Acute Pyelonephritis in Pregnant Women: Features of Treatment

Introduction. The prevalence of acute pyelonephritis (AP) in pregnant women varies from 3% to 18%. There is an increase in the AP incidence in pregnant women over the past two decades with the growth of purulent-destructive forms incidence. Currently, there is no unity of views on the issues of therapeutic tactics in pregnant women according to the literature data. Besides, there are no clear criteria for the timing and choice of the method of upper urinary tract (UUT) drainage. This circumstance determines the relevance of the study of the effectiveness of minimally invasive methods of AP treatment and UUT obstructive lesions in pregnant women.

Purpose of the study. To study the effectiveness of minimally invasive methods of AP treatment in pregnant women.

Materials and methods. The results of AP treatment and various UUT obstructive lesions in 293 pregnant women from 2013 to 2018 years were analyzed. Patients` age: from 15 to 42 years (mean is 25 years). At the same time, 237 (81%) patients were in the second and third trimesters of pregnancy. Urodynamic disorders were resolved in 123 (42%) patients with stenting, ureter catheterization, and percutaneous nephrostomy (PNS). In 28 (9.5%) cases, UUT obstruction was caused by kidney stones, in 7 (2.4%) cases contact ureterolithotripsy (CULT) was performed on this occasion.

Results. In 16 (5.4%) patients developed complications, such as sepsis and septic shock. Purulent-destructive AP forms were observed in 8 (2.7%) pregnant women. AP was stopped in all patients against the background of the restored urine passage and ongoing conservative therapy. The need for lumbotomy, kidney`s decapsulation, carbuncles` excision, nephrectomy did not arise in any case. Eventually, 221 (75%) pregnant women had timely deliveries. Preterm birth was observed in 52 (17%) pregnant women. Maternal mortality has not been reported. Antenatal fetal death was detected in 2 (0.6%) cases within 1-2 months after discharge from the urological division.

Conclusion. Timely conservative managment of AP in pregnant women with adequately restored of urine passage allows to minimize severe septic complications and avoid traumatic open surgical interventions.

The study did not have sponsorship. The authors have declared no conflicts of interest.

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