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:

1. If pyelonephritis, cystitis, or renal failure have been observed in a woman previously.
2. Infection of urological organs with pathological microorganisms, which cause inflammation.
3. Hypothermia, weakened immunity of the pregnant woman.
4. 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 especially 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:

1. General and biochemical blood test - the level of leukocytes with pyelonephritis increases significantly, and hemoglobin decreases.
2. 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.
3. General urine test - taken to identify protein and leukocytes in the urine.
4. 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.
5. 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:

1. 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.
2. 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.
3. 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 cases 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:

1. 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.
2. 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.
3. Empty your bladder at least every 3-4 hours, preventing harmful microorganisms from multiplying.
4. When planning a pregnancy, be sure to undergo a kidney examination for chronic pyelonephritis and treat existing diseases of the genitourinary system.
5. Pregnant women should not be overcooled, get cold feet and backs, and dress inappropriately for the weather.
6. 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.

A common cause of inflammatory processes in the genitourinary system is pregnancy. Infectious and inflammatory processes develop in all segments of the urinary system, that is, in the bladder, ureters and kidneys. According to statistics, pyelonephritis in pregnant women ranks first among diseases of the urinary system. It is provoked by urinary stasis due to fetal growth. The pregnant uterus puts pressure on the kidneys and ureters, thus preventing the flow of urine.

In stagnant urine, microbes, bacteria and fungal flora, even conditionally pathogenic, quickly develop. Pyelonephritis worsens in the second trimester and can aggravate the further development of the fetus and cause irreparable damage to the health of the mother. Therefore, treatment of pyelonephritis during pregnancy is a serious task for gynecologists and nephrologists in order to save the lives of both: the child and the mother.

The hormonal background in pregnant women undergoes a transformation from the moment of fertilization of a mature egg. Within 8-13 weeks (second trimester), some changes in the parameters of the genitourinary system occur in the body of a pregnant woman under the influence of progesterone.

This hormone provokes a decrease in muscle tone of the ureters and bladder. The growing uterus puts pressure on the kidneys, the biological fluid of the body stagnates, and as a result there is a high risk of microbial infection. Most often, the right kidney suffers, this is explained by the anatomical feature of its location.

Urine stasis leads to expansion of the cups and pelvis. If the fetus is large or twins are observed, then the pathology can develop into hydronephrosis. In the second trimester, there is a risk of gestational pyelonephritis during pregnancy. Toxicosis can aggravate the pathology and complicate the course of pregnancy.

During this period, there is a risk of miscarriage and stillbirth. After suffering from pyelonephritis, patients give birth to children with hypoxia and various infections, as well as with a reduced immune system.

Symptoms of the disease

The symptoms of an infectious-inflammatory process in the kidneys during pregnancy are no different from the symptomatic picture of patients in the normal position. But the symptoms of pyelonephritis during pregnancy can be confused with toxicosis, so diagnostic tests need to be carried out to confirm the diagnosis.

Symptoms of the pathology are as follows:

• fever and chills (low-grade fever, increases at night);
• migraine;
• loss of appetite, nausea and gag reflex;
• pain syndrome;
• localization of pain in the lower back or only the area of ​​the diseased kidney (bilateral pyelonephritis is characterized by bilateral pain, and unilateral pyelonephritis is characterized by only one side where the diseased kidney is localized);
• increased pain during a deep breath, strong cough, as well as when resting at night in a certain position (lying on your back, on your side).

Important! The chronic form of kidney inflammation or chronic pyelonephritis during pregnancy manifests itself weakly, and sometimes without any signs, therefore, with the slightest complications, it can lead to irreversible processes, including death of the mother and fetus. If symptoms such as headache, lumbar pain, weakness and impaired diuresis are detected, immediately be examined by a nephrologist.

The symptoms of an infectious-inflammatory reaction of the kidneys in pregnant women are very similar to the signs of a miscarriage, so the pregnant woman should be consulted by a gynecologist and nephrologist.

Pyelonephritis manifests itself in different periods of pregnancy in completely different ways:

• in the early stages, the lower back and lower abdomen hurt;
• in the second half of pregnancy, the pain intensifies, plus the above symptoms appear.

In some cases, pyelonephritis is detected during random laboratory or instrumental studies. The attending physician will prescribe an individual list of therapeutic drugs under inpatient supervision with regular laboratory tests.

Treatment regimen for gestational pyelonephritis

Pyelonephritis in pregnant women should be treated according to a specific scheme, which consists of several points: body position, herbal medicine and drug treatment.

Choosing the right position

This treatment option is based on relieving compression of the ureters and freeing the urinary tract for the free passage of urine. Sleeping or lying on your back is strictly prohibited. The most optimal position is the left side. The knee-elbow position during pregnancy and in the presence of a diagnosis of pyelonephritis is a lifeline.

This pose relieves the ureters, bladder, and kidneys from constant pressure. Urine is released freely, removing all toxins from the body. You need to be in this position several times a day, up to about 15 times for 15 minutes, during which time the kidneys will have time to work normally and there will be no stasis in them.

Adjusting your drinking regime

If there is no significant swelling or high blood pressure, it is preferable to increase the fluid intake to 2-3 liters per day. Non-carbonated drinking water, juices, compotes and fruit drinks are recommended.

Strong tea and coffee are not allowed for pregnant women diagnosed with chronic or acute pyelonephritis.

Herbal treatment (herbal medicine)

Herbal infusions or teas have a diuretic effect, but not all herbs are suitable during pregnancy, or rather, there is a list of contraindications, namely: bearberry, yarrow, parsley, licorice, juniper fruits.

The list of acceptable herbal-based products includes: cranberries and lingonberries (fruit drinks from berries), nettle, birch buds.

A decoction of oats has a healing effect. Oats increase the hypertonicity of the ureters, it does not affect the contractile function of the uterus, has an anti-inflammatory effect and improves the functioning of the gastrointestinal tract. As a raw material for preparation, take 200 g of cereal per 1 liter of water, cook over low heat for about 2 hours. Drink 50 ml three times a day before meals.

Among herbal preparations, you can take Canephron. It contains centaury, lovage and rosemary, this is an ideal combination to eliminate kidney inflammation during pregnancy.

Drug therapy

In the early stages, it is not recommended to carry out drug therapy, since the placental protection (barrier function) does not work and all medications reach the embryo, disrupting its formation. Medicines can provoke abnormalities in the development of organs and systems. At this time, herbal treatment is recommended for pregnant women.

In case of poor tests with pain, fever and general malaise, you will have to take antibacterial drugs in the form of Amoxicillin or Amoxiclav, otherwise the pathology can lead to complications including sepsis and miscarriage.

In the second trimester of pregnancy, antibacterial and antimicrobial agents, such as cephalosporins (I and III generations), are recommended. These include the antibiotics Ceftriaxone or Cefazolin, as well as Furadonin. After 34-36 weeks, they are taken for 7-10 days.

Macrolides (Josamycin, Sumamed, Erythromycin) are widely used without harming the health of the fetus and mother. This group eliminates almost all types of microbial flora. Nitroxoline or 5-NOK is the most important drug; it is prescribed at 4-5 months of pregnancy in the phase of acute kidney inflammation, cystitis and inflammation of the ureters.

Important! Concerning Gentamicin, Lincomycin, Levomycitin, as well as Tetracycline and Biseptol– these drugs are included in the group of prohibited drugs for pyelonephritis in pregnant women.

Infectious and inflammatory pathology of the kidneys and urinary tract of pregnant women occupies the main place among diseases in this period. It is recommended that all women be observed by a nephrologist and constantly be examined to exclude complications during pregnancy, childbirth and the postpartum period.

Video: Pregnancy and kidneys: urine tests during pregnancy

Pyelonephritis - inflammation of the kidney structures (pelvis, calyces, parts of the tubular apparatus) - can be acute or chronic. The acute form most often occurs in girls, as a complication of childhood infections, sore throat. Due to unclear or hidden symptoms, it can be missed and unnoticeably become chronic.

Chronic pyelonephritis during pregnancy presents great difficulties. If before the disease was dangerous only for the woman, now it harms the health of the unborn child.

Statistics indicate that kidney inflammation is detected in every tenth pregnant woman (according to other authors - in 5%). Applying the most optimal treatment without affecting the fetus is a serious task that requires a joint decision by obstetricians-gynecologists, therapists, and urologists.

What types of chronic pyelonephritis are possible during pregnancy?

It is important to distinguish two types of chronic pyelonephritis:

• primary chronic - the acute disease proceeded latently, very quickly, signs of chronic inflammation are revealed almost immediately;
• secondary - the woman had a previous kidney pathology (urolithiasis, congenital anomalies, cystitis and urethritis) long before pregnancy, great importance is attached to the presence of chronic adnexitis, enterocolitis.

In the primary process, symptoms appear immediately after infection of the kidney tissue, and secondary inflammation lasts for years and can proceed unnoticed. The infection comes and is replenished from neighboring organs.

If chronic pyelonephritis is provoked and detected during the early stage of pregnancy, then it is called gestational. It is believed that it is associated with overload of diseased kidneys. It is characterized by rapid progression of the disease with the development of chronic renal failure.

To select treatment, it is also important to establish the presence of urinary tract obstruction (obstructions to the outflow of urine).

• With a non-obstructive process the disease is much easier, since the flow of urine washes away and removes some of the bacteria. This serves as one of the defense mechanisms.
• Obstructive chronic pyelonephritis causes stagnation of urine, increased proliferation of microorganisms, and reflux into higher areas using the mechanism of reflux or reverse flow. This form cannot be cured without normalizing the outflow.

Inflammation can occur in only one kidney or affect both at once (unilateral and bilateral pyelonephritis).

Reasons for the development of pyelonephritis during pregnancy

It has been established that chronic pyelonephritis is more often detected in previously nulliparous women during their first pregnancy. This is associated with a fairly high tone of the muscles of the anterior abdominal wall. They transfer the pressure of the growing uterus from the abdominal press to the ureters and bladder. The compression occurs more strongly than in subsequent pregnancies. This contributes to the development of urinary stagnation and increases the risk of infection.

Other reasons:

• hormonal changes - an increase in progesterone levels by 3 months relaxes the muscles of the bladder and ureters, which leads to curvature, bends, and then to stagnation of urine in the renal pelvis and impaired circulation in the tissues;
• the placenta actively produces estrogens, they contribute to the proliferation of pathogenic flora;
• dilated ovarian veins also contribute to compression of nearby ureters; anatomically, the most “convenient” conditions for infection are created in the right kidney, therefore chronic pyelonephritis is most often recorded on the right;
• an enlarged uterus in the case of multiple pregnancies, a narrowed pelvis or a large fetus causes the most pronounced compression of the ureters; women with these features are more likely to become infected;
• decreased physical activity - a woman preparing to become a mother often suffers from toxicosis in the early stages of pregnancy, then it becomes difficult to carry an enlarged belly, her own weight increases, varicose veins appear in the legs, so the usual way of life is replaced by weakness, increased fatigue, and an urge to lie down more .

The “peak” level of progesterone in a pregnant woman is recorded at 17–18 weeks, and estrogen at 13–14 weeks

All together creates and maintains a vicious circle, promoting the penetration of infection and chronic inflammation in the kidneys.

What pathogens should you be wary of?

Infection occurs by microorganisms coming from the external environment (exogenous) and by own bacteria from chronic foci of tonsillitis, sinusitis, cholecystitis, colitis, caries.

Routes of infection:

• hematogenous - microorganisms are introduced into the bloodstream, activation of old untreated distant lesions is possible (for example, with sinusitis, chronic otitis);
• lymphogenous - an infection that persists in the lymph nodes travels through the lymphatic vessels to the kidneys; it is located in tissues adjacent to the urinary tract (intestines, genitals).

During pregnancy, infection through the lower urinary tract (urethra, bladder) occurs less frequently.

The sources of the disease are often opportunistic microorganisms that inhabit the intestines and bladder. They become overly active, exhibit aggressive properties, and multiply quickly.

The following is found in the urine of pregnant women:

• E. coli;
• staphylococci;
• enterococci;
• Pseudomonas aeruginosa;
• Proteus;
• Klebsiella

Much less often the causative agents of pyelonephritis are:

• yeast-like fungi;
• chlamydia;
• mycoplasma;
• ureoplasma.

The important thing is that usually not one pathogenic microorganism is detected, but several at once.

Symptoms of pyelonephritis in pregnant women

Signs of non-obstructive chronic pyelonephritis are difficult to identify. They are often masked by general complaints of pregnant women about:

• increased fatigue;
• weakness;
• feeling of heaviness in the lower back;
• swelling of the face in the morning.

There is no intense pain or high fever. It is possible to identify signs of renal pathology with ultrasound.

The presence of obstruction significantly complicates the clinical picture of chronic inflammation. The woman notes:

• pain of a rather intense nature on one side or both in the back and lower back, possibly radiating to the groin;
• temperature rise to 38 degrees and above;
• frequent urination with cutting, burning.

This condition is provoked by any options for reducing immune defense:

• previous influenza or ARVI;
• stress and anxiety;
• improper nutrition.

The pain forces the woman to maintain a forced position (pressing her knees to her stomach)

The manifestation of pain depends on the timing of pregnancy:

• in the first trimester - the pain is very intense, reminiscent of a prolonged attack of renal colic;
• after 20 weeks they become moderate and gradually disappear.

If chronic pyelonephritis has a long history, then a pregnant woman may have high blood pressure. In this case, diastolic pressure is significantly higher than the normal level. Hypertension of renal origin is characterized by severe course and poor response to medications. A woman has a clinical picture of hypertensive crises:

• headache;
• nausea and vomiting;
• dizziness;
• heartbeat;
• pain in the heart area.

How dangerous is pyelonephritis for a pregnant woman?

In the first trimester, with exacerbation of chronic pyelonephritis, quite severe intoxication occurs. Together with intense pain, it can lead to miscarriage, as the tone of the uterus sharply increases.

The situation is complicated by restrictions on the use of medications. It is difficult to find effective and safe antibacterial agents. The effect of most antibiotics on the pregnant uterus causes irreversible pathology of the fetus and increased tone.

The following adverse effects are considered complications from chronic pyelonephritis:

• gestosis;
• spontaneous miscarriage in the early stages (up to 22 weeks) or premature birth;
• placental insufficiency, hypoxia, abruption and fetal death - urinary retention and acute expansion of the pelvicaliceal volume causes spasm of the capillary network, narrowing of the arteries, and accordingly the nutrition of the placenta worsens;
• the development of anemia is characteristic of the second trimester;
• polyhydramnios;
• accelerated formation of renal failure against the background of;
• infectious-toxic shock with massive bacterial proliferation.

What disorders may occur in the fetus?

For a child, chronic pyelonephritis of the mother is no less dangerous.

The disease disrupts the developmental conditions of the fetus, starting from the embryonic stage

The most severe consequences are:

• the formation of congenital defects and developmental anomalies that cause oxygen deficiency (hypoxia) and maternal anemia;
• the risk of intrauterine infection increases when bacteria enter the blood;
• death at different stages and periods of pregnancy.

Less severe, but very significant, include the child’s sharply reduced immunity. This prevents him from adapting to independent life after birth, constantly threatens him with counter infections, and impedes growth and development.

Methods for diagnosing pyelonephritis during pregnancy

After clarifying the complaints, the doctor conducts a mandatory examination of the pregnant woman. In the early stages, in thin women, the edge of the kidneys can be palpated. Pain on palpation and a positive Pasternatsky sign (tapping on the lower back) suggest pyelonephritis.

During pregnancy, all women must undergo regular blood and urine tests. Signs of chronic pyelonephritis include:

• acceleration of ESR in the blood and leukocytosis;
• in the urine - a significant number of leukocytes, the formation of active cells, protein, and an increased content of bacteria.

If bacteriuria is detected, they are referred for a bacteriological analysis of urine to determine sensitivity to antimicrobial drugs. This helps select treatment.

Using ultrasound, abnormal sizes of the kidneys and their structures and stone formation in the urinary tract are determined

X-ray examination with contrast or against the background of an air bubble is not used in pregnant women due to increased radiation exposure to the uterine area. But after giving birth, a woman needs to complete the examination in order to have a complete understanding of the causes of chronic kidney damage.

How can chronic pyelonephritis be treated during pregnancy?

The complexity of treatment during pregnancy is due to the increased toxicity of drugs for the unborn child. Therefore, the requirements for non-drug methods of influencing inflammation are increasing to the maximum.

During the period of exacerbation, the woman is hospitalized in the pregnancy pathology department at the perinatal center. She is assigned:

• bed rest for maximum kidney sparing during symptoms of intoxication;
• It is recommended to sleep on your healthy side;
• therapeutic exercises during the period of subsidence of the main process and with satisfactory health;
• a diet with the obligatory addition of fresh vegetables and fruits, dairy products;
• for drinking berry fruit drinks, dried fruit compotes, fresh juices from cranberries, lingonberries, currants, sea buckthorn, gooseberries, mineral waters.

For pyelonephritis, exercises in the knee-elbow position are indicated

In the case of a mild flow, the above measures are sufficient. But in case of severe pain, high temperature and other signs of intoxication, drugs with antibacterial action are prescribed. Broad-spectrum antibiotics are advantageous, capable of destroying different types of microorganisms. The course of treatment depends on the effectiveness. For pregnant women, they try to limit the use of antibiotic injections to seven days.

Antispasmodics are used to relieve pain.

Vitamins are prescribed at the same time. Probiotic preparations that restore normal intestinal flora (Bifidumbacterin, Acipol) are considered useful.

To enhance the flushing effect, herbal diuretics (Canephron, Brusniver) are prescribed. Some herbal decoctions from the advice of traditional healers are recommended. Plants should not increase the tone of the uterus. They are best used during the remission stage, to prevent exacerbation.

The following can be included in kidney tea after your doctor’s permission:

• marsh calamus;
• bearberry;
• flax seeds;
• Birch buds;
• liquorice root.

Calamus roots are collected in autumn or early spring

In case of severe intoxication, the liquid is additionally administered intravenously.

If the course of chronic pyelonephritis is complicated by suppurative processes in the kidneys, hypertension with heart failure, then you have to think about saving the mother’s life. At any stage of pregnancy, surgery to remove the kidney is performed under general anesthesia.

It is better for a woman who has suffered an exacerbation of chronic pyelonephritis to give birth in a specialized maternity ward. You may need emergency care, a caesarean section.

How to avoid exacerbation of pyelonephritis?

Prevention of pyelonephritis should be done both before and during pregnancy. Knowing about her disease, a woman should undergo a full check-up before conceiving and, if necessary, receive sufficient antibacterial therapy.

• Maintain motor activity as much as possible (morning exercises, walking, swimming);
• the diet must be complete and must contain fruits, vegetables, protein from meat and fish;
• drinking a regime of two liters per day will help flush the urinary system;
• dress warmly in chilly weather;
• do not delay emptying the bladder, go to the toilet regularly every 3-4 hours;
• do not self-medicate, contact your obstetrician-gynecologist in a timely manner, get tested and truthfully talk about disturbing disorders.

The confidence of some expectant mothers in their health can only be welcomed if it is confirmed by tests. Observation at the antenatal clinic and periodic hospitalization helps to avoid difficult situations during childbirth and protect the child.

Pyelonephritis is often detected during pregnancy. Pyelonephritis is a disease of inflammatory and infectious origin. In its case, the interstitial tissue of the kidney is damaged; the inflammatory process then spreads to the calyx and pelvis. Statistics show that pyelonephritis in pregnant women occurs in different ways. In most women, the right kidney is affected. In 7% of cases, bacteriuria is detected: this disease can lead to pyelonephritis.

There are several causes of pyelonephritis during pregnancy. The most important thing is that harmful bacteria affect the kidneys and kidney tissue. To prevent pyelonephritis during pregnancy, other diseases associated with the genitourinary system need to be treated in a timely manner. We also note that urodynamics may be impaired in pregnant women: such a disorder can provoke pyelonephritis.

In fact, pregnancy is a predisposing factor for the development of diseases. At this time, the woman’s immunity is impaired, and therefore the body becomes vulnerable. Thus, a pregnant woman is more prone to various diseases, including pyelonephritis. As the fetus grows, the uterus becomes larger. It puts pressure on the organs of the genitourinary system: this phenomenon can also lead to pyelonephritis.

The infection can spread hematogenously or urinogenously. In the first case, the body already has an infectious focus, but women often become infected through the urinogenous route. This is due to the fact that the functioning of the genitourinary system is disrupted and, subsequently, damage to the urinary tract occurs. Against the background of this problem, hypokinesia appears. Soon, the pregnant woman develops vesicoureteral reflux, and the renal pelvis begins to experience serious pressure. Microbes enter the pelvis along with urine. All these processes lead to the development of pyelonephritis in a pregnant woman.

Basically, the disease is characterized by destructive purulent damage to the kidney tissue (pyelonephritis during pregnancy should be given special attention. If left untreated, the disease will cause complications that are dangerous to the health of the mother and the unborn child).

You will be told more about the disease in this video.

Types

1. Depending on the form and duration: acute and chronic pyelonephritis.
2. By the nature of appearance: primary and secondary.
3. According to the condition of the urinary ducts: obstructive and non-obstructive.
4. According to the prevalence of inflammation in the kidneys: one-sided and two-sided.

Symptoms

Let's look at the symptoms of pyelonephritis in a pregnant woman: their nature depends on the form of the disease (acute or chronic).

Note that the chronic form of the disease differs from the acute form. In her case, the symptoms are mild. Lower back pain is sometimes aching in nature. Chronic pyelonephritis is accompanied by a disturbance in general well-being, and the woman often feels drowsy. Such symptoms cannot be ignored, attributing them to a special situation. You need to immediately consult a doctor (nephrologist or gynecologist)!

Diagnostics: can all methods be used?

To identify the disease, the doctor collects an anamnesis, during which he analyzes the complaints of the pregnant woman. It is important to consider clinical signs and laboratory findings.

• MRI can be used to identify the disease: it is highly informative and has no contraindications during pregnancy.
• To confirm the diagnosis, it is necessary to perform a hemogram, study urine tests and the results of the Zimnitsky test.
• As for ultrasound, it is performed, but is not a highly informative method in the presence of a chronic form of the disease.

Diagnosis in pregnant women excludes some research methods. In this case, x-rays cannot be used; Chromocystoscopy and radionuclide studies are also not used. During diagnosis, the doctor should differentiate pyelonephritis from other ailments with similar symptoms.

Treatment during pregnancy

Objectives in the treatment of pyelonephritis:

How does the treatment itself work?

• The doctor prescribes several antibacterial drugs for the pregnant woman. In addition to them, herbal uroseptics are prescribed. Complex therapy includes the use of drugs to eliminate intoxication.
• The woman also takes medications for symptomatic therapy. It is important to monitor the condition of the expectant mother and prevent hypoxia. Symptomatic treatment is combined with antibacterial treatment: the doctor prescribes drugs based on plant extracts: Phytolysin, Canephron.
• A pregnant woman needs to stay in bed and drink enough fluids (preferably clean water).
• Antispasmodics can improve urine flow.

There are two indications for surgery: an abscess and a renal carbuncle. If treatment of pyelonephritis does not produce results, cesarean section is recommended.

Treatment by timing

• If pyelonephritis occurs in the first trimester, you need to use herbal preparations: they are safe for the fetus.
• The doctor may prescribe semi-synthetic penicillins, followed by antibiotic therapy. The duration of antibacterial treatment is 8-11 days, but much depends on the severity of the disease.
• In the first trimester, Amoxicillin or Ampicillin may be prescribed.
• At the second and third stages, the doctor may prescribe Cefoperazone, Erythromycin, Ofloxacin.
• During the postpartum period, the woman takes Pefloxacin or Meronem.

Prevention and proper nutrition

It is important to observe the prevention of pyelonephritis during pregnancy:

• Nutrition needs to be given special attention: it should be varied, healthy, balanced.
• You should not eat pickled, spicy, too salty or sour dishes.
• Remember: your diet should not include dishes with spices.
• It is better for a pregnant woman to consume 2000 kcal per day: you should not overeat.
• The diet is prescribed by a doctor: in most cases, he recommends “Table 5”.
• To avoid the consequences of pyelonephritis, you need to urinate on time.
• If you are not allergic to cranberries, drink fresh juice: this product contains a lot of vitamins.
• Cranberry helps fight germs that have entered the urinary ducts.
• Your diet should be light: food should not burden the internal organs.
• Prevent constipation.
• Eat soft foods.
• Vegetable salads are very useful: they help improve digestion.

Be healthy and be sure to treat the disease with a doctor so as not to harm either yourself or your baby.

In the chronic form, the symptoms of pyelonephritis are mild. This is where the danger lies. A pregnant woman may at times be bothered by headaches, fatigue, lethargy, and painful pulling sensations in the lumbar region. But in some cases, chronic pyelonephritis clearly worsens - with elevated temperature, rapid pulse, and sharp pain in the back. A pregnant woman feels pain when urinating, frequent urges.

Signs of pyelonephritis during pregnancy resemble the symptoms of the onset of self-abortion (threatened miscarriage). In any case it is necessary seek medical help immediately. The first signs of awakening chronic pyelonephritis can appear at the very beginning of pregnancy. Pain in the lumbar region, radiating spasms to the lower abdomen, weakness, drowsiness. In the later stages, it is difficult to detect the disease. Painful sensations are mildly expressed, and the patient’s well-being is assessed as satisfactory. A diagnosis can only be made after thorough research.

How to treat inflammation in the kidneys

Acute kidney inflammation during pregnancy requires immediate treatment, and you cannot put off going to the doctor until later. In addition to the threat of miscarriage and the risk of premature birth, the likelihood of intrauterine infection increases - and this dangerous for the fetus and its normal development. Bacteria, penetrating the placenta, cause inflammation of the lining of the uterus. Even if you manage to carry the baby to term and the baby is born on time, he may develop serious abnormalities of the kidneys, lungs and other organs. Pyelonephritis can also affect the pregnant woman herself in the form of late toxicosis and severe anemia.

It is impossible to treat pyelonephritis without the help of qualified doctors at home. Traditional methods, taking decoctions and infusions will not lead to recovery, but will only worsen the situation. A severe course of the disease can lead to intoxication and septic shock in a woman.

Pyelonephritis can be detected and its severity determined using the following research methods:

• general blood and urine analysis;
• determination of platelet activity;
• measurement of renal temperature.

Medicines for pyelonephritis are selected taking into account:

• previous treatment;
• research results;
• assessment of urine acidity.

How to treat pyelonephritis during pregnancy, when it is undesirable to take many medications during this crucial period? Therapy includes taking powerful antibiotics. The harm to the pregnant woman and fetus from their use will be significantly less than from the consequences of advanced inflammation. The choice of antibiotics allowed for pregnant women is not large. It all depends on what infection caused the disease. This can be determined by bacteriological urine culture. The obstetrician-gynecologist, together with the therapist, selects antibiotics, sets the dosage and duration of the course.

Antibacterial drugs

Treatment is carried out under strict supervision in a hospital:

1. In the first trimester of pregnancy, low-toxic drugs that do not have a damaging effect on the embryo are prescribed. These include the penicillin group. These are Amoxil, Amoxiclav, Amoxicillin, Augmentin.
2. In later stages, when the child’s organs have developed sufficiently, the choice of antibacterial agents increases. Macrolides, nitrofurans or cephalosporins are added to penicillins. You can use Furadonin (no longer than 10 days).
   For any period of time, it is prohibited to take Biseptol, Levomycetin, drugs of the tetracycline group, fluoroquinolones.
3. When pyelonephritis develops after childbirth, fluoroquinolones are used. At this time, breastfeeding is suspended. Treatment lasts 10 days. To a newborn, medications are administered subcutaneously or intravenously.
4. Along the way, the nephrologist can prescribe antipyretics, urinary antiseptics, vitamin therapy, sedatives, and herbal medicine. Herbal medicine consists of taking bearberry, cornflower flowers, polpolona, ​​Uroflux, Phytolysin, Canferon - a mixture of centaury, rosemary and lovage.
5. In severe cases of pyelonephritis, “positional treatment” is used. The pregnant woman is placed on her side, where the healthy kidney is located. Strongly bends knees and elbows. The edge of the bed is raised so that the head is lower than the legs. The uterus moves back slightly, putting less pressure on the kidneys. It is recommended to sleep not on your back, but on your healthy side.
6. Catheterization is performed when positional treatment of pyelonephritis does not produce results. A special catheter is inserted into the affected organ. Through it, fluid is removed directly from the organ.
7. In complicated forms of pyelonephritis with suppuration, decapsulation of the diseased kidney is performed, removing the inflamed capsule.

Diet

Treatment of pyelonephritis during pregnancy involves following a strict diet. Fatty, spicy, smoked, salty, sweet, and spicy foods are excluded from the diet. It is extremely important to restore the drinking balance so that the kidneys are flushed of accumulated infections. Juices, herbal teas, still mineral water, and rosehip decoction, which has a diuretic effect, are suitable for this. It is important that during an exacerbation there is no constipation. They promote inflammatory processes in the bladder and kidneys. To do this, it is recommended to drink oatmeal broth. It removes mucus well, does not increase the tone of the uterus, and improves stool.

The acute stage of kidney inflammation is very painful. Characterized by sudden increases in temperature, nausea, and lethargy. During this period, bed rest should be observed. Typically, an exacerbation of pyelonephritis lasts 4-8 days. After this, physical activity will be required to increase the outflow of fluid from the upper urinary canals. Doctors recommend taking the “cat pose” for 10-15 minutes - standing on all fours, the woman arches her back slightly. This position promotes the flow of urine.

What is the danger to the fetus?

Prolonged pyelonephritis, left unattended by the mother, does not go away without a trace and can affect the child. Having penetrated the womb, bacteria can cause intoxication of the fetus and underdevelopment of the kidney organs. The fetoplacental barrier is destroyed, and the infection enters the blood of mother and baby. This is detrimental to the child.

What else is dangerous about advanced pyelonephritis during pregnancy? It causes hypoxia in the unborn baby - oxygen starvation. Oxygen helps the development of internal organs and systems. Its deficiency causes retarded development and subsequent underdevelopment.

Prevention of pyelonephritis in pregnant women

Is there a way to prevent pyelonephritis and what should be done at the first suspicion of the disease? It is possible to avoid the negative development of the disease. For this, a pregnant woman is recommended:

• drink cranberry juice. It promotes acidification of urine and prevents the proliferation of bacteria;
• drink more fluids. If there is no swelling of the legs, the pregnant woman is not subject to high blood pressure, she should drink at least 2 liters. liquids per day, including borscht, soups, jelly, juicy fruits.
• maintain personal hygiene;
• move more, stay in the fresh air;
• can’t stand it when you want to go to the toilet;
• eat properly and balanced;
• do special gymnastics to reduce pressure on the pelvic organs and kidneys;
• visit an obstetrician-gynecologist in a timely manner, regularly take all tests prescribed by him;
• At the first signs of illness, immediately contact your doctor.