Pregnancy is an important stage in the life of every woman. However, the process of carrying a baby in the womb is a stress factor for the body. During this period, chronic diseases are often exacerbated. The first symptoms of pyelonephritis during pregnancy may not be recognized by everyone. This explains the late appeal of women for medical help.
Medical certificate
Pyelonephritis is commonly understood as an inflammatory disease of the renal pyelocaliceal system. Various bacteria provoke its development. The disease can occur at absolutely any gestational age. It manifests itself in a triad of symptoms: increased blood pressure, lower back pain, the appearance of protein with impurities in the urine.
In a healthy body, the kidney consists of several small cups, which are combined into larger pelvis. Of these, urine through the ureter is sent to the bladder. Such a structure provides optimal filtration of the fluid in the body. During pregnancy, the uterus increases day by day and constantly presses on the organs of the urinary system, thereby provoking stagnation. This creates favorable conditions for the activity of pathogenic flora and, as a consequence, the development of pyelonephritis.
Varieties of ailment
There are several types of disease.
Depending on the time of occurrence, primary and secondary pyelonephritis is isolated. In the primary inflammatory process, it is not accompanied by impaired urodynamics, there are no other kidney pathologies. Secondary pyelonephritis develops against the background of diseases of the genitourinary system.
By the nature of the course, an acute and chronic form is distinguished. Acute pyelonephritis during pregnancy manifests itself suddenly. Primary symptoms make themselves felt within a few hours or days after infection. With proper treatment, the disease lasts about 10-20 days and ends with recovery. The chronic form is a sluggish and periodically exacerbating inflammatory process. It is characterized by the replacement of healthy connective tissue. The disease is often complicated by renal failure, hypertension.
Causes and Risk Factors
The main reason for the appearance of kidney pyelonephritis during pregnancy is the penetration of infection. Various microorganisms can provoke the disease, but most often these are conditionally pathogenic bacteria (E. coli, streptococci, staphylococci). Various viruses and fungi that are sexually transmitted infections can also act as pathogens.
Doctors identify several predisposing factors that help the infection to develop actively:
- frequent hypothermia;
- addictions;
- inactive lifestyle;
- abnormalities in the development of the genitourinary system;
- non-observance of personal hygiene;
- the presence in the diet of a large amount of spicy, oily and salty foods;
- a history of chronic cystitis or pyelonephritis.
The acute form of the disease occurs mainly due to changes in the hormonal background. To maintain pregnancy and allow the child to fully develop, the body carries out a physiological decrease in immunity. Therefore, a woman becomes especially susceptible to various ailments of an infectious and inflammatory nature.
If prevention was not carried out at the planning stage, most likely, chronic pyelonephritis will worsen during pregnancy. In this case, the provoking factor is not only a decrease in immunity, but also an increase in the load on the urinary system.
During pregnancy, the amount of fluid in the female body increases. This is due to the abundant production of blood, amniotic fluid. As a result, the amount of urine increases. The renal pelvis and calyx expand, they accumulate more urine, which also increases the risk of inflammatory processes.
Clinical picture
The first symptoms of pyelonephritis during pregnancy usually appear at weeks 22-24. The degree of their severity depends on the form of the disease. The acute symptoms are characterized by the following symptoms:
- temperature rise;
- severe chills;
- nausea and vomiting;
- muscle aches;
- headaches;
- discomfort in the lower back.
Increased pain is usually observed at night. It can give to the upper abdomen, to the perineum or thighs. Discomfort is aggravated by physical exertion or movement, on the back or side. Changes are observed in the process of urination. Urine acquires a cloudy hue, a pungent odor. The process itself is accompanied by severe discomfort.
In the case of a chronic form, a woman is concerned about dull pain in the lumbar region. General weakness and fatigue are also observed.
Diagnostic Methods
In approximately 70% of women, pregnancy and pyelonephritis are not a coincidence. Most of the patients already have a history of pathologies of the kidneys or other parts of the urinary system.
To identify the inflammatory process, a pregnant woman is usually prescribed urine and blood tests. Only by their results can we conclude about the presence or absence of infection in the body. In addition, gram staining of urine is recommended. This examination method allows you to obtain information about the causative agent of the disease. To assess the sensitivity of pathogenic flora to antibiotics, a bacteriological study of urine is prescribed.
Among instrumental diagnostic methods, the most informative is ultrasound. With its help, you can evaluate the structure of the tissues of the organ, identify areas with seals and expansion of the renal pelvis.
Differential diagnosis is carried out with urolithiasis, adnexitis, acute cholecystitis, and hepatic colic. Therefore, consultation with specialized specialists (urologist, nephrologist, surgeon) may also be required.
Drug therapy
The acute form of the disease or its exacerbation in a chronic course must be treated in a hospital. In this case, you should act immediately.
Drug treatment of pyelonephritis during pregnancy involves the appointment of antibiotics. The doctor should select the drugs, taking into account the clinical picture and the individual characteristics of the patient's body. Do not be afraid of antibiotics. Their use is justified and does not pose a threat to the mother and child, when compared with a high risk of complications.
In the first trimester, the laying of the vital organs of the child takes place, therefore, the drug effect is undesirable. If the diagnosis showed only deviations from the norm in urine tests, it will probably be possible to limit oneself to measures to change the lifestyle. With active inflammation, fever and severe pain, penicillin-type antibiotics are indicated (Ampicillin, Oxacillin).
Starting from the second trimester of pregnancy, pyelonephritis and other similar pathologies are stopped by antibiotics from the group of cephalosporins of the 2nd and 3rd generation (Suprax, Ceftriaxone). Additionally, macrolides and aminoglycosides are prescribed. It is worth noting that tetracyclines, fluoroquinolones, Levomycetin and Biseptol are strictly contraindicated at any stage of bearing a child.
To enhance the therapeutic effect, antimicrobials and uroantiseptics are used in parallel. In order to stop the pain syndrome, the administration of antispasmodics is indicated (Papaverine, No-Shpa). Comprehensive therapy also includes sedatives and vitamin complexes.
Lifestyle Guidelines
Pyelonephritis and pregnancy - these two conditions always require lifestyle changes. In the case of the development of the disease in acute form, you need to adhere to a special diet. First of all, it is recommended to increase the amount of fluid consumed (more than 2 liters per day). It is important to exclude spicy, fatty and fried foods from the diet. The emphasis should be on fresh vegetables and fruits.
In the chronic course of the disease, the diet provides the following rules:
- restriction of consumption of meat and fish broths, spices;
- compliance with the drinking regime;
- reducing the amount of salt to 8 g per day;
- the use of vitamin-rich foods.
If during the acute stage the symptoms of pyelonephritis in women during pregnancy are expressed by severe pain and fever, bed rest is indicated. Usually, medication prescribed by a doctor gives positive results after 4-8 days. After this period, you can return to an active lifestyle. A similar approach is designed to provide the best outflow of urine.
Help traditional medicine
Pyelonephritis must be treated strictly under the supervision of a gynecologist and in a hospital. The use of traditional medicine is categorically prohibited. This not only does not bring the desired result, but can also harm the baby inside the womb.
On the other hand, some herbs cannot be used during pregnancy. Certain species can trigger uterine contractions and premature births, diarrhea, and allergic reactions.
If a doctor recommends diuretics for treating pyelonephritis during pregnancy in women, you can use cranberry or lingonberry fruit drinks, a lingonberry decoction. However, prior coordination with the gynecologist is still necessary. Berry fruit drinks not only contribute to the removal of excess fluid from the body, but also saturate it with vitamins, which positively affects the immunity of a pregnant woman.
Consequences of the disease
Usually the disease goes through several stages of development. First, inflammation occurs. In the absence of treatment, small abscesses form in the affected area, which gradually merge together, forming a kidney abscess. This condition is life-threatening for a pregnant woman. Infection from an abscess can spread throughout the body along with blood flow and cause sepsis. Such complications can lead to death or disability. However, with timely treatment, the prognosis is favorable.
According to medical reviews, pyelonephritis during pregnancy can provoke other, no less dangerous complications even before the appearance of a kidney abscess. Among them should be noted:
- increase in blood pressure;
- development of uterine hypertonicity, as a result, premature birth;
- the spread of the pathological process to the pelvic organs, infection of the fetus;
- the occurrence of renal failure;
- the appearance of gestosis.
The development of gestosis is especially often diagnosed during pregnancy with pyelonephritis in the later stages. A similar condition entails malnutrition of the fetus and the occurrence of intrauterine hypoxia. Oxygen deficiency often leads to the death of the child.
Treatment tactics for complications
The treatment of complications is largely determined by the trimester of pregnancy. Pyelonephritis in the early stages of pregnancy, accompanied by the threat of termination, requires maintenance therapy. It involves taking antispasmodics and bed rest. In the second and third trimesters, gestosis or placental insufficiency most often develops. In this case, treatment should be aimed at maintaining the functions of the placenta, improving the condition of the fetus.
In some cases, pregnancy and pyelonephritis are incompatible. Indications for its interruption may be the following violations:
- severe gestosis;
- treatment inefficiency;
- acute renal failure;
- acute fetal hypoxia.
The interruption procedure is usually carried out by artificial labor. Caesarean section is prescribed in exceptional cases. This is due to the high risk of postoperative complications, which manifest themselves in the form of endometritis and parametritis.
Prevention Methods
To avoid the development of pyelonephritis during pregnancy and its complications, doctors recommend adhering to the following rules:
- regularly undergo examinations by a gynecologist in a antenatal clinic;
- adhere to proper nutrition;
- avoid hypothermia;
- monitor drinking regimen.
It is very useful for pregnant women to take daily walks and do special gymnastics. This is very useful for the full functioning of the circulatory system.