification using special machines. In this case, pregnancy is out of the question. The second disability group is assigned to chronic pyelonephritis with frequent exacerbations and complications, as well as the initial form of kidney failure. Pregnancy usually ends with a caesarean section. Persons included in the third group experience periodic urination problems and can give birth on their own.

Possible complications of pyelonephritis in pregnant women:

acute or chronic kidney failure;
gestosis and toxicosis;
peripheral circulatory disorders;
thrombosis and thromboembolism of the great vessels;
infectious-toxic shock and development of sepsis;
premature birth, early miscarriage, stillbirth;
intrauterine infection of the fetus;
abnormalities in the formation of the nervous, cardiovascular, respiratory and endocrine systems in an infant;
death of a child in late and early stages.

Prevention of pyelonephritis during pregnancy

During the period of bearing a baby, a woman is especially vulnerable and susceptible to the influence of various pathogenic microflora. Any hypothermia, prolonged exposure to the cold, or an accidentally contracted infection can cause the development of pyelonephritis. Unfortunately, most environmental factors have a significant impact on the body, and it is not possible to completely remove them. However, a system of preventive measures aimed at protecting women's health is currently widely used.

In his practical activities, the author of this article has repeatedly encountered various stages and types of pyelonephritis in pregnant women. After treatment, all patients were prescribed specific prophylaxis and given some recommendations for correcting their usual lifestyle. Those who were able to give up bad habits and change their eating style did not experience relapses of pyelonephritis. In others, on the contrary, the course of the disease was complicated by the formation of stones in the kidneys and ureters.

Give up bad habits. Alcohol, nicotine and drugs used during pregnancy not only cause delays in fetal development and the risk of premature birth, but also cause a serious blow to the health of the entire body. Cigarette smoke causes spasms of the blood vessels responsible for feeding the kidneys, and the ethyl alcohol contained in alcohol disrupts the formation of healthy cells.
It is unacceptable to drink alcohol during pregnancy
Maintain good hygiene. It is known that in the area of the vagina, urethra and anus there are a huge number of pathogenic microorganisms that can be carried back into the renal pelvis with urine flow. This is why it is so important to take a morning and evening shower or bath every day, use thin pads for discharge and change bed and underwear. Remember that ordinary gels and shampoos are not suitable for intimate hygiene and can disrupt the vaginal microflora, causing dysbacteriosis. It is recommended to purchase special soap at the pharmacy for these purposes.
Attend gymnastics for pregnant women. Many women believe that waiting for childbirth is a process during which you can relax as much as possible and not maintain the desired physical shape. However, exercise not only has a tonic effect on the muscles, but also helps reduce venous and arterial congestion in the pelvic area. You can practice both at home and in group training with a master. An additional advantage to general physical education will be exercise with a fitball: it also helps to better prepare for the upcoming birth.
Gymnastics helps keep the body in good shape
Always dress appropriately for the weather. Pregnant women are much more susceptible to developing colds and viral diseases that attack the body during hypothermia. If you spend a lot of time outdoors, choose long down jackets or fur coats, warm jackets and sweaters made of natural wool.
Treat existing purulent-inflammatory diseases before planning pregnancy. As mentioned earlier, the source of bacterial microflora in pyelonephritis can be caries, carbuncle, boil, or even an old scratch. Doctors strongly recommend undergoing a full medical examination to identify and eliminate such ailments. If necessary, the woman is prescribed antibacterial therapy for up to two weeks. After all the activities have been completed, you can safely begin planning your pregnancy.
Treatment of caries must be carried out before pregnancy
Take the necessary tests and participate in screenings. It is believed that a system of regular blood and urine testing will identify even the earliest stages of pyelonephritis. It is necessary to register with the antenatal clinic of your clinic within a period of up to twelve weeks. If you become ill with pyelonephritis in the later stages, the first thing you should do is notify your doctor.

Pyelonephritis is one of the most frequently diagnosed kidney pathologies during pregnancy, which affects up to 12% of women. This is a urinary tract disease in which inflammation of the renal collecting system develops, caused by a bacterial infection. Doctors call the development of pathology during the period of bearing a baby “gestational pyelonephritis.” How dangerous is pyelonephritis, what complications during pregnancy can it lead to? How to treat pyelonephritis during pregnancy?

Pyelonephritis is a urological infectious disease. The infection affects the kidneys (calyces, pelvis) and leads to disruption of their functioning, affecting the urinary system. The risk of developing and developing kidney disease increases specifically in pregnant women, when the kidneys have to work under increased stress. In addition, the hormonal levels of a woman carrying a baby change. The activity of female hormones affects the functioning of the urinary system and kidneys, significantly reduces the tone of the ureter, and blood circulation in the organs is impaired. The longer the pregnancy, the more the actively growing uterus puts pressure on the ureter, preventing the outflow of urine from the kidneys, which leads to infection and the development of inflammatory processes in the organs. Sources of infection of the ureter and inflammation of the renal pelvis are pathogenic organisms (chlamydia, streptococci, E. coli, etc.).

Pyelonephritis during pregnancy is caused by the following reasons:

If pyelonephritis, cystitis, or renal failure have been observed in a woman previously.
Infection of urological organs with pathological microorganisms, which cause inflammation.
Hypothermia, weakened immunity of the pregnant woman.
Lack of moderate physical activity, walks in the fresh air, sedentary lifestyle.

Depending on when the woman first suffered inflammation, primary and secondary pyelonephritis are distinguished. If the disease was first diagnosed during pregnancy, this is the primary form of pyelonephritis. With secondary pyelonephritis, an exacerbation of the disease diagnosed before conception occurs.

Doctors make a diagnosis based on the form of the disease:

Chronic form of pyelonephritis. The peculiarity of this form of the disease during pregnancy is hidden symptoms that may not appear or may make themselves felt periodically. Only through laboratory and bacteriological tests of urine can the presence of an infection in the kidneys be determined. This variant of the disease is observed in expectant mothers who previously suffered from pyelonephritis, and an exacerbation occurred during pregnancy.
Acute pyelonephritis is manifested by sharp and sudden symptoms of the disease after infection. The disease develops in less than a day. Timely treatment contributes to a quick recovery without complications.

Pyelonephritis during pregnancy: symptoms

The main symptoms and first signs of the disease appear from the 2nd trimester (22-24 weeks of pregnancy), depending on the form of the disease.

The acute form of pyelonephritis is usually accompanied by a high temperature of up to 38-40 degrees and chills. A pregnant woman feels a sharp pulling or sharp pain in the lumbar region, sometimes only on one affected side. Painful sensations and shooting pains from the lower back spread to the abdomen and perineum. The pain can be quite severe, making it difficult for a woman to get out of bed. There is a disturbance in the process of urination: the urine changes color, becomes cloudy, acquires a pungent odor, and sharp pain is felt when urinating. In addition to painful sensations, the pregnant woman feels body aches, lethargy, weakness, and nausea.
Chronic pyelonephritis during pregnancy is not so pronounced and is manifested by tolerable pain in the lower back, which is aching and dull in nature. The pregnant woman feels weak, drowsy, and gets tired quickly. Sometimes the patient may not attach importance to pain, considering it normal during pregnancy. The pain may increase gradually, and the color and smell of the urine changes over time.

Pyelonephritis in early pregnancy - features of its course

Kidney disease that occurs in the 1st trimester (up to 12 weeks) is particularly severe and painful. The pain is intense and resembles acute renal colic. The woman cannot relax, she is forced to take the only position that is comfortable for her at the moment, which slightly dulls the pain and curls up. The inflammatory process is very dangerous for the course of pregnancy and can lead to its termination.

In addition, there is a possibility of infection of the fetus and disruption of its normal development. Treatment of kidney inflammation is complicated by the fact that many drugs, including antibiotics, are not prescribed to pregnant women. The main task of doctors is to find the safest and most effective way to solve this problem in order to minimize the likelihood of complications and consequences after treatment.

Consequences of pyelonephritis during pregnancy

Expectant mothers who have had to deal with kidney inflammation are worried about the consequences and complications after the illness. Possible complications of pregnancy include:

Exacerbation of chronic pyelonephritis in late pregnancy (up to 30 weeks) can cause premature birth.
Kidney pathology in the 1st trimester threatens spontaneous miscarriage.
Anemia is a frequent companion of a pregnant woman after suffering from pyelonephritis, and is dangerous due to complications - leading to forced oxygen starvation of the fetus.
Infectious-toxic shock.
The occurrence of acute renal failure, purulent inflammation in the kidney.
Polyhydramnios.
Gestosis in pregnant women is one of the most dangerous complications, manifested by increased blood pressure, which leads to vasospasm, swelling, and fetal hypoxia.

How dangerous is pyelonephritis during pregnancy for the fetus?

The consequences of pyelonephritis for the unborn baby are no less terrible. The intoxication that accompanies the disease has a negative impact on the condition of the fetus, causing disruption of the blood supply, which leads to fetal hypoxia. As a rule, after a disease suffered during pregnancy, the newborn is born with a low weight, and developmental delay is often diagnosed. Microorganisms that cause kidney inflammation can infect the fetus in the womb and lead to the formation of malformations or fetal death.

To avoid all the terrible consequences of this insidious disease, it is necessary to consult a doctor in time at the first symptoms and begin treatment prescribed by the doctor as quickly as possible.

Pyelonephritis in women during pregnancy - diagnosis

To diagnose kidney pyelonephritis during pregnancy, a number of laboratory tests are performed, on the basis of which the doctor prescribes appropriate treatment:

General and biochemical blood test - the level of leukocytes with pyelonephritis increases significantly, and hemoglobin decreases.
Urinalysis according to Nechiporenko - shows the level of immune cells of leukocytes in the urine. Their increased content is a clear sign of an inflammatory process.
General urine test - taken to identify protein and leukocytes in the urine.
Bacterial urine testing is used to accurately identify the causative agent of the disease, and its sensitivity to a specific group of antibiotics is also determined.
Ultrasound of the kidneys - as a rule, an ultrasound examination shows an enlargement of the organ and a change in its structure.

After the necessary research, the doctor prescribes treatment for the patient.

Pyelonephritis during pregnancy: treatment

Pyelonephritis is a disease with dangerous complications and consequences that requires treatment in a hospital under the supervision of qualified physicians. At the first, even slight, suspicion of kidney inflammation, a pregnant woman should consult a doctor. Only a doctor, after conducting an examination and tests, will prescribe treatment and select drugs that are safe for the fetus. While in the hospital, bed rest is mandatory. Physical activity is contraindicated for pregnant women; absolute rest is recommended. When treating a patient in the first trimester of pregnancy, if pyelonephritis is mild, doctors can prescribe non-drug treatment, which consists of the following:

Dieting. The expectant mother's diet should be rich in fruits and vegetables, and fermented milk products are healthy. Avoid the use of vinegar, spices, onions and garlic, spicy and pickled foods. It is necessary to temporarily limit the consumption of strong tea, coffee and quit smoking. To avoid swelling, it is advisable to reduce salt intake.
Compliance with drinking regime. A woman suffering from pyelonephritis should drink at least 3 liters of fluid per day. In addition to water, you can drink berry juices (cranberry, currant, lingonberry), and compotes.
For better outflow of urine from the infected kidney, a pregnant woman needs to sleep on her side; sleeping on her back is not recommended. Doctors advise taking the knee-elbow position and staying in it for up to 15 minutes several times a day.

If the course of the disease causes severe pain and occurs with complications, doctors prescribe treatment with antibiotics, the choice of which depends on the duration of pregnancy and the severity of the disease.

To treat pyelonephritis during pregnancy, antibiotic treatment is used:

Ampicillin;
Cephalosporins;
Oxacillin;
Gentamicin.

In addition to antibiotics, the doctor prescribes antispasmodics and, if necessary, painkillers. Many pregnant women become anxious and panic when they learn that the doctor has decided to use antibiotics for treatment. Expectant mothers should understand that the lack of antibiotic treatment, especially in severe forms of the disease, is much more dangerous for the fetus and poses a threat to the health and life of the baby. There are antibiotics that are approved in the early stages, but starting from the second half of pregnancy, the sensitivity of the fetus to certain groups of antibiotics decreases and their use is safe for the baby.

Folk remedies for pyelonephritis during pregnancy

Unconventional methods of treating any disease during pregnancy should be treated with particular caution. Pharmacies offer a wide range of medicinal herbs and preparations, the action of which is aimed at “washing out” the infection from the kidneys and relieving inflammation. These are bud herbs, bearberry, calamus, etc. Herbs are brewed with boiling water and filtered. Take 1 glass of decoction three times a day before meals, for a course of 2 months. Before taking renal preparations, you should consult with your doctor.

In addition to medicinal decoctions, you can brew compotes or fruit drinks from cranberries, lingonberries, sea buckthorn, which have an excellent diuretic effect, and also brew rose hips. You can drink healthy drinks throughout your pregnancy.

The most effective recipes for pyelonephritis

Decoction of corn silk.
Pour 1 tablespoon of corn silk with 1 glass of water and cook for 20 minutes. Leave the broth for half an hour and then strain. Take 2 tbsp tincture every three hours.
Yarrow tincture.
Pour 2 teaspoons of pharmaceutical herb into a glass of water and leave for 1 hour, strain. Take 3 tbsp 5 times a day.

Prevention of pyelonephritis during pregnancy

As you know, the best way to treat a disease is its prevention. To avoid infection and prevent kidney inflammation, a pregnant woman must adhere to the following rules:

Engage in moderate physical activity; daily walks in the fresh air are beneficial. By doing special gymnastics for pregnant women, you can strengthen your back muscles to improve the tone of your internal organs.
If a pregnant woman suffered from cystitis or pyelonephritis before conception, then from the first weeks of pregnancy it is important for her to follow a diet and drinking regime for better outflow of urine from the kidneys.
Empty your bladder at least every 3-4 hours, preventing harmful microorganisms from multiplying.
When planning a pregnancy, be sure to undergo a kidney examination for chronic pyelonephritis and treat existing diseases of the genitourinary system.
Pregnant women should not be overcooled, get cold feet and backs, and dress inappropriately for the weather.
Drink at least 1.5 liters of liquid per day, including vitamin juices and compotes.

A careful and careful attitude towards yourself and your health, and compliance with preventive measures will help prevent the development of dangerous kidney disease. If you were unable to avoid infection and discover symptoms of pyelonephritis, immediately seek medical help to begin treatment without delay.

As is known, women are susceptible to pyelonephritis 5 times more often than the male half of humanity, which is due to the anatomical features of the urinary system of the female body. In pregnant women, pyelonephritis is one of the most common extragenital diseases and is diagnosed in 6–12% of cases. Treatment of this disease during pregnancy should begin immediately, since the infection adversely affects not only the woman’s condition, but also the health and development of the fetus.

Pyelonephritis in pregnant women: definition and classification

Pyelonephritis is an inflammatory process in the kidney that affects both the interstitial tissue of the organ and the collecting system (the place where urine accumulates).

Classification

According to the development mechanism:
- primary pyelonephritis (the disease occurred on its own, it was not preceded by any pathology of the urinary system);
- secondary - an inflammatory process in the kidneys has developed against the background of existing nephroptosis (prolapse of the kidney), urolithiasis (urolithiasis) or other diseases of the kidneys and urinary tract.
With the flow:
- acute - an inflammatory process in the kidneys developed for the first time during gestation or the gestational period, therefore it is called pyelonephritis during pregnancy or gestational pyelonephritis;
- chronic - the disease occurred before conception and manifested itself during pregnancy (exacerbation of the chronic process).
By localization:
- bilateral, when both kidneys are involved in the process;
- unilateral (right- or left-sided) - during gestation, the uterus moves to the right as it grows and “oppresses” the right kidney, as a result of which expectant mothers are more often diagnosed with right-sided pyelonephritis.
By form:
- serous;
- purulent (the most unfavorable form of the disease, especially during gestation);
- latent (without clinical manifestations);
- hypertensive (with increased blood pressure);
- azotemic (with the development of renal failure) and others.

In addition, gestational pyelonephritis is divided into 3 types:

pyelonephritis during pregnancy;
pyelonephritis of women in labor (that is, arising during childbirth);
postpartum pyelonephritis or postpartum pyelonephritis (clinic of postpartum gestational pyelonephritis appears on the 4th – 6th day and in the second week of the postpartum period).

Causes and mechanism of development of the disease

Gestational pyelonephritis is caused by pathogenic and opportunistic microorganisms: bacteria and viruses, protozoa and fungi. Most often, the causative agents of the disease are gram-tricital bacteria of the intestinal group: Proteus, Enterococcus, Escherichia coli, staphylococci, Klebsiella and others, as well as streptococci and staphylococci. Infectious agents spread mainly hematogenously (through the bloodstream) from existing foci of chronic infection (tonsils, carious teeth, respiratory tract, inflamed gall bladder, etc.). But an ascending route of infection from the urethra, bladder or chronic lesions of the genital organs (cervicitis, colpitis, endometritis, etc.) is also possible.

Development mechanism

Why does pyelonephritis occur so often during pregnancy? The main predisposing factor is mechanical. The growing uterus compresses neighboring organs, especially the ureters, which disrupts the outflow of urine from the renal collecting system; it lingers there and serves as a favorable breeding ground for the growth and reproduction of infectious agents. In this regard, pyelonephritis often develops in the second and third trimesters of pregnancy.

The second point that predisposes to the development of the disease is hormonal and humoral changes in the body associated with pregnancy. As a result of these factors, the upper urinary tract undergoes anatomical changes (hypotonia, hypokinesia, dyskinesia of the pyelocaliceal system). In particular, under the influence of the pregnancy hormone progesterone, which is designed to relax not only the muscles of the uterus, but also all other smooth muscles of the internal organs, the ureters expand, lengthen and bend with kinks and looping. In addition, the ligamentous apparatus of the kidneys is weakened, which increases nephroptosis.

Thirdly, the increased level of estrogen in pregnant women gives impetus to the growth of pathogenic flora, primarily E. coli. Also, do not forget about the somewhat reduced immunity during the gestational period - which prevents the mother’s body from rejecting the fetus as a foreign object.

Much more often, primigravid women suffer from pyelonephritis. In 93% of cases, the right kidney is involved in the inflammatory process due to dextrorotation of the pregnant uterus and the anatomical features of the right ovarian vein.

Risk factors

Certain factors can provoke the occurrence of the disease in pregnant women:

previous urinary tract infection (cystitis, urethritis, asymptomatic bacteriuria or asymptomatic bacteriospermia of a partner);
developmental anomalies of the urinary system;
urolithiasis (kidney stones aggravate stagnation of urine in the renal pelvis, which leads to the activation of opportunistic flora and the development of the inflammatory process);
inflammation of the female genital organs (most often colpitis and vulvovaginitis);
low standard of living (poor nutrition and living conditions, heavy and hazardous production);
diabetes;
chronic extragenital pathology (thyroid disease, cardiovascular diseases, endocrine disorders).

In the postpartum period

In the first days after birth, the risk of developing the disease increases significantly, which is facilitated by the emergence of new factors:

contraction (involution) of the uterus occurs slowly, which in the first 5–6 days of the postpartum period creates compression (squeezing) of the ureters;
preservation of progesterone in the maternal body (up to three months), which supports dilatation (expansion) of the ureters and urethra;
complications of the postpartum period (late bleeding due to uterine hypotension or placenta residue);
inflammation of the genital organs;
urological disorders caused by acute urinary retention or prolonged catheterization of the bladder (in the first 2 hours after birth).

Risk levels

The occurrence or exacerbation of chronic pyelonephritis significantly complicates the course of the gestational period of pregnancy and is fraught with the development of complications dangerous for both the mother and the child. In this regard, the risk of pyelonephritis for the course of this pregnancy is calculated, which takes into account: the form of the disease, the degree of renal dysfunction and the condition of the expectant mother’s body as a whole. First of all, pyelonephritis in pregnant women significantly increases the risk of developing renal failure and arterial hypertension. The disease with these complications aggravates the course of gestosis up to preeclampsia and eclampsia. There are 3 degrees of risk of kidney inflammation in pregnant women:

Grade 1 (low risk)
This risk level is assigned to pregnant women with uncomplicated pyelonephritis, which first appeared during the gestational period. If timely and adequate treatment is provided, the serious threat to the health of the mother and fetus is minimal. The course of pregnancy and delivery without complications.
Grade 2 (moderate risk)
The woman has a history of chronic pyelonephritis, which in up to 30% of cases causes a complicated pregnancy. If complications do not develop, then the course of pregnancy and childbirth ends favorably, otherwise premature birth or miscarriages are possible.
Grade 3 (high risk)
A high risk of pyelonephritis is assigned to women whose disease is complicated by renal failure and arterial hypertension, or inflammation of a single kidney. Further prolongation of pregnancy is contraindicated.

Clinical picture

Gestational pyelonephritis begins acutely, with signs of intoxication and urological symptoms. The severity of intoxication syndrome depends on the form and duration of the disease. In addition, the type of pathogen, the severity of infection, the route of infection, the woman’s immunity, and gestational age are of no small importance.

The leading symptoms of intoxication include: fever up to 38 - 40 degrees, chills and sweating, headache, lethargy, nausea and vomiting. In addition, nagging or aching pain appears in the lumbar region. If one kidney is affected, pain appears on its side, if both, then pain occurs on both sides. Frequent and painful urination may occur; the patient may note cloudy urine mixed with pus or flakes.

Diagnosis of pyelonephritis during pregnancy

It is necessary to differentiate pyelonephritis from the threat of miscarriage. To clarify the diagnosis, the following laboratory tests are prescribed:

complete blood count (leukocytosis, aneosinophilia, anemia, lymphopenia, accelerated ESR);
biochemical blood test (increased creatinine, nitrogen, possibly increased bilirubin, AST and ALT);
general urinalysis (increased leukocytes, red blood cells and casts);
urine according to Nechiporenko;
urine according to Zimnitsky (isohyposthenuria and nocturia);
bacteriological culture of urine to identify the pathogen and determine its sensitivity to antibiotics.

Of the instrumental methods, the leading role is played by ultrasound of the kidneys, which allows not only to diagnose the dilation of the pyelocaliceal system, but also to determine the carbuncle or abscess of the kidney, inflammation of the perinephric tissue. Chromocystoscopy and catheterization of the ureters are also used to restore urine outflow. In the postpartum period and in extreme situations, when there is a threat to the woman’s life, excretory urography and dynamic scintigraphy are prescribed.

Pyelonephritis in pregnant women: complications, impact on the fetus

The disease not only poses a threat to the health of the expectant mother and the course of pregnancy, but also negatively affects the growth and development of the fetus.

The periods of pregnancy during which the likelihood of developing the disease increases are called critical periods:

24 – 26 weeks (the emergence of a threat of miscarriage, caused not only by the increased excitability of the uterus, but also by the woman’s febrile state, pain syndrome and the action of exotoxins of intestinal bacteria);
32 – 34 weeks – the size of the uterus is maximum, which significantly affects the topography of the kidneys and causes compression of the ureters;
39 - 40 weeks - on the eve of birth, the presenting part of the fetus descends into the small pelvis and presses against its entrance, causing compression of the bladder, stagnation of urine in the urinary tract and renal pelvis;
4 – 12 days after birth.

Complications of pregnancy

The disease (especially with exacerbation of the chronic process) increases the risk of the following obstetric complications:

late gestosis (up to 89% and higher in women with chronic pyelonephritis);
threat of miscarriage and miscarriage in the first trimester;
premature birth;
secondary placental insufficiency;
anemia;
anomalies of generic forces;
bleeding during and after childbirth;
septicemia (blood infection) and septicopyemia (blood poisoning and the formation of purulent foci in the body);
infectious-toxic shock;
purulent-septic diseases after childbirth;
acute renal failure.

Complications for the fetus

In turn, one or another obstetric complication adversely affects the intrauterine development of the child and leads to the following consequences:

hypoxia and fetal growth retardation (the result of gestosis, anemia and placental insufficiency);
antenatal fetal death, during childbirth or in the first 7 days of life (perinatal mortality reaches 30%);
intrauterine infection (in early stages leads to fetal malformations);
prolonged jaundice;
development of purulent-septic diseases after birth;
reduced immunity.

Treatment and delivery

The treatment of gestational pyelonephritis is carried out by an obstetrician-gynecologist together with a urologist (nephrologist). All expectant mothers with an acute process or exacerbation of a chronic one are subject to mandatory hospitalization.

Non-drug therapy
The first step in treatment is to restore urine passage using the following measures:

Bed rest
The horizontal position and warmth improve blood flow in the kidneys and prevent stagnation of urine in the renal pelvis and ureters. Bed rest is prescribed for a period of 5–7 days (until the symptoms of intoxication disappear and the temperature decreases). In a unilateral process, the woman is placed on her healthy side with her knees bent and the foot end of the bed is slightly raised. In this position, the uterus deviates from the inflamed kidney and the pressure on the ureter decreases. In the case of bilateral pyelonephritis, the expectant mother is recommended to take (3 to 5 times a day) the knee-elbow position, in which the uterus also deviates and stops putting pressure on the kidneys and ureters.
Diet
For kidney inflammation, drinking plenty of acidic drinks is recommended, up to 3 liters per day. Cranberry and lingonberry fruit drinks, a decoction (infusion) of bearberry leaves, lingonberries, horsetail, oats, rose hips, and chamomile have healing properties. You should exclude tea, coffee, sweet carbonated drinks, chocolate, fatty, fried and spicy foods, smoked meats and pickles, and fast food. Food should be baked, stewed or boiled.

Drug treatment

Antibiotic therapy
The basis of treatment for the disease is the prescription of antibacterial drugs. In the first 12 weeks, ampicillin, oxacillin or penicillin is prescribed. In the second trimester, the administration of cephalosporin antibiotics (kefzol, claforan) and macrolides (josamycin, rovamycin) is allowed for up to 7–10 days.
Nitrofurans
Starting from the second trimester, uroantiseptics or nitrofurans (5-NOK, nitroxoline, furadonin, nevigramon) are added to antibiotics.
Antispasmodics and desensitizing drugs
Suprastin and Claritin are prescribed as desensitizing agents; no-spa, papaverine, and baralgin are prescribed as antispasmodics. In addition, taking sedatives (valerian or motherwort extract) is indicated.
Diuretics
To enhance the effect of antibiotics, diuretics are prescribed in low dosages (dichlorothiazide, furosemide).
Infusion therapy
For the purpose of detoxification, rheopolyglucin, hemodez, and saline solutions are injected intravenously.
Vitamins and iron supplements

Surgical treatment
If conservative treatment fails, surgical intervention is performed:

ureteral catheterization;
nephrostomy, decapsulation or resection of the kidney, and in severe cases, removal of the kidney when purulent-destructive inflammation occurs (apostematous nephritis, carbuncle or kidney abscess).

Indications for surgical intervention:

there is no effect after antibiotic therapy (1–2 days), plus signs of intoxication and inflammation increase (increased leukocytosis, ESR, creatinine);
obstruction (blockage) of the urinary tract with stones.

Delivery

Delivery for gestational pyelonephritis is recommended through the vaginal birth canal. The labor management plan includes the prescription of antispasmodics, painkillers and prevention of fetal hypoxia. Caesarean section is performed only for strict obstetric indications.

About 7% of pregnant women suffer. The disease can disrupt the normal course of pregnancy and fetal development. Considering the seriousness of pyelonephritis, every pregnant woman needs to take a urine test several times throughout her pregnancy in order to notice the warning signs of kidney disease in time.

Causes of pyelonephritis in pregnant women

Pyelonephritis is an inflammation of the renal pyelocaliceal system. Inflammation is caused by bacteria. In approximately 80% of cases, pyelonephritis is provoked by opportunistic flora: Escherichia coli, Enterobacter, Klebsiella, etc. Less commonly, the culprits of the disease are,. Bacteria enter the kidneys either from the lower urinary organs (urethra, bladder), or are carried through the bloodstream from foci of chronic infection.

The changes that occur in the female body during pregnancy contribute to the progression of the inflammatory process in the kidneys. Thus, hormonal changes with increased synthesis lead to a decrease in the tone of the ureters, bladder, renal calyces and pelvis. This causes urine flow to slow down and become stagnant, which can be considered ideal conditions for bacterial growth.

In addition, the enlarging uterus puts strong pressure on the ureters, which also causes a disruption in the proper passage of urine. This is why pyelonephritis often occurs at the end of the second trimester (at 22-26 weeks), when the uterus is already greatly increasing in size.

When a pregnant woman gets sick with pyelonephritis for the first time in her life, they talk about the development gestational pyelonephritis. There are also situations when a woman had chronic pyelonephritis even before the child was conceived, and during pregnancy the disease worsened. Regardless of the form of the disease, the treatment used is the same.

Symptoms of pyelonephritis in pregnant women

Pyelonephritis in pregnant women can occur in different ways. Yes, when acute pyelonephritis symptoms of the disease are pronounced, general health worsens. Chronic pyelonephritis, as a rule, is asymptomatic and an inflammatory process can only be suspected if certain abnormalities are detected in urine tests.

Acute pyelonephritis accompanied by an increase in temperature, which can reach very high numbers. The woman feels overwhelmed and tired. She may be bothered by chills and headaches. At the same time, it appears, which may be more pronounced on one side. The pain can radiate to the lower abdomen, thigh, and groin. If pyelonephritis is accompanied by inflammation of the lower urinary organs, the woman is also bothered by a frequent urge to urinate and a burning sensation.

Chronic pyelonephritis can make itself felt only by a slight increase in temperature, rapid fatigue, and discomfort in the lower back. In case of exacerbation, the symptoms of pyelonephritis become more pronounced. Often pregnant women do not suspect they have the disease. In this case, women learn from the doctor about existing pyelonephritis only after the results. When examining urine, leukocytes, bacteria, and also a small amount of protein are detected in it.

Pyelonephritis is not a harmless disease at all. The inflammatory process complicates the course of pregnancy, childbirth and can even lead to impaired fetal development.

Complications of pyelonephritis in pregnant women include:

Late gestosis ();
Miscarriage;
Fetal infection;
Fetal hypotrophy.

Treatment of pyelonephritis during pregnancy

If acute pyelonephritis is detected, the patient is hospitalized in a hospital. This is a mandatory condition, since the woman must remain in bed, and therapy must be carried out under the supervision of an obstetrician-gynecologist or nephrologist.

The basis of treatment is the prescription, only these medications can destroy the bacteria that cause pyelonephritis. In the treatment of pregnant women, the safest antibiotics are used, namely:

Penicillins (Ampicillin, Oxacillin);
Cephalosporins (Cefuroxime, Cefoperazone);
Macrolides (Josamycin, Azithromycin).

In the first trimester of pregnancy, when the fetal organs are still forming, mothers prefer penicillins in treatment. From the second trimester, macrolides and cephalosporins are already prescribed. The average duration of antibiotic treatment is ten to fourteen days.

Important!Together with antibiotics, antiseptic drugs from the nitrofuran group (Furagin) are prescribed. Herbal uroantiseptics (Canephron) are used as additional treatment. These drugs alone will not be able to defeat pyelonephritis without antibiotics.

If there is intoxication, the pregnant woman is given detoxification therapy. To restore the passage of urine, a woman is prescribed antispasmodics (Drotaverine, Papaverine). In addition, better urine flow is facilitated by placing the pregnant woman on her healthy side with her legs elevated. For the same purpose, a woman is recommended to take the knee-elbow position for ten minutes several times a day. At this time, you can leaf through a magazine or watch a tablet to pass the time.

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