- 1 Why the disease occurs in pregnant women
- 1.1 Who is at risk
- 2 Classification chart
- 3 How to suspect an ailment: symptoms of pyelonephritis in pregnant women
- 3.1 Acute forms
- 3.2 Chronic course
- 4 How to confirm the diagnosis
- 5 Features of treatment
- 5.1 GeneralRecommendations for accelerating recovery
- 5.2 Medications
- 5.3 Phytotherapy
- 5.4 Surgical methods
- 6 Possible complications in women and the skinand
- 7 How to prevent disease
Factors associated with pregnancy, contribute to the fact that pyelonephritis in women can be caused even by opportunistic bacteria, that is, those that normally do not cause infection. But most often inflammation of the kidneys cause intestinal and pseudomonas aeruginosa, enterococci or staphylococci.
Why the disease occurs in pregnant women
Pregnancy is a time of change for the
- Physiological reduction of immunity. A similar state develops so that there is no rejection of a woman's embryo, which is half-alien to a woman. The reverse side of this is an increase in the likelihood of infectious diseases.
- Discharge of urine outflow. With increasing gestation period, the growing uterus squeezes the organs of the small pelvis and retroperitoneal space. This prevents a normal outflow of urine, which provides favorable conditions for the reproduction of bacteria. Normally there is a constant "flushing" of pathogens, which to some extent reduces the risk of exacerbation of the disease.
- Subcooling. In this case, there is a local decrease in immunity and activation of opportunistic pathogens.
- Malformations of the urinary system. Kidney, ureter, bladder. Injury and surgery in these organs. During pregnancy, there is aggravation of any conditions that can change the normal outflow of urine. This provokes the multiplication of bacteria and the onset of inflammation.
- Sexual infections. The short and wide urethra in women predisposes to an upward urinary tract infection. Untimely treatment of UTI( urinary tract infection) can lead to pyelonephritis.
- Presence of foci of chronic infection in the body. It is believed that even carious teeth can provoke pyelonephritis.
Who is at risk
When registering for each woman in the position, the probability of developing infectious complications is determined. Pyelonephritis during pregnancy threatens the following girls:
- with chronic pyelonephritis - even if for many years there have been no exacerbations of pathology;
- with frequent episodes of cystitis, urethritis - that is, with exacerbations of diseases of the lower parts of the urinary system;
- in the presence of latent sexual infection - for example, chlamydia, ureaplasmosis, cytomegalovirus infection;
- in the pathology of the development of the urinary system s - including only one kidney or organ transplanted;
- for diseases of the vessels - first of all, it is the defeat of the arteries in diabetes mellitus, atherosclerosis, arterial hypertension;
- for metabolic disorders - excessive body weight or endocrine diseases;
- foci of chronic infection in the body - tonsillitis, caries, cholecystitis, endometritis.
Depending on the clinical picture, prescription of the disease and other factors, different forms of gestational pyelonephritis are isolated.
Table - Classification of pregnant women's pyelonephritis
|By the number of exacerbations||Acute pyelonephritis||- A single episode of the disease completely past after treatment|
|Chronic||- The inflammatory process lasts longer than 6 months or during this period 3 or more occurredExacerbations|
|By the number of involved kidneys||Single-sided||- One kidney|
|is damaged Two-way||- Signs of kidney damage from both sides|
|By the mechanism of infection||Ascending||- The disease was caused by the penetration of infection from the urethra and bladder|
|Descending||- Infectious agent hit with blood|
|By the nature of inflammation||Serous||- Accompanied by non-pulmonary discharge in the pelvis, cups and kidney substance|
|Purulent||- Characterized by pus accumulation in kidney structures and severe|
How to suspect ailment: symptoms of pyelonephritis in pregnant women
The clinical picture of acute disease and exacerbation of pyelonephritis most often does not cause difficulties for diagnosis, in contrast to the chronic course of the disease.
Acute forms of
During pregnancy, young girls have to face mostly acute forms during pregnancy. Symptoms of the disease in this case in early terms do not differ from those in the later. The main manifestations include the following:
- pain and discomfort in the lumbar region;
- increase in body temperature to 38-39 ° C;
- symptoms of intoxication;
In chronic pyelonephritis, without exacerbation a woman can feel good. But this is not a proof of the normal functioning of the kidneys. If the function is violated, one another can perform compensatory filtration of the blood.
About severe changes in the kidneys with chronic pyelonephritis will be indicated by the following symptoms:
- increase in pressure, poorly amenable to correction by drugs;
- appearance of swelling, which does not pass after rest;
- chronic decrease in hemoglobin of blood.
How to confirm the diagnosis of
Diagnosis of the disease includes a thorough laboratory examination of urine, as well as instrumental determination of kidney function. The following tests are necessary to confirm the diagnosis and the choice of treatment.
- General analysis of urine. It increases the number of leukocytes, protein, cylinders( specific inclusions of the cylindrical form).Urine becomes a cloudy shade due to the accumulation of bacteria and epithelium.
- Urine examination by Nechiporenko. Determines the number of white blood cells in a portion of urine.
- Urine analysis for Zimnitskiy. Helps to find out whether there is a disruption in kidney function, whether urine is sufficient to excrete, and whether there is a delay in fluid in the body.
- Bacteriological seeding. Only the result that urine for analysis was taken before the start of antibiotic therapy can be considered reliable. In this exact definition of the pathogen allows you to select the most suitable antibiotics for your mother and baby and makes the treatment of pyelonephritis during pregnancy as effective as possible.
For differential diagnosis, ultrasound is performed on the kidneys. As in the early and later terms, it is absolutely harmless for the baby. In this case, one can detect edema of the organ and surrounding fatty tissue. If there are secondary changes in the kidneys( wrinkling or bloating of the pelvis), this will also be seen with ultrasound.
Features of treatment
In most cases, the conservative treatment of pyelonephritis in pregnant women is a sufficient measure for the recovery of a woman and the prevention of intrauterine infection of the baby.
General recommendations for accelerating the recovery of
In addition to the basic treatment, it is necessary to follow the recommendations for lifestyle and nutrition in order to accelerate recovery. They will be as follows.
- Observe the drinking regime. If there is a lack of fluid, intravenous infusions of medicinal solutions are performed.
- Sleeping on a healthy side. This is important in order not to disturb the outflow of urine.
- Do the exercises. Several times a day, it is necessary to occupy the knee-elbow position for 10-15 minutes. Such an exercise is especially useful starting from the 2nd trimester, when the uterus squeezes the urinary tract.
- Use a diet with a minimum of salt. Otherwise, its excess will provoke fluid retention in the body and aggravate the disease.
Drug treatment has two directions:
- aimed at destroying the infection;
- therapy for the preservation of pregnancy with signs of the threat of its interruption.
Drug therapy can be carried out both at home and in the hospital. This depends on the duration of the disease, the severity of pyelonephritis and the presence of other diseases. The following groups of medicines are usually used.
- Antibiotics. These are the most important medicines for the patient. Preparations are selected taking into account the identified pathogens and features of the woman's body. All of them should be safe for the baby. Most often used are "Amoxicillin", "Ampicillin" and their forms, protected from bacterial resistance: "Amoclav", "Amoxiclav".With intolerance to penicillin and its derivatives, antibiotics of the cephalosporin series are prescribed: Cefepime, Ceftriaxone, Cefazolin.
- Spasmolytic and analgesic agents. Used to remove discomfort. Starting with the first trimester, it is allowed to use "No-shpu" and "Papaverin".
Along with medicines, it is also effective to use folk remedies for the treatment of pyelonephritis. Basically, these are fees for making teas, infusions, decoctions, fruit drinks. You can use the following plants:
- rose hips;
Surgical treatment during pregnancy is used in extreme cases, when the consequences for the child in the absence of such treatment exceed the risks of the operation itself. The following surgical options are possible:
- opening and drainage of renal abscesses;
- stent placement in case of urine outflow.
Possible complications in woman and fetus
Complications can occur both from the side of the kidneys in the woman, and in the developing baby. To prevent them it is possible only at competent treatment in time of the found out deviations.
Consequences for the woman:
- purulent-necrotic processes in the kidney;
- inflammation of the adrenal gland;
- arterial hypertension( eclampsia);
- Bacteriotoxic shock:
- renal failure;
In addition, after suffering pyelonephritis, the risk of gestosis( the so-called "late toxicosis") increases in the 3rd trimester of pregnancy. Sometimes in these cases, pyelonephritis is called "gestosis".
How to prevent disease
Prophylaxis of pyelonephritis helps to prevent the occurrence of disease. This will save mom and baby from not always using safe medications and terrible complications of the disease itself. Basics of prevention are as follows:
- to avoid hypothermia;
- with frequent infections to drink courses from phytopreparations during the entire period of gestation;
- regularly give a general urine test and for Nechiporenko( with chronic pyelonephritis);
- comply with the drinking regime - at least 1.5 liters of clean drinking water per day.
Pyelonephritis in pregnant women is a common pathology in the presence of a chronic infection in the urinary tract. During the entire period of gestation, it is necessary to prevent disease at risk groups. You should regularly take urine tests, as well as undergo an extended examination if you suspect a pathology. This will help in a timely manner to identify and cure ailment.