Pyelonephritis of the kidneys in pregnant women. The risk of pyelonephritis during pregnancy

It is one of the most common diseases of pregnant women and poses a danger to the health of mothers and children. It occurs in every tenth pregnant woman, in some cases leads to serious complications, both during pregnancy and after it.

To this we can add that pregnancy itself is a provoking factor leading to the development of acute forms of pyelonephritis. Of course, this causes a more severe course of already formed chronic kidney disease.

Why does chronic pyelonephritis get worse during pregnancy?

During pregnancy, some body functions change, which can provoke disease

The main reason is a violation (more precisely - complication) of the passage of urine, due to changes in the location and size of the uterus, as well as the effect of progesterone on the internal receptors of the urinary tract.

The uterus (in the second half of pregnancy) deviates somewhat and turns to the right, putting pressure on the right kidney. This, incidentally, explains the fact that with an exacerbation of pyelonephritis in pregnant women, it is the right kidney that suffers more, as a rule. In the organ itself, there is an expansion of the urinary elements (calyx-pelvic system), the ureters expand. The capacity of the urinary tract is increased to 50-70 ml (per kidney).

Congestion in the kidney can be caused by oversaturation of urine

The kidney and ureter, overloaded with urine (congestion and increased pressure), find themselves in a situation favorable for exacerbation of chronic pyelonephritis. In this case, primary pyelonephritis can also form.

These processes are observed in pregnant women with kidney disease from the 3rd to the 8th month (before the prolapse of the fetus).

From the 8th month, there has been an improvement in the condition of the pregnant woman. Finally, the kidneys return to normal, as a rule, by the 4th month after birth.

Factors provoking exacerbation

An essential role is played by the condition of the ligamentous apparatus of the kidneys, as well as the condition of the fat capsule.

If pregnancy is combined with low body weight, the likelihood of an exacerbation of pyelonephritis increases significantly. Try to adjust your first trimester nutrition accordingly.

Of course, the current state of the kidneys plays a role, as well as the severity of vesicoureteral reflux (i.e., reverse urine flow).

Often, an exacerbation of pyelonephritis is associated with peak hormone levels, which is quite typical for pregnant women.

In this case, the problem is not so much in the dysfunction of the renal valvular apparatus, but in the effect of estrogen and progesterone on some types of receptors. This situation can be suspected in time and the gynecologist-endocrinologist can help fix it.

Even in the absence of a focus of chronic infection in the body (or with its relative passivity), in pregnant women, the infection often rises from bladder, or spreads through the lymphatic or bloodstream.

In the first case, stagnation in the ureters and the kidneys themselves contribute to this, in the second - a drop in immunity, which is not uncommon during pregnancy.

As a result, an exacerbation of chronic pyelonephritis develops, or an acute renal infection (acute

The causative agent is most often Escherichia coli, Proteus, Enterococcus, Staphylococcus aureus, Candida.

What is the danger of a disease during pregnancy

Early toxicosis can be a consequence of exacerbation of chronic pyelonephritis

An exacerbation of pyelonephritis leads to early gestosis (toxicosis), with extensive symptoms: pressure increases, edema develops, and there may be convulsions. There is a loss of protein in the urine.

Gestosis, as you know, is still the main cause of maternal mortality.

Against the background of an exacerbation, miscarriages and premature births occur quite often. The placenta can flake off prematurely, which also leads to miscarriage.

With severe immunodeficiency of the mother, the fetus can be infected with the pathogen that initiated the exacerbation of pyelonephritis. In this case, the child may develop abnormally, as his tissues experience hypoxia (lack of oxygen and nutrients).

After an exacerbation during pregnancy, pyelonephritis in the postpartum period is much worse, which affects the quality of life of the mother.

Severe complications of the disease: sepsis (septicemia, septicopyemia), toxic (bacterial) shock. Given the high mortality of these conditions, pregnant women with pyelonephritis are always considered a high-risk group.

If you have (or have had, at least once) pyelonephritis or any other kidney disease - be sure to inform your gynecologist about it.

Symptoms of chronic pyelonephritis in expectant mothers

The chronic form can proceed for a rather long time in the absence of an expanded clinic. More precisely, some soreness in the lower back is present, as well as a slight increase in body temperature, however, the patient, often, does not attach due importance to this.

This is either due to the abundance of "special effects" characteristic of pregnancy as a condition (vomiting, bloating, taste perversion, irritability, etc.), or due to the habit of constant pain from the kidneys (with untreated or severe pyelonephritis, urolithiasis, etc.).

Signs in the photo

General weakness Nausea and vomiting Discoloration and odor of urine Elevated temperature body

Weakness gradually increases, the color of urine may change. All this, by the way, can also be attributed to the patient to the pregnancy itself, especially if the pregnancy is the first. Low back pain appears, which can be both dull and sharp (stabbing). The pain is usually worse when the body bends forward.

At the first signs of exacerbation of chronic pyelonephritis in a pregnant woman, you must call a doctor

Exacerbation of the chronic process is accompanied by the following phenomena:

• The body temperature rises to 39-40 0С, chills appear;
• The pregnant woman begins to vomit up to vomiting, appetite decreases;
• Urine may have a pungent and unpleasant odor. The color may turn reddish;
• Great general weakness.
• high body temperature (38-40 degrees);

Doctors differentiate exacerbation with acute appendicitis, colic, cholecystitis, as well as nephropathy and manifestations. It will not work out on its own, therefore, with the above symptoms, the pregnant woman is hospitalized.

During an exacerbation of chronic pyelonephritis (even if suspected), the pregnant woman must be unconditionally hospitalized.

Risk levels

There are 3 levels of risk to prevent maternal mortality. The first includes uncomplicated primary pyelonephritis during pregnancy. In this case, there are no special contraindications for pregnancy.

If a woman had chronic pyelonephritis before pregnancy, she already falls into the second risk group.

The first and second groups are additionally monitored by a nephrologist or therapist, and most of these pregnancies are resolved safely.

If pyelonephritis is combined in a pregnant woman with hypertension, anemia, or there is only one kidney, pregnancy is contraindicated.

Of course, you can leave the fruit, but you will have to sign a lot of necessary documents and listen to several specialized specialists. The risk to your life in this case is quite real, and the health of the fetus is at risk until (and during) the birth.

Treatment of chronic pyelonephritis in pregnant women

One aspect of treatment is detoxification therapy

Pyelonephritis is treated according to strict principles of therapy, i.e. the pathogen is sown, an antibiotic is selected for it, taking into account the contraindications and side effects of the drug. It must be understood that the benefit / risk ratio can go quite far beyond the boundaries of the instructions for the drugs.

The need to prescribe this or that drug is due to concern for the safety of the mother and the fetus. Since life is of the highest value, the appointment of non-indicated drugs during an exacerbation of chronic pyelonephritis in pregnant women is allowed.

In addition to antibiotics, they are prescribed vitamins, mineral waters (Essentuki No. 20), antispasmodics and diuretics, physiotherapy and exercise.

A pregnant woman is given detoxification therapy - rheopolyglucin, protein solutions, hemodesis are dripped. To prevent fetal developmental disorders, trental is prescribed (reduces tissue hypoxia).

If the treatment is not effective enough, ureteral catheterization can be performed for a stable passage of urine.

An exception may be very strict obstetric indications, for example, the discrepancy between the linear parameters of the small pelvis and the head of the child.

If pyelonephritis is accompanied by severe toxicosis, early delivery is performed.

The woman in labor is observed in the hospital for 10 days, after which she is discharged from the hospital home, under the supervision of a nephrologist (urologist).

If you adhere to simple dietary rules, the risk of exacerbations can be reduced

It is necessary to consume a lot of liquid (more than 2 liters per day), fried, spicy and fatty foods are excluded. In the absence of combined pathologies from the digestive system, it is advisable to consume a lot of vegetables and fruits every day.

Meat, fish and mushroom broths are contraindicated (meat, fish and mushrooms can be added to vegetables and cereals), since extractive substances can provoke an exacerbation of pyelonephritis.

To reduce the load on the kidneys, it is necessary to reduce the consumption of table salt (total consumption per day up to 8 g).

When the first signs of exacerbation appear, strict bed rest is shown. In the period of remission, on the contrary, it is desirable to be quite active, as this improves the outflow of urine.

Compliance with these rules, plus timely consultations from specialized specialists, significantly reduce the risk of exacerbation of chronic pyelonephritis during pregnancy. At the first signs of an acute process (fever, weakness, back pain), call a doctor immediately.

Share with your friends!

Pyelonephritis can be called a predominantly "female" disease, for the beautiful half of humanity suffers from this painful misfortune several times more often than the strongest.

Moreover, this is true for women during pregnancy, who, due to various circumstances, fall into a special risk group for the incidence of pyelonephritis.

And since the kidney disease of the expectant mother does not pass without leaving a trace for the pregnant baby, and the treatment of this disease requires the use of non-harmless drugs, pyelonephritis during pregnancy becomes a serious problem.

Pyelonephritis is an infectious disease of the kidneys, or rather, their structure, which ensures the normal outflow of urine, accompanied by an inflammatory process. The causative agents of the disease can be E. coli, bacteria such as "cocci", gram-negative bacteria, as well as other pathogens that have entered the kidney.

Any infectious disease occurring in the body can also cause infection of the genitourinary system, bacteriuria and, in the future, the development of pyelonephritis.

Classification

When diagnosing pyelonephritis, note its origin:

• Primary.

The pathological process in the kidneys is not due to previous diseases of the kidneys and urinary tract. Pathologies of the anatomical structure of these organs were also not observed earlier.

• Secondary.

The disease occurs as a consequence of a previous urological disorder (urolithiasis, obstruction of the urinary tract, etc.).

However, doctors are inclined to believe that against the background of the absolute health of the genitourinary system, pyelonephritis cannot occur, rather, there may be an undetected primary disease, and therefore, the classification into primary and secondary is very conditional.

Depending on whether both kidneys have suffered from an infectious lesion or one, pyelonephritis is distinguished:

• one-sided, i.e. one kidney is affected, which is characteristic of the primary disease;
• bilateral, i.e. both kidneys are affected, which is characteristic of a secondary disease.

By the nature of the course, pyelonephritis can be:

• acute, with obvious clinical symptoms. This form is characterized by severe spasmodic pain in the lumbar region or girdle, which can "shoot" in the leg, buttocks, abdomen, etc., painful urination (cystitis), sweating;
• chronic, proceeding practically without pronounced external symptoms, which does not diminish its destructive consequences. Often, it is possible to suspect him only by the results of laboratory tests.

Acute kidney pyelonephritis, in its form, is:

• serous;
• pustular - a more dangerous form.

The clinical picture of chronic pyelonephritis in pregnant women is varied:

• Practically asymptomatic - latent.

Patients are concerned only with malaise, weakness, only a urine test gives a little, and an increased ESR may be observed in the study of blood. In this case, a low urine density should be alerted. Over time, the "sluggish" form of the disease is transformed into:

• Azotemic.

Expressed through uremia, impaired renal function - renal failure. In most cases, the process of organ “drying out” is irreversible.

• Recurrent.

Periods of exacerbation of pyelonephritis are replaced by periods of "calm" (remission);

• Hypertensive.

When the disease proceeds against a background of high blood pressure, hypertensive crises are possible. In this case, there may not be a violation of the outflow of urine.

• Anemic.

In which, against the background of pyelonephritis, a deficiency of erythrocytes is noted in the patient's blood, the indicators of urine analysis may be normal;

• Hematuric.

Blood is found in the urine. An extremely rare form.

How does a kidney infection get?

A provocative infection can enter the kidneys in different ways:

It first enters the organs located anatomically below the kidneys, and causes urethritis (inflammation of the urethra), cystitis (inflammation of the bladder), appears in the kidneys (pyelonephritis);

• Descending (hematogenous).

It gets from an infected organ through the bloodstream. Thus, pyelonephritis can be provoked, for example, even by an infection from an untreated carious tooth or chronic sinusitis;

• Lymphogenous.

Penetrates through the lymphatic system, for example from the intestines.

However, in order for the kidney to be damaged by pathogens, there must be so-called supportive factors: weakening of immunity, impaired urinary function, impaired renal blood flow, etc.

Why is pyelonephritis dangerous during pregnancy?

Doctors note that pregnancy against the background of pyelonephritis is more common, moreover, in its severe forms.

But even an uncomplicated form of gestational pyelonephritis in an expectant mother can lead to serious consequences for the child:

• Miscarriage.

Pain attack stimulates contractile ability myometrium of the uterus, which threatens with premature termination of pregnancy;

• Intrauterine fetal infection.

The infectious principle of pyelonephritis can lead to infection of the fetus, this is especially true for the latent chronic form.

• Suffering fetus from oxygen starvation.

It is noted that against the background of pathological changes in the kidneys in the gestational period, the development of hypoxia (up to asphyxia) and fetal malnutrition often occurs. Anemia and hypertension combined with pyelonephritis also have a negative effect on the blood supply to the placenta and the development of a bearing baby.

The consequences of pyelonephritis suffered by the mother during pregnancy for newborns are often prolonged jaundice, hypothermia, CNS lesions, etc.

Pyelonephritis, transferred in early pregnancy, can lead to malformations and fetal death in the antenatal or early postpartum period.

Early diagnosis of gestational pyelonephritis plays an important role in predicting the success of measures taken to eliminate the disease or transfer it to the stage of permanent remission.

Diagnostics

To diagnose pyelonephritis in pregnant women, external symptoms, data from laboratory tests of urine and blood of patients, ultrasound of the kidneys, anamnesis are taken into account.

Analysis of urine

Laboratory analysis of urine for the diagnosis of pyelonephritis includes:

• General urine analysis.

Conducted for the detection of excess of the norm of leukocytes, proteins, bacteria (in the total volume of urine), determination of the acid-base index of urine, its relative density.

Take 50 ml for analysis. from the total amount of morning urine into a sterile container. When selecting, there are strict requirements for the hygiene of the genitals.

• Urine analysis according to Nechiporenko

To determine the specific value of erythrocytes, leukocytes and cylinders per 1 ml. urine. For analysis, take the mid-morning urine portion in a sterile container, neglecting the first and final portions.

• Zimnitsky test

It is carried out to determine the total volume of excreted urine and its change depending on the time of day, analysis of urine density.

For the study, the entire volume of urine released during the day, starting at 9.00, is taken into the vessels, changing them every three hours, a total of 8 vessels are required. The last portion of urine for analysis is collected the next day at 6.00.

• Sowing urine to determine the causative agent of the pathogenic process (bacteriuria).

Sowing the infection allows you to choose the most effective drug to fight the disease. In practice, for complete confidence in the seeding results, it must be carried out at least three times.

The study of urine for the diagnosis of pyelonephritis in pregnant women is of the utmost importance, however, it should be noted that changes in the composition of urine characteristic of it can be caused by other kidney diseases.

Therefore, it is inappropriate to limit itself only to urinalysis for diagnostic purposes.

Blood test

In the course of laboratory research with pyelonephritis, characteristic changes in the leukocyte blood count are determined, namely, the appearance of a large number of immature leukocytes, dysproteinemia, which indicates an inflammatory process in the body; rapid erythrocyte sedimentation (increased ESR), which is typical for infectious diseases.

The prognosis for the condition of the mother and the fetus with gestational pyelonephritis depends on the nature of the disease:

• acute uncomplicated gestational pyelonephritis with timely adequate treatment allows you to carry the pregnancy to the end and give birth to a healthy baby in a natural way;
• exacerbation of the chronic form during gestation can cause miscarriage, prenatal fetal death, etc.;
• gestational pyelonephritis, complicated by hypertension, functional disorders in the kidneys is becoming a serious threat to the life of the mother and fetus.

In the case of gestational pyelonephritis of a single kidney, an unconditional indication for abortion appears.

Treat expectant mother with gestational pyelonephritis, as well as in the "non-pregnant" period with the use of antibacterial, anti-inflammatory drugs, physiotherapy, phytotherapy, and the choice of funds is made taking into account the safety for the fetus.

Simultaneously with the treatment of the mother, measures are taken to improve the condition of the fetus, treat it for malnutrition.

In the postpartum period, the list of medicines can be expanded, however, in this case, the question arises about the possibility of breastfeeding.

The acute form most often occurs during pregnancy. Due to its pronounced manifestations, its diagnosis, as a rule, does not cause difficulties.

Symptoms

Signs of acute pyelonephritis are very painful:

• persistent hyperthermia (increased body temperature);
• cloudy urine;
• often, painful urination ();
• incessant (may be local or shingles);
• chills, severe sweating;
• signs of intoxication of the body, etc.

The clinical picture of gestational pyelonephritis is confirmed by laboratory and instrumental studies characteristic of the disease.

Treatment of acute pyelonephritis during pregnancy

Treatment of gestational pyelonephritis includes a whole range of measures, in which the use of medications plays a leading role. In addition to prescribing drugs, the patient's treatment regimen includes instructions for observing drinking and eating behavior, performing "positional therapy", and taking herbal teas.

Drug treatment

Since the origin of pyelonephritis is infectious, the main method of dealing with it is the use of antibacterial agents: antibiotics, antiseptics.

The choice of specific drugs is based on minimizing the negative effect of drugs on the fetus, depending on the duration of pregnancy and the condition of the expectant mother. It is necessary to take into account the sensitivity of the infection to the drug according to the results of microbiological culture of urine, and also to observe the patient's tolerance of the drug.

In the first trimester, the choice of medicines for the treatment of pregnant women is strictly limited due to the risk of damaging effects on the embryo, therefore, the use of antibiotics of the penicillin group (inhibitor-protected ampicillin / sulbactam, amoxicillin / clavulanate, etc.), plant-based uroantiseptics (for example , "Kanefron").

For more later dates, after the formation of the placental barrier, the list of approved medicines can be expanded. After the 16th week of pregnancy, joint use with pecinillins, the use of cephalosporin groups of the II-IV generation (Suprax, Ceftriaxone, Zeporin, inhibitor-protected cefoperazone / sulbactam, etc.), macrolides (erythromycin, etc.) is permissible. ).

At the same time, the antimicrobial nevigramone, 5-NOK and other uroseptics are connected. Reception of uroseptics, as a rule, is continued for a long time to prevent recurrence of the disease.

Aminoglycosides (gentamicin, kanamycin, etc.) are prescribed during pregnancy only for strict indications. Fluoroquinolones, tetracyclines and some other toxic antibiotics are prohibited. There is a restriction on the use of sulfinamides in the I and III trimesters.

In cases of a complicated course of pyelonephritis, detection of a polymicrobial infection, ineffectiveness of the previous use of antibacterial agents, carbapenems ("Tienam", "Merexid", etc.) may be prescribed to a pregnant woman.

Antibacterial therapy is carried out against the background (Suprastin, Zirtek, Claritin, etc.) and vitamin therapy.

In a severe course of the disease, treatment begins immediately, after the patient's admission to the clinic, with broad-spectrum antibiotics. The first priority is to relieve symptoms of pyelonephritis and restore urinary function (if necessary, using a catheter). For this, antispasmodics are prescribed (no-shpu, etc.).

The main antibiotic treatment for acute pyelonephritis lasts about 1.5 - 2 weeks. The use of uroseptic agents is longer and is about a month.

In extremely severe cases, with acute purulent pyelonephritis, there may be indications for a surgical operation to excise the festering area of \u200b\u200bthe affected kidney. This is not an indication for termination of pregnancy.

Diet and drinking regimen

With gestational pyelonephritis, it is recommended to increase fluid intake, ideally, drinking non-carbonated water or weak teas, fruit drinks (preferably cranberry, lingonberry, sea buckthorn), diluted juices, vitamin broths.

Compliance with the drinking regime - at least 2 liters of liquid per day - helps to "wash out" the infection, and the recommended berry fruit drinks, in addition to a diuretic, also have bactericidal properties.

Strong tea, coffee, sugary carbonated drinks, sodium mineral waters should be discarded, as drinks of this kind provoke puffiness. The use of alcoholic beverages, by default, is contraindicated during pregnancy.

Diet restrictions apply to food containing an excessive amount of protein, salt, fat, foods that create an excessive burden on the kidneys. Therefore, it is advisable to refrain from baked goods, fatty meats, fish, cheese, gastronomy (sausages, sausages, etc.), concentrated protein broths, hot spices, canned food, etc.

Restrictions in sugar and sugar-containing foods (this also applies to sweet fruits) is also recommended for pyelonephritis, since excess weight gain in combination with kidney disease dramatically increases the risk of arterial hypertension. Moreover, if the expectant mother has manifestations of preeclampsia.

Positional therapy

Positional therapy for gestational pyelonephritis refers to certain body positions in which the manifestations of urinary obstruction are significantly reduced.

Folk remedies

Application folk ways treatment for gestational pyelonephritis must necessarily be agreed with the attending physician, since some herbal remedies during pregnancy are unsafe for use.

A popular remedy for pyelonephritis is "flushing" the kidneys with watermelon. It should be consumed on an empty stomach without restrictions during the day (be careful with urolithiasis).

An effective remedy is considered to be a decoction of oatmeal: boil 1 cup of oats in 1 liter of water for 2 - 3 hours, cool, strain, take 100 ml three times a day before meals.

We can talk about successful treatment if blood and urine tests performed three times, with a difference of several days, demonstrated the absence of bacteriuria, normalization of leukocytes in urine and other laboratory parameters, of course, with an external improvement in the patient's well-being.

It is extremely important to achieve this, otherwise untreated acute pyelonephritis can transform into a chronic form of the disease.

Chronic pyelonephritis during pregnancy

The chronic course of the disease, in contrast to its acute form, may not manifest itself in an obvious way for a long time through the patient's well-being. During pregnancy, even exacerbations of chronic pyelonephritis can be erased, making it difficult to diagnose. The consequences of a latent long-term illness can be irreversible.

Symptoms

The chronic form of pyelonephritis is characterized by a wave-like course: periods of exacerbation of the disease are replaced by periods of remission.

The manifestations of the external symptoms of chronic pyelonephritis depend on the current stage:

• the stage of exacerbation is similar clinical picture with acute pyelonephritis: sharp pains, high temperature, fever, etc.
• the remission stage does not have vivid manifestations. Occasionally, a woman may be bothered by low back pain, fatigue, dizziness, nausea, etc.

Therefore, the main symptoms of chronic pyelonephritis are changes in laboratory test results, as well as kidney ultrasound data.

Treatment

Medical prescriptions for chronic pyelonephritis depend on its stage:

• in the acute stage, the treatment prescribed for the expectant mother is similar to that shown in acute pyelonephritis. The goal of therapy is to eliminate foci of infection, relieve symptoms of the disease, and restore urine outflow.
• in the stage of remission, medical instructions relate to the prevention of recurrence of pyelonephritis and contain recommendations on the use of herbal remedies designed for a long course of use, physiotherapy, positional therapy and lifestyle.

Prevention of recurrence of the chronic form

Measures taken to prevent gestational pyelonephritis include:

• regular examinations of urine, blood of expectant mothers, for the early detection of pathogenic microorganisms, as well as the diagnosis of the disease itself at the initial stage;
• use of prophylactic doses drugs (antibiotics, as prescribed by a doctor, herbal preparations);
• enriching the diet with a sufficient amount of vegetables, fruits;
• observance of the drinking regime, including infusions, decoctions of diuretic herbal preparations permitted during pregnancy, renal teas;
• positional therapy;

Early and late pregnancy hospitalization

Referral to the hospital with gestational pyelonephritis is given by:

• in the acute form or exacerbation of the chronic form of the disease;
• if renal failure is detected;
• with added gestosis;
• if there is a threat of premature spontaneous abortion;
• if there is a medical indication for terminating pregnancy due to complications that are life-threatening to the mother;
• if there are medical indications for the use of surgical methods of treatment;
• if, according to the research results, a deterioration in the condition of the fetus is detected, etc.

In addition, expectant mothers with pyelonephritis are entitled to planned hospitalizations:

• in the first trimester of pregnancy - for examination by urologists and obtaining a prognosis for the further course of pregnancy against the background of pyelonephritis;
• at the beginning of the last trimester of pregnancy - a period of increased risk of exacerbations of pyelonephritis and gestational complications.

It is important that the expectant mother understands the seriousness of kidney disease and its possible consequences for the baby and does not neglect the passage of all kinds of studies required during pregnancy.

And in the case of a diagnosis of "gestational pyelonephritis" reasonably followed all the prescriptions of doctors. Only in this case there is a chance for a favorable outcome of pregnancy, childbirth for the mother herself and her baby.

A common problem for women during pregnancy is a violation of the outflow of urine. The growing uterus has a negative effect on the surrounding tissues. In particular, it compresses the ureters. Due to stagnant fluid, the risk of diseases of the organs of the excretory system increases.

REFERENCE! Pyelonephritis is an infectious and inflammatory process that affects the renal tissue. It can also spread to her pelvis and calyx.

Gestational pyelonephritis first occurs during gestation (at 22–28 weeks) or in the early postpartum period (at 2–5 days).

At this difficult time for a woman, the number of predisposing factors for the onset of kidney inflammation increases. This pathology is life-threatening for the mother and baby.

REFERENCE! In obstetrics, pyelonephritis during pregnancy is observed with a frequency of 3-10%, second in prevalence only to diseases of the cardiovascular system.

Kinds

Any pyelonephritis is classified according to the form of the course of the disease:

• Sharp. A vivid clinical picture. After complex therapy, complete recovery occurs.
• Chronic. Symptoms are blurry. Therefore, laboratory tests are of diagnostic value. Like any chronic disease, it cannot be completely cured. It is only possible to stop the attack and maintain the period of remission for a long time.

According to medical standards, pyelonephritis is additionally subdivided according to the source of infection:

• Primary. Appears without preconditions from other organs. Pathogenic flora most often enters the excretory system from the environment through the urethra.
• Secondary. It is formed against the background of the presence of a focus of inflammation in the body. The infection spreads by the hematogenous route and settles in the kidneys.

ICD code

According to the international classification of diseases compiled by the World Health Organization, gestational pyelonephritis falls into two categories:

• O23. Urogenital tract infection during pregnancy.
• O86. Other postpartum infections.

The reasons

Pyelonephritis occurs when there is inflammation in the gastrointestinal tract, genitals and distant foci of suppuration in the tissues (carbuncles, boils, carious teeth). The infection circulates in the blood and lymph vessels and spreads throughout the body.

It is also possible for its penetration into the urinary organs from the environment through the urethra.

Causative agents of the disease

Among the causative agents of pyelonephritis during pregnancy, bacteria occupy the leading place:

• Intestinal or Pseudomonas aeruginosa.
• Staphylococci.
• Proteus.
• Enterobacteriaceae.
• Klabsiella.
• Streptococci.
• Very rarely - non-clostridial anaerobes.

Fungi of the genus Candida can also cause a purulent process in the interstitial renal tissue.

Symptoms

Pyelonephritis during pregnancy usually occurs in the 2nd trimester (22–28 weeks).

In this case, the patient complains about:

• Feeling unwell: irritability, weakness (especially in the morning), general malaise, nausea.
• Sleep disturbance, headache.
• Increased blood pressure. This may be an indicator of hypertension or kidney disease.
• Increased body temperature, fever is possible.
• Chills.
• Difficulty and / or painful urination. There may be false urges.
• Swelling of the legs is considered normal due to venous congestion. If the face is puffy, you should consult a therapist for advice.
• Soreness in the lumbar region. With prolonged walking or prolonged stay on the legs, its intensity increases.

Complications

Obstetricians-gynecologists and neontologists are afraid of pyelonephritis. It is terrible for a woman and a fetus with its complications, which can lead to their death.

Suggested options for aggravating pyelonephritis during pregnancy:

• Activation of immunity and its aggressive effect on the baby.
• Premature birth. In 30% of mothers with this diagnosis, babies are born prematurely.
• Gestosis is a frequent manifestation of late toxicosis. The nature of edema, high blood pressure, flashing "flies" before the eyes.
• Anemia and, as a consequence, fetal hypoxia, which will lead to a deviation in its development (hypotrophy) or death.
• Bleeding.
• The spread of infection throughout the body.

IMPORTANT! Monitoring the condition of the unborn child is necessary from the first weeks after conception.

Risk factors and degrees

The predisposing phenomena for the onset of pyelonephritis in women during pregnancy include:

• Violation of the outflow of urine. By the end of the first trimester, the level of estradiol and progesterone in the blood increases. Hormonal changes can affect the muscle tone of the organs of the excretory system. The urine flow slows down. Stagnation creates favorable conditions for the growth of bacteria.
• The presence of chronic infectious diseases.
• Abnormalities in the structure of the organs of the urinary system.
• Violation of blood circulation in the kidneys.
• Refluxes are the reverse flow of urine into the overlying parts of the excretory tract.

There are additional features of pregnant women in which the doctor may suspect pyelonephritis:

• Narrow pelvis.
• Polyhydramnios.
• Large fruit.

Doctors identify three degrees of risk for this disease:

1. Pyelonephritis of pregnant women without complications.
2. One kidney is affected, characterized by the addition of hypertension (high blood pressure) or azotemia (an increase in the content of nitrogenous metabolic products in the blood).
3. Severe flow. The risk of sepsis or organ failure is high. Damage to both kidneys. Pregnancy is contraindicated.

Influence of pyelonephritis depending on the duration of pregnancy

First trimester	Late pregnancy	Danger to a woman	Fetal disorders
More severe course of the disease. Treatment is complicated. In early pregnancy, many medications are contraindicated.	Mother's anemia.	Premature birth.	Intrauterine infection.
Sharp unbearable lower back pain. Clinically confused with renal colic.	Fetal hypoxia.	Gestosis is a triad of symptoms: swelling, protein in the urine, and increased blood pressure.	Doom.
Forced posture "embryo" (curled up and pulling his legs to the stomach).	Spontaneous miscarriage.	Placental abruption.	Formation of malformations.
Spasm of the uterus. The risk of miscarriage is high.		Fetal hypoxia.
Strong intoxication.		Polyhydramnios.
Infection of the fetus is possible, which leads to deformities and malformations. To save life, women are forced to terminate their pregnancies.		Anemia.
		Renal failure
		Development of sepsis and toxic shock.

Consequences for the child

Pyelonephritis in the expectant mother affects not only her body, but also the baby:

• Miscarriage. Pain and infection stimulate the uterus. It begins to shrink, which can lead to premature birth. Such children are born weak or with disabilities.
• Fetal infection. Causative agents of inflammation, subject to their active growth and a decrease in the mother's immunity, can penetrate into amniotic fluid... Intrauterine infection ends with the death of the child or the formation of deformities in him. The pregnancy is terminated.
• Pyelonephritis causes the development of anemia and hypertension in a woman. Oxygen starvation of the fetus leads to its malnutrition. The baby dies from asphyxia or is born underdeveloped.
• Newborns of such mothers often suffer from pathologically prolonged jaundice, hypothermia, low weight and slow weight gain, as well as from lesions of the central nervous system.

Prevention of complications

With favorable resolution of pyelonephritis, the pathological infiltrate in the kidneys is absorbed or replaced by connective tissue. The consequence of this process is a decrease in the excretory function of the body.

With a complication of the disease, suppuration of the cortical layer and the capsule of the kidney occurs. Its parenchyma is compressed and necrotic (dies off). The failure of this organ during pregnancy threatens with miscarriage or death of the mother.

This can be avoided when registering and fulfilling doctors' appointments:

• The main recommendation is to go through all the procedures indicated by the doctor.
• Refuse traditional medicine and self-medication. Therapy is selected only by a specialist and on an individual basis.
• Compliance with the exact dosage of medicines.
• Change the diet according to the diet, maintain an adequate drinking regime.

• During pregnancy, urine tests are required 2 times a month.
• From 22 to 28 weeks, the control becomes more thorough. Urine should be taken weekly.
• Being under the supervision of a nephrologist.
• If a specialist insists on hospitalization, you should not refuse.

Diagnostics

The diagnosis is made based on the collected history, complaints and research results.

What the doctor pays attention to:

• Acute pyelonephritis has a vivid typical clinical picture. In the chronic form of the disease, the symptoms are less pronounced.
• Positive symptom of Pasternatsky. When tapping at the site of the projection of the kidneys on the lumbar region, pain appears. It indicates the presence of an inflammatory process in them.
• Laboratory and instrumental research methods.

Survey type.	What will they find?	What does it point to?
Urine analysis: general, according to Nechiporenko, according to Zimnitsky, bacteriological.	Leukocytes, erythrocytes, bacteria, protein. Salts: phosphates, urates, oxalates. Determine the type of pathogen, its sensitivity to antibiotics.	The presence of a focus of the inflammatory process.
Ultrasound of the kidneys.	Assess the state of the calyx-pelvis system.	Pathological changes in the excretory organs.
General blood analysis.	Increased ESR and leukocytosis.	Inflammation.
Fetal examination: ultrasound, cardiotocography, dopplerometry.	The doctor must necessarily monitor the state of the child's organs inside the womb during the detection and treatment of maternal pyelonephritis.

Differential diagnosis

Disease	Research method	The difference
Glomerulonephritis.	Rehberg's test (glomerular function is assessed).	An increase in filtration rate indicates glomerulonephritis. Decrease indicates renal failure.
Amyloidosis of the kidneys.	Urine tests, plain radiography of the abdominal organs.	There are no leukocytes and bacteria in the urine. The function of the nephrons is not impaired. On the roentgenogram, the kidneys are the same, normal or enlarged.
Hypertonic disease	Taking anamnesis, ultrasound, blood pressure measurement, excretory urography.	The absence of a history of previous inflammatory diseases of the excretory system (cystitis, urethritis, urolithiasis). Unstable increase in blood pressure, the effectiveness of antihypertensive drugs. Absence of pathologies in the results of urine tests. Ultrasound of the kidneys unchanged.
Diabetic glomerulosclerosis.	Examination, questioning, angiography of vessels of individual organs, urine analysis, X-ray of the abdominal cavity.	The presence of gestosis diabetes mellitus and its signs: damage to the vessels of the retina, lower extremities, polyneuritis, etc. Urinalysis results are within normal limits. The X-ray was normal.

Treatment

Prolonged inflammation of the kidney parenchyma leads to compression of its tubules. As a result, the function of the nephrons is disrupted - the excretion of urine is difficult.

Toxic substances that were normally excreted in urine remain in the body and damage the tissues of the mother and fetus. In order to avoid termination of pregnancy with pyelonephritis, complex and early treatment is required.

Fundamental principles of therapy:

1. Hospitalization of patients with exacerbation of the disease, manifestation of gestosis and deterioration of the baby's condition. In the hospital, patients are under constant supervision of medical personnel, which will help to avoid complications.
2. Increased urine flow. With stagnant urine, the load on the kidneys increases.
3. Elimination of edema.
4. Antibacterial therapy - the fight against pathogens.
5. Removal of microbial toxins from the body (albumin, protein).
6. Sanitation of the urinary tract.
7. Special diet.

• If drug therapy is ineffective, the ureter is catheterized to restore urine outflow.
• When an abscess or carbuncle of the kidney forms, doctors resort to surgical intervention.

Drug treatment

With an exacerbation of pyelonephritis, the doctor's tactics are aimed at restoring the outflow of urine, alleviating the condition and eliminating the cause of the disease, if possible.

Conservative treatment:

1. Antibacterial therapy.
2. Antimycotic (antifungal) drugs (nystatin, levorin).
3. Vitamins. Diet is preferred. Women during pregnancy are advised to include in their diet an increased amount of fruits, vegetables, cottage cheese, lean varieties of fish and meat.

IMPORTANT! When products are heat treated, the amount of nutrients in them decreases. Therefore, it is recommended to eat fruits and vegetables raw.

1. Nitrofurans (antimicrobial).
2. Antispasmodics (no-shpa, papaverine).
3. Desensitizing agents.
4. Detoxification therapy.
5. Uroantiseptics (nitroxoline, nevigramone).

IMPORTANT! This list of medications can be used to treat exacerbation of chronic pyelonephritis.

In the remission stage, the main goal of therapy is to prevent exacerbation and maintain the most comfortable state of the urinary system and the body as a whole.

Such treatment involves:

1. Compliance with a diet. Avoiding spicy and salty foods will reduce the incidence of thirst. Drinking acidic drinks is necessary to prevent the formation of stones in the excretory organs.
2. Antibacterial therapy.
3. Antispasmodics.
4. Diuretic herbal medicine.

The duration of the course is 10-14 days.

Antibiotics during pregnancy

The fight against the causative agent of pyelonephritis is the main goal of all treatment.

Initially, broad-spectrum drugs are prescribed.

After identifying the pathogen and its sensitivity to certain groups of antibiotics, drugs are prescribed that do not have an aggressive effect on the fetus:

• Semi-synthetic penicillins (Amoxiclav).
• Cephalosporins (Suprax, Cefazolin).

The choice of medication depends on the gestational age, the severity of pyelonephritis and its duration.

The course of treatment is at least 10 days.

IMPORTANT! During pregnancy, fluoroquinolones and sulfonamides should not be taken. Aminoglycosides are used only under one condition - a threat to the patient's life.

Folk remedies

It is worth giving up self-medication. Therapy is selected only by a specialist and on an individual basis. You should consult your doctor before using non-traditional home treatments.

Diuretic herbal remedies are more likely to belong to traditional medicine, which is only an adjunct to drug therapy.

Pregnancy is a special condition of a woman's body. During this period, there are a number of restrictions. With herbal medicine, you need to know the list of plants prohibited for expectant mothers:

• Bearberry.
• Juniper fruits.
• Parsley root and seeds.
• Yarrow.
• Licorice.

A sufficient volume of water should be taken per day - about 1.5–2 liters per day in the absence of edema.

The listed funds can be used as a treatment and for preventive purposes.

Phytotherapy

The most famous herbal diuretic drug is Kanefron. Its use is permissible during pregnancy.

The composition of the combined remedy includes: centaury herb, medicinal lovage root, rosemary leaves.

It has the following pharmacological actions:

• Diuretic. The diuretic effect relieves swelling.
• Anti-inflammatory.
• Spasmolytic. Expansion of blood vessels helps to lower blood pressure.
• Antimicrobial. The main goal of any treatment is to destroy the causative agent of pyelonephritis.

Side effects: allergic reaction to drug components, dyspeptic disorders (nausea, possible vomiting, diarrhea).

IMPORTANT! Reception of Kanefron during childbearing and during breastfeeding is permissible only after consulting a doctor, subject to his recommendations for dosage.

Diet

• Pastries made from pastry or puff pastry (including bread).
• Soups based on meat, fish and bean broths.
• Any canned food and smoked products.
• Sausages.
• Fatty types of cheeses.
• Sweet (especially cream cakes).
• Fatty fish and meat.
• Salty food and drinks (including mineral waters).
• Caffeinated products.
• Hot seasonings.
• Mayonnaise and ketchup.
• Alcohol.

The amount of fluid consumed is limited to 800–1000 ml per day.

What you can eat:

• Vegetarian-based soups.
• Low-fat dairy products.
• Lean meat and fish.
• Eggs. No more than 2 per week.
• Oil.
• Any cereals.
• Durum wheat pasta.
• Vegetables and fruits raw, boiled or baked.
• Sausages: dairy or dietary. Unsalted low-fat ham is allowed.
• Mild spices: parsley, dill, bay leaf, cinnamon.
• The emphasis is on a plentiful sour drink (various unsweetened fruit drinks).

IMPORTANT! Before drawing up a diet, a doctor's consultation is required!

Prevention

To prevent the development of pyelonephritis, the expectant mother needs to change her lifestyle.

To do this, it is enough to include several mandatory items in the daily routine:

1. Moderate physical activity. Hiking every morning and evening can improve your mood and overall well-being.
2. A set of exercises for pregnant women. IN modern world there are special gymnastics programs for expectant mothers. Classes are held in groups in sports centers. The exercises are aimed at strengthening the muscles of the back and legs. Additionally, the blood supply to all organs improves and the skin tone rises.

REFERENCE! A doctor's consultation is required before choosing an exercise program!

If a woman had a history of urological diseases before becoming pregnant, it is strongly recommended to adhere to a special diet from the first trimester that reduces the load on the kidneys.

IMPORTANT! Registration is required! For a more favorable prognosis, it is worth planning a child in consultation with doctors. Even if the pregnancy is repeated!

2.When urging to urinate should not be tolerated! Empty the bladder every 3-4 hours.

3. The expectant mother should avoid hypothermia to prevent urogenital diseases.

Questions From Readers

Women with diagnosed pyelonephritis begin to panic and fear for the child's life. The following are frequently asked questions from patients on this topic.

If one kidney is affected, more careful monitoring of the state of the excretory system of the mother and the development of the baby is required. In this case, there are no contraindications for pregnancy.

If you have kidney failure, it is better to postpone planning for a child and consult your doctor.

If pyelonephritis is bilateral, pregnancy is contraindicated.

Childbirth with pyelonephritis

In the first 24 weeks with gestosis, hospitalization in the urology department is allowed. At a later date - only to the maternity hospital.

With pyelonephritis, childbirth takes place naturally.

Cesarean section produced rarely and only for strict obstetric or gynecological indications.

IMPORTANT! A child born to a mother suffering from pyelonephritis is at risk, since such babies often have a predisposition to the occurrence of purulent-septic diseases!

On the way from a positive pregnancy test to the delivery room, the expectant mother lies in wait for many pitfalls and obstacles. One of them is pyelonephritis of pregnancy, also known as gestational pyelonephritis. Today we will talk about the features of the course of pyelonephritis during pregnancy, as well as the causes, symptoms and methods of treatment of this disease.

Why does pyelonephritis occur during pregnancy

Pyelonephritis is an infectious kidney disease, and the inflammatory process can be caused not only by microorganisms that have entered the internal organs from the external environment, but also by bacteria that are permanent residents of the human body.

Typically, the causative agents of pyelonephritis are:

• Staphylococci;
• Enterococci;
• E. coli;
• Proteus;
• Pseudomonas aeruginosa.

As a rule, pathogens enter the kidneys by a hematogenous route from foci of infection already existing in the body. Pyelonephritis during pregnancy is extremely rare as a result of infection through the urinary tract (urethra, bladder). At the same time, there are a number of factors that contribute to the development of this ailment in expectant mothers:

1. A change in the hormonal background in a woman's body begins from the moment of conception, and by 8-12 weeks of gestation, the tone of the ureters decreases, and their length and width increase as a result of the action of progesterone and other hormones. The consequence of this process is urinary stagnation and an increased risk of infection. In women who have encountered this problem before, against the background of such stagnation, an exacerbation of chronic pyelonephritis may occur during pregnancy;
2. The larger the uterus becomes, the more it compresses the urinary tract. This is especially acute in the case of an anatomically narrow pelvis in a pregnant woman, multiple pregnancy or too large a fruit;
3. Hormonal changes lead to the expansion of the ovarian veins, they begin to squeeze the ureter. because of anatomical features the structure of internal organs, the right kidney most often suffers from such compression. The outflow of urine is disturbed, the renal pelvis is stretched up to hydronephrosis. All this together contributes to the occurrence of pyelonephritis during pregnancy;
4. Estrogens, actively produced by the placenta, contribute to the development of pathogenic flora, in particular E. coli.

Symptoms of pyelonephritis in pregnant women

In the case of an acute form of the disease, suspect pyelonephritis future mother may for the following symptoms:

• Sharp or dull pain in the lumbar region, aggravated by bending forward;
• Discoloration of urine. It acquires a reddish tint, a strong unpleasant odor and becomes cloudy;
• Increase in body temperature up to 38-40 ° C;
• Nausea, in some cases vomiting;
• Chills;
• Decreased appetite;
• General weakness.

Chronic pyelonephritis during pregnancy for a long time can proceed without severe symptoms. The latent form, as a rule, is accompanied by a slight increase in body temperature, while recurrent chronic pyelonephritis is manifested by general symptoms (fever, weakness, back pain).

Features of the treatment of pyelonephritis during pregnancy

The first and main task of physicians in such a situation is to restore the outflow of urine from the pelvis. This can be done by relieving the pressure of the uterus on the kidneys and ureters. For this purpose, positional therapy is used. It is undesirable for a woman to sleep on her back, the best option is on her left side. During the day, you should repeatedly take the knee-elbow position and stay in this position for 5 to 15 minutes - this allows you to improve the outflow of urine.

When the outflow of urine is restored or not disturbed, the treatment of pyelonephritis during pregnancy is carried out with antibiotics, herbal remedies, antispasmodics and other necessary drugs. Therapy is prescribed by a doctor on an individual basis.

So, with the onset of cystitis, it is usually possible to do with phytotherapy (collection of kidney herbs, kidney tea, a decoction of wild rose or lingonberry leaf). In the first trimester, when the formation of the placenta has not yet been completed, antibiotics are prescribed in exceptional cases. For the treatment of acute pyelonephritis during pregnancy, antibiotics of the penicillin group, aminoglycosides, cephalosporins and macrolides can be used. Expectant mothers are strictly prohibited from taking tetracyclines and streptomycins. The selection of the drug occurs after determining the category of the pathogen and its sensitivity to certain antibiotics. The course of treatment is supplemented with sedative tinctures of valerian or motherwort, as well as vitamins PP, B and C in order to prevent miscarriage.

As for the chronic form of pyelonephritis during pregnancy, treatment is usually transferred to the postpartum period, however, the patient's condition is monitored more closely (blood and urine tests are prescribed more often than healthy pregnant women).

Consequences of pyelonephritis during pregnancy and its effect on the fetus

Expectant mothers faced with the inflammatory process of the kidneys are concerned about the question: is pyelonephritis dangerous during pregnancy? Of course, if you let the disease take its course and do not go to the doctor, the likelihood of an unfavorable outcome is quite high. The inflammation can go deeper into the tissues, which threatens with glomerulonephritis, which can ultimately result in renal failure. In rare cases, phlegmon or kidney abscess may develop. Despite the fact that this complication is relatively rare, no one wants to get into the sad statistics.

All this concerns the health of the woman herself, but it is necessary to understand that the child will suffer primarily from the disease. Often the consequence of pyelonephritis during pregnancy is intrauterine infection of the fetus. It also happens that kidney inflammation leads to premature onset of labor and spontaneous abortion.

In newborns, the consequences of intrauterine infection can be different. While some children develop normal conjunctivitis, which does not pose a danger to life, others are born with severe infectious lesions of vital organs.

Sometimes pyelonephritis during pregnancy leads to intrauterine hypoxia, as a result of which the fetus receives less oxygen than necessary. In this case, children are delayed in development, are born with low birth weight.

Prevention of pyelonephritis in pregnant women

First of all, pyelonephritis occurs in people with weakened immunity. And since all pregnant women have a decrease in immunity (otherwise, bearing a fetus that is genetically foreign to female bodywould be impossible), the conclusion is simple: be attentive to yourself. To avoid pyelonephritis during pregnancy, try to dress warmly, avoid hypothermia, exclude fried foods, pickles and smoked meats from the menu, drink more liquid, observe the rules of personal hygiene, and most importantly, do not forget to visit the toilet every 3-4 hours.

Happy pregnancy and easy delivery!

Text: Inga Stativka

4.79 4.8 out of 5 (24 votes)

Approximately 6 to 12% of pregnant women experience an inflammatory process in the kidneys called pyelonephritis. It is believed that it is pregnancy that provokes this disease. Pyelonephritis during pregnancy is dangerous not only for the expectant mother, but also for the baby. In order to prevent complications, it is important to diagnose the disease in time and begin the necessary treatment.

Signs of pyelonephritis

Pyelonephritis during pregnancy, which should be treated immediately, is an inflammation of the renal pelvis. Various microorganisms are capable of provoking it, which begin to multiply actively when obstructed outflow of urine. The focus of infection can be a process of a purulent-inflammatory nature developing in a woman's body.

Distinguish between primary and secondary pyelonephritis.

1. They say about the primary when the exacerbation of pyelonephritis during pregnancy occurred for the first time and used to be a woman never faced this problem;
2. Secondary is an ailment that bothered the patient even before conception, but, against the background of pregnancy, its aggravation occurred.

The main symptoms of the disease include:

• increased body temperature;
• chills;
• painful urination;
• pain in the lumbar region (for what reasons the pain in this area may bother you, read the article Right side hurts during pregnancy \u003e\u003e\u003e);
• headache (related article: Headache during pregnancy \u003e\u003e\u003e);
• in rare cases, nausea and vomiting appear (sometimes, vomiting and nausea accompany a woman at the beginning of pregnancy, what to do in this case, learn from the article Nausea during pregnancy \u003e\u003e\u003e).

Causes of pyelonephritis during pregnancy

1. Why is pregnancy one of the main factors provoking the onset of the disease? The fact is that with the growth of the uterus, it begins to put pressure on the surrounding organs and on the kidneys as well. Thus, it can happen in them violation of the outflow of urine;
2. Pyelonephritis in early pregnancy can occur due to a sharp natural decrease in immunity during this period;
3. In addition, a change in the hormonal balance in pregnant women can lead to various disruptions in the work of the female body.

Gestational pyelonephritis - what is it?

Pregnant women are often diagnosed with gestational pyelonephritis. He can hit the expectant mother in any trimester. In an acute course, the disease manifests itself as intoxication of the entire woman's body. The predisposing factors that can lead to its development include:

• hypothermia;
• hereditary ailments of the kidneys and urinary system;
• cystitis or pyelonephritis, which were observed before pregnancy (read the article on the topic: Cystitis in early pregnancy \u003e\u003e\u003e);
• diabetes;
• bacteriuria during pregnancy.

Gestational pyelonephritis during pregnancy is manifested by the following symptoms:

1. body temperature over 38 degrees;
2. pain in the lumbar region that increases after prolonged standing or walking;
3. increased blood pressure;
4. increased urination;
5. change in the amount and color of urine.

A clinical analysis of urine, in which the content of protein, leukocytes and bacteria will be exceeded, helps to diagnose the disease. Based on this, as a rule, the diagnosis of pyelonephritis during pregnancy is made. The doctor will tell you what to do to cure the disease.

After bacterial culture of urine, it is possible to determine the type of pathogen and to which drug it is sensitive. Later, these medicines will be used for treatment. In addition, your doctor will prescribe an ultrasound and Doppler ultrasound scan to determine the condition of the fetus.

Having learned about the need to use antibiotics, you are worried if it will harm your baby?

Know! Studies have shown that after the 20th week of pregnancy, when the disease most often occurs, the placenta is already sufficiently formed and can protect the fetus from the action of antibacterial drugs.

In addition, the harm to the baby from their use will be much lower than what gestational pyelonephritis can cause him.

With proper and timely treatment, the risk of premature birth is sharply reduced - from 50% to 5% - and the risks of possible disorders in the child also decrease. Therefore, the disease requires mandatory treatment, otherwise pyelonephritis during pregnancy can cause the following consequences for the child and mother:

• hypothermia;
• hypotrophy;
• intrauterine infection and damage to the nervous system of the fetus;
• premature birth;
• the birth of a baby with a low weight;
• placental abruption.

Treatment of pyelonephritis during pregnancy

How to treat pyelonephritis during pregnancy, only a doctor can say. Self-medication in this case can only aggravate the woman's condition and harm the child. Antibacterial drugs allowed during this period include:

1. Ampicillin;
2. Cephalosporins;
3. Oxacillin;
4. Gentamicin.

Important! Treatment should be carried out in an inpatient setting under medical supervision.

• Regardless of the degree of the disease, the patient is prescribed antispasmodics and pain relievers. In some cases, acupuncture helps to refuse them;
• To relieve pressure on the ureters and allow urine to flow out, the woman is advised to sleep on her side, avoiding supine position;
• Throughout the day, doctors advise to get into a knee-elbow position and stay in it for up to 10 minutes. If such methods do not lead to an improvement in the condition of the expectant mother, then she may be assigned to catheterization of the ureter or drainage of urine from the damaged kidney;
• If the disease is accompanied by suppuration, then it is necessary to remove the fibrous capsule or even the diseased organ;
• If the disease is very advanced, the doctor may decide on the need for artificial termination of pregnancy;
• General strengthening therapy includes taking sedatives and vitamin-mineral complexes;
• Compliance with a special diet and drinking regimen is very important. The diet consists in the complete exclusion of fatty, fried, salty, spicy, smoked, various seasonings from the diet (and about which diet will be useful for any mother during pregnancy, learn from the article Secrets of proper nutrition for a future mother \u003e\u003e\u003e);
• If the pregnant woman does not have edema, and her blood pressure is within normal limits, then she is recommended to drink 2-3 liters of liquid every day. Non-carbonated water, cranberry or berry juice, dried fruit compote, jelly are suitable for this. But coffee and strong tea for the period of treatment must be completely abandoned;
• Also, various diuretic teas are not recommended for pregnant women, especially if they contain licorice and bearberry (for more information about taking herbs, see the article Herbal tea during pregnancy \u003e\u003e\u003e). But a decoction of oats can be a real find. It relieves inflammation and, at the same time, does not affect the tone of the uterus.

To prepare it, you need to pour 1 glass of cereal with 1 liter of cold water and boil for 2 hours. After the broth has completely cooled down, strain it and drink 0.5 cups before meals.

Prevention of pyelonephritis during pregnancy

To prevent pyelonephritis from bothering the expectant mother, she must follow the preventive rules, which include:

1. Moderate physical activity. Every day you need to walk in the fresh air for at least 1 hour;
2. Special gymnastics classes. You can find courses for pregnant women today in almost every fitness center. Through physical exercise, you can strengthen the back muscles, improve the tone of internal organs and, thereby, prevent inflammatory processes in the kidneys;
3. If a woman had already suffered from kidney diseases before pregnancy, then, already with early datesshe needs to follow a diet that promotes the outflow of urine;
4. The need to comply with the drinking regime;
5. Emptying the bladder at least every 3-4 hours.

Only by being attentive to her health and observing the prevention of pyelonephritis, a pregnant woman can prevent the development of the disease. But, if, nevertheless, his symptoms appeared, it is necessary to visit a doctor as soon as possible and take the necessary measures to eliminate the pathology.