Pyelonephritis and pregnancy: causes, symptoms, treatment and consequences

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

Pregnancy is an important stage in the life of every woman. However, the process of carrying a child in the womb is a stress factor for the body. During this period, chronic diseases often worsen. Not everyone can recognize the first symptoms of pyelonephritis during pregnancy. This explains why women are late in seeking medical attention.

Medical certificate

Under pyelonephritis it is customary to understand an inflammatory disease of the pyelocaliceal apparatus of the kidneys. Its development is provoked by various bacteria. The disease can manifest itself at absolutely any stage of pregnancy. It manifests itself as a triad of symptoms: increased blood pressure, lower back pain, the appearance of protein with blood impurities in the urine.

In a he althy body, the kidney consists of several small cups, which are combined into larger pelvises. From them, the urine goes through the ureter to the bladder. This structure ensures optimal filtration of the fluid in the body. During pregnancy, the uterus that grows day by day constantly presses onorgans of the urinary system, thereby provoking congestion. This creates favorable conditions for the activity of pathogenic flora and, as a result, the development of pyelonephritis.

Varieties of disease

There are several types of disease.

Depending on the time of occurrence, primary and secondary pyelonephritis are distinguished. In the primary inflammatory process is not accompanied by violations of urodynamics, there are no other pathologies of the kidneys. Secondary pyelonephritis develops against the background of diseases of the genitourinary system.

Acute and chronic forms are distinguished by the nature of the course. Acute pyelonephritis during pregnancy appears suddenly. Primary symptoms appear within hours or days after infection. With proper treatment, the disease lasts about 10-20 days and ends with recovery. The chronic form is a sluggish and periodically aggravated inflammatory process. It is characterized by the replacement of he althy connective tissue of the organ. The disease is often complicated by renal failure, hypertension.

Causes and risk factors

The main cause of kidney pyelonephritis during pregnancy is infection. Various microorganisms can provoke the disease, but most often these are opportunistic bacteria (E. coli, streptococci, staphylococci). Various viruses and fungi, sexually transmitted infections can also act as pathogens.

Doctors identify several predisposing factors,that help the infection to actively develop:

• frequent hypothermia;
• bad habits;
• inactive lifestyle;
• anomalies in the development of the genitourinary system;
• poor personal hygiene;
• presence in the diet of a large amount of spicy, fatty and s alty foods;
• history of chronic cystitis or pyelonephritis.

The acute form of the disease occurs mainly due to changes in hormonal levels. To keep the pregnancy and allow the child to fully develop, the body carries out a physiological decrease in immunity. Therefore, a woman becomes especially susceptible to various ailments of an infectious and inflammatory nature.

If prevention was not carried out at the planning stage, most likely, chronic pyelonephritis will worsen during pregnancy. In this case, the provoking factor is not only a decrease in immunity, but also an increase in the burden on the urinary system.

During pregnancy, the amount of fluid in the female body increases. This is due to the abundant production of blood, amniotic fluid. As a result, the amount of urine increases. The renal pelvis and calyx dilate and accumulate more urine, which also increases the risk of inflammation.

Clinical picture

The first symptoms of pyelonephritis during pregnancy usually appear at 22-24 weeks. The degree of their severity depends on the form of the disease. The following symptoms are characteristic of the acute variant:

• temperature increase;
• great chills;
• nausea and vomiting;
• muscle aches;
• headaches;
• discomfort in the lower back.

Intensification of pain is usually observed at night. It can give to the upper abdomen, to the perineum or thighs. Discomfort is aggravated by physical exertion or movement, on the back or side. Changes are observed in the process of urination. Urine acquires a cloudy hue, a pungent odor. The process itself is accompanied by severe discomfort.

In the case of a chronic form, a woman is worried about dull pains in the lumbar region. There is also general weakness and fatigue.

Diagnostic Methods

In about 70% of women, pregnancy and pyelonephritis are not a coincidence. Most have a history of pathology of the kidneys or other parts of the urinary system.

Urine and blood tests are usually prescribed to detect an inflammatory process in a pregnant woman. Only by their results it is already possible to draw a conclusion about the presence or absence of an infection in the body. Gram stain is also recommended. This method of examination allows you to obtain information about the causative agent of the disease. To assess the sensitivity of pathogenic flora to antibiotics, a bacteriological study of urine is prescribed.

Among the instrumental diagnostic methods, ultrasound is the most informative. With its help, you can assess the structure of the tissues of the organ, determine areas with seals and expansion of the renal pelvis.

Differential diagnosis is carried out with urolithiasis, adnexitis, acute cholecystitis, hepatic colic. Therefore, consultations with specialized specialists (urologist, nephrologist, surgeon) may also be required.

Drug therapy

The acute form of the disease or its exacerbation in the chronic course must be treated in a hospital. In this case, action should be taken immediately.

Drug treatment of pyelonephritis during pregnancy involves the appointment of antibiotics. The doctor should select drugs taking into account the clinical picture and the individual characteristics of the patient's body. Do not be afraid of antibiotics. Their use is fully justified and does not pose a threat to the mother and child, when compared with a high risk of complications.

In the first trimester, the laying of the vital organs of the child occurs, so the medicinal effect is undesirable. If the diagnosis showed only abnormal urine tests, it will probably be possible to limit yourself to lifestyle changes. With active inflammation, high fever and severe pain, antibiotics of the penicillin series ("Ampicillin", "Oxacillin") are indicated.

Starting from the second trimester of pregnancy, both pyelonephritis and other similar pathologies are stopped with antibiotics from the group of cephalosporins of the 2nd and 3rd generation ("Supraks", "Ceftriaxone"). Additionally, macrolides and aminoglycosides are prescribed. It is worth noting that tetracyclines, fluoroquinolones, Levomycetin and Biseptol are categorically contraindicated at any stage.childbearing.

To enhance the therapeutic effect, antimicrobial agents and uroantiseptics are used in parallel. In order to stop the pain syndrome, antispasmodics are indicated ("Papaverine", "No-Shpa"). Complex therapy also includes sedatives and vitamin complexes.

Lifestyle advice

Pyelonephritis and pregnancy - these two conditions always require lifestyle changes. In the case of the development of the disease in an acute form, you need to follow a special diet. First of all, it is recommended to increase the amount of fluid consumed (more than 2 liters per day). It is important to exclude spicy, fatty and fried foods from the diet. Emphasis should be placed on fresh vegetables and fruits.

In the chronic course of the disease, the diet provides for the following rules:

• limiting the consumption of meat and fish broths, spices;
• compliance with the drinking regime;
• reducing the amount of table s alt to 8 g per day;
• eating vitamin-rich foods.

If during the acute stage the symptoms of pyelonephritis in women during pregnancy are expressed by severe pain and temperature, bed rest is indicated. Usually, the medical treatment prescribed by the doctor gives positive results in 4-8 days. After this period, you can return to an active lifestyle. This approach is designed to provide a better outflow of urine.

Help of traditional medicine

Pyelonephritis needs to be treatedstrictly under the supervision of a gynecologist and in a hospital. The use of traditional medicine is strictly prohibited. Not only will this not bring the desired result, but it may also harm the baby inside the womb.

On the other hand, some herbs should not be used during pregnancy. Some species can provoke uterine contractions and premature birth, diarrhea, allergic reactions.

If a doctor recommends diuretics for the treatment of pyelonephritis during pregnancy in women, you can use cranberry or lingonberry fruit drinks, a decoction of lingonberry leaf. However, prior approval from the gynecologist is still required. Berry fruit drinks not only help to remove excess fluid from the body, but also saturate it with vitamins, which has a positive effect on the immunity of a pregnant woman.

Consequences of the disease

Usually, the disease goes through several stages of development. First there is inflammation. If left untreated, small pustules form in the affected area, which gradually merge together, forming a kidney abscess. This condition is dangerous for the life of a pregnant woman. An infection from an abscess can spread throughout the body along with the bloodstream and cause sepsis. Such complications lead to death or disability. However, with timely treatment, the prognosis is favorable.

According to medical reviews, pyelonephritis during pregnancy can provoke other, no less dangerous complications even before the appearance of a kidney abscess. Notable among them are:

• high blood pressure;
• development of uterine hypertonicity, asconsequence, premature birth;
• spread of the pathological process to the pelvic organs, infection of the fetus;
• occurrence of kidney failure;
• appearance of preeclampsia.

The development of preeclampsia is especially often diagnosed during pregnancy with pyelonephritis in the later stages. Such a condition entails malnutrition of the fetus and the occurrence of intrauterine hypoxia. Oxygen deficiency often leads to the death of a child.

Treatment tactics for complications

Treatment of complications is largely determined by the trimester of pregnancy. Pyelonephritis in early pregnancy, accompanied by the threat of miscarriage, requires maintenance therapy. It involves taking antispasmodics and bed rest. In the second and third trimesters, preeclampsia or placental insufficiency most often develops. In this case, treatment should be aimed at maintaining the functions of the placenta, improving the condition of the fetus.

In some cases, pregnancy and pyelonephritis are incompatible. The following violations may serve as indications for its interruption:

• severe preeclampsia;
• ineffective treatment;
• acute kidney failure;
• acute fetal hypoxia.

The interruption procedure is usually carried out by artificial induction. Caesarean section is prescribed in exceptional cases. This is due to the high risk of postoperative complications, which manifest themselves in the form of endometritis and parametritis.

Prevention Methods

To avoid the development of pyelonephritis during pregnancy and its complications, doctors recommend following these rules:

• regular check-ups with a gynecologist in a antenatal clinic;
• keep proper nutrition;
• avoid hypothermia;
• monitor drinking regimen.

It is very useful for pregnant women to take daily walks and do special gymnastics. This is very useful for the full functioning of the circulatory system.