Acute pyelonephritis and pregnancy. Pregnancy and chronic pyelonephritis

During pregnancy, a woman's body is gradually rebuilt. But sometimes adaptation occurs at the limit of possibilities, which creates the prerequisites for the occurrence of gestational pathologies. Symptoms of pyelonephritis during pregnancy also occur if the mother's body could not adapt to the rapidly growing fetus. Changes in the load on the kidneys and peculiarities of urodynamics during this period can lead to a disease that does not always go away after childbirth.

Acute pyelonephritis develops in 3-10% of all pregnancies. Most often, the primary disease occurs during the first gestation. This is due to a more elastic anterior abdominal wall. It is not so much subject to stretching, so the growing uterus puts pressure on the ureters, leading to their narrowing and worsening of the outflow of urine. At repeated pregnancy primary pyelonephritis occurs much less frequently.

Who is at risk

For inflammation in the pyelocaliceal system, certain conditions are necessary.

Anatomical features. Congenital anomalies in the structure of the kidneys or ureters disrupt the mechanism of urine outflow. Before pregnancy, this may not attract attention, but already on early dates often there are signs of stagnation of urine and the development of inflammation.
Infection. Inflammatory processes in the kidneys that were before conception, asymptomatic bacteriuria, as well as cystitis, colpitis and foci of chronic infection in the body can lead to infection of the kidneys.
Urodynamic disorders. Normally, urine flows through the ureters to the bladder, where it gradually accumulates. But in pregnant women, under the influence of progesterone, there is a decrease in ureteral motility, a moderate expansion of the pelvis, and a weakening of the sphincters. Therefore, urine reflux can occur - reverse reflux. Also, the development of gestational pyelonephritis is affected by the turbulent nature of the urine flow. Stagnation and an increase in hydrostatic pressure lead to the development of pathogenic microorganisms.

The causative agents of pathology are:

staphylococci;
streptococci;
Proteus;
coli;
enterococci.

The risk of developing pathology with urolithiasis, diabetes mellitus, and the patient's low social status increases.

Symptoms of pyelonephritis during pregnancy

The acute form is characterized by an abrupt onset, manifested by signs of intoxication, fever. Chronic pyelonephritis proceeds with periods of exacerbation and remission, is a consequence of an acute illness. Depending on the gestational age, the signs of pathology have their own characteristics.

1 trimester. Severe pain syndrome, which resembles renal colic. The main localization is in the lower back, but it also extends to the lower abdomen, genitals.
2nd and 3rd trimesters. The pain syndrome is not so pronounced, urination disorders are more disturbing. Sometimes, when an attack of pain occurs, a woman takes a forced knee-elbow position, in which her condition is alleviated.

Pyelonephritis during pregnancy can mimic the course of other diseases, which leads to a delay in treatment. Therefore, differential diagnosis of acute adnexitis, cholecystitis, hepatic colic is necessary.

What can turn

The critical period for the onset of pathology is the 2nd trimester. A rapid increase in progesterone, an increase in the uterus lead to the appearance of the first symptoms. In the same period, the first complications may appear. Possible consequences for the fetus: intrauterine infection, developmental delay, stillbirth. On later dates the following complications may develop:

anemia;
premature birth;
placental insufficiency;
preeclampsia;
septicemia;
infectious-toxic shock.

Anemia in pyelonephritis is a consequence of impaired synthesis of erythropoietin, a substance that stimulates the division of red blood cells.

bad script

Preeclampsia is a dangerous complication that, in severe cases, can lead to placental abruption and fetal death, as well as the development of DIC in the mother. This condition occurs against the background of fluid retention and the formation of edema, increased blood pressure. A protein appears in the urine, which carries along part of the water and enhances the manifestations of preeclampsia.

Preeclampsia negatively affects the functioning of all body systems. Swelling of the fundus leads to visual impairment. Sweating of the liquid part of the blood also occurs in the heart muscle. The consequence of this is a violation of the rhythm, bradycardia, the development of left ventricular failure. This affects the blood supply to the lungs: edema also develops in the lung tissue, ventilation decreases. The accumulation of gas exchange products leads to the development of metabolic acidosis.

The danger is the formation of DIC, which can occur in a chronic form throughout pregnancy. This increases the viscosity of the blood, there is a risk of thrombosis and embolism.

Gradually, violations lead to the development of multiple organ failure. This is a condition that is difficult to treat and leads to death.

When pregnancy is contraindicated

To prevent the development of such a scenario, it is necessary to carefully approach pregnancy. Pyelonephritis is not always severe. But there are conditions in which it is impossible to minimize the risks. Pregnancy is prohibited in the following situations:

pyelonephritis, which is combined with azotemia;
arterial hypertension in chronic pyelonephritis;
defeat of a single kidney;
glomerulonephritis with hypertension or azotemia.

The disease threatens grave consequences Therefore, expectant mothers are prescribed inpatient treatment for pyelonephritis.

Survey

If pyelonephritis is suspected, laboratory tests and instrumental studies are prescribed. Tests are required:

Reberg;
Addis-Kakovsky;
Zimnitsky;
Emburge.

Held general analysis blood and urine, research according to Nechiporenko. In pathology, they reveal a large number of leukocytes in urine, bacterial cells. An increase in the concentration of residual nitrogen and urea is also often found.

Instrumental diagnostics is carried out only by methods that are safe for the child, X-ray and radioisotope methods are not used. The basis of diagnosis is:

Doppler ultrasound of the kidneys;
thermal imaging;
cystoscopy;
chromocystoscopy.

Sometimes ureteral catheterization is used, during which purulent urine flows. This method brings some relief to the state.

Therapy Options

Treatment of pyelonephritis during pregnancy is aimed at improving laboratory parameters, restoring kidney function and stopping the main symptoms. Medical and non-pharmacological methods are used.

To improve the passage of urine, it is necessary to take the knee-elbow position several times a day for 10-15 minutes. Sleep - only on a healthy side.

diet

The diet should help increase the amount of urine, acidify it and improve the outflow. Therefore, it is necessary to drink cranberry juice, mineral waters without gases are recommended. The menu limits the amount of salt, pickled, fatty and spicy dishes. Exclude:

sorrel;
mushrooms;
legumes;
cabbage;
muffin.

Increased gas formation should be avoided so that there is no additional increase in intra-abdominal pressure, and stool regularity should be monitored.

Folk recipes

Treatment folk remedies can only be used in combination with conservative therapy. The cause of inflammation of the kidneys is a bacterial infection, and it cannot be defeated without antibiotics. From folk methods at home, you can use kidney fees, a decoction of bearberry, lingonberry. Feedback on this treatment is positive from doctors and patients.

Medications

Antibiotics are prescribed taking into account the sensitivity of the pathogen to them and the gestation period. Protected aminopenicillin preparations are used orally or as injections:

amoxicillin and clavulanic acid;
amoxicillin and sulbactam.

With intolerance to penicillin, cephalosporins of the second and third generations are prescribed. But they are preferred in the later stages. From the second trimester, macrolides can be prescribed.

The following antibiotics have negative consequences for the child:

fluoroquinolones;
sulfonamides;
aminoglycosides.

They are used only in severe cases for health reasons on the part of the mother. The treatment lasts 10-14 days, and the criterion of cure is a two-time good urine test.

Operation

Sometimes there is a need for surgical treatment. This usually occurs with the ineffectiveness of drug therapy and with the development of an abscess or carbuncle of the kidney.

In rare cases, the course of the disease becomes critical, when the preservation of pregnancy becomes impossible. Medical interruption is performed under such conditions.

- an inflammatory process in the renal tissue - often diagnosed for the first time precisely with the onset of pregnancy. Kidney pathology can manifest itself even in those women who have never complained about the organs of the urinary system.

Inflammation of the kidneys in pregnant women is also called differently. According to various sources, from 1% to 12% of all pregnant women suffer from this disease.

Why exactly future mothers are prone to urinary tract diseases and why is pyelonephritis dangerous during pregnancy? Let's try to figure it out.

Causes of gestational pyelonephritis

Even with a perfectly normal pregnancy, the growing uterus gradually squeezes nearby organs. Increased pressure is also experienced by the ureters - thin tubules through which the resulting urine flows from the kidneys to the side. Bladder.

When the outflow of urine is slowed down due to compression of the ureters, fluid stagnation occurs, accompanied by an expansion of the kidneys. This increases the risk of bacterial contamination of the kidney tissue and the development of infection in this organ.

Gestational pyelonephritis is more at risk for women who are pregnant for the first time.. In such expectant mothers, the front wall of the abdomen is more elastic, since they have not yet given birth even once. In this case, the uterus experiences greater resistance from the abdominal wall, and the ureters are compressed more strongly. The kidneys experience a significant load, which creates conditions for the development of the inflammatory process in them.

The following factors also increase the risk of developing gestational pyelonephritis:

previously transferred or;
hypothermia of a woman, especially swimming in cool water or walking barefoot;
existing pathologies of the kidneys, including their expansion;
high blood pressure blood;
the absence of one kidney.

Thus, to the greatest extent, the risk of gestational diabetes is increased by existing diseases of the kidneys or other organs. future mother.

What is dangerous pyelonephritis during pregnancy

The inflammatory process in gestational pyelonephritis usually occurs in both kidneys.. With the timely start of treatment, the pathological process quickly fades due to conduction.

However, not all expectant mothers go to the doctor even if they have symptoms of kidney inflammation. In the first weeks after conception, a woman’s fever and or back are “written off” as characteristic manifestations of pregnancy. Indeed, such symptoms often appear in the first trimester.

Important! If you miss the onset of the disease or refuse to take the prescribed antibacterial medicines, then pathological destructive changes can occur in both kidneys. As a result, dangerous complications of pregnancy arise, such as.

With preeclampsia, not only the kidneys are damaged, but blood pressure also rises abnormally, which affects not only the woman, but also the developing fetus. A purulent process may begin in the kidneys, requiring not only medical, but in some cases surgical intervention.

In order to avoid such complications, it is recommended for a future mother to monitor her well-being and control kidney function. If there is suspicious pain or a change in the color of urine, you should immediately contact a specialist. This will quickly stop the process of inflammation of the kidneys at the initial stage with a minimal effect of drugs on the woman's body.

Symptoms of gestational pyelonephritis

Manifestations of gestational pyelonephritis, as a rule, increase suddenly.

The most common symptoms are:

fever up to 38 degrees or more, as well as chills;
in the region of the kidneys;
pain when urinating (if pyelonephritis is complicated by cystitis due to the ingress of bacteria from the kidneys through the ureters into the bladder);
change in the color of urine and its volume;
increased urge to urinate;
weakness and general deterioration.

The nature of the manifestations largely depends on the duration of pregnancy. So, in the first trimester, severe lower back pain is usually observed, radiating to the lower abdomen. In the second half of the gestation period, pain is less pronounced, but kidney damage can be more dangerous.

IN individual cases gestational pyelonephritis can be almost asymptomatic. In this case, the disease can be detected only after passing tests or passing.

Diagnosis of gestational pyelonephritis

To diagnose pyelonephritis, expectant mothers are prescribed the following examinations:

. Inflammation of the kidneys is indicated by a pathological increase in the number of leukocytes in a urine sample, the detection of protein and bacteria.
. Gestational pyelonephritis is accompanied by an increase in the number of leukocytes in the blood and.
Ultrasound will help assess the condition of the kidneys, detect signs of expansion of the renal pelvis and other manifestations of pyelonephritis.

When confirming the diagnosis of inflammation of the kidneys, additional tests are also carried out. To determine the variety of pathogenic bacteria, sensitivity to certain antibiotics is also performed. Based on the results of the analysis, the doctor will be able to prescribe the most effective antibacterial drug, which is especially important during pregnancy, because excessive medication is unsafe for the expectant mother.

In some cases, asymptomatic bacteriuria is diagnosed in pregnant women. In this case, tests show the presence of bacteria in the urine, but no symptoms appear. Such a condition also requires mandatory treatment, because otherwise infection of the fetus with the appearance of concomitant severe complications is possible.

Treatment of pyelonephritis in pregnant women

To combat gestational pyelonephritis, the following methods are used:

Important! Acute pyelonephritis is treated only in a hospital. In the presence of asymptomatic bacteriuria, it is possible to carry out therapeutic measures at home.

If treatment is successful, subsequent births are usually uneventful. With the development of late toxicosis with impaired renal function, it may be recommended.

Prevention of pyelonephritis during pregnancy

Of course, it is better to prevent the occurrence of gestational pyelonephritis than to deal with its consequences throughout the pregnancy.

Warn appearance dangerous symptoms the following steps will help:

The most reasonable choice would be to follow the above tips, not only when carrying a fetus, but also long before the start of pregnancy. The absence of any kidney disease before conception and general good health are a fairly reliable guarantee of the excellent well-being of the expectant mother and the birth of a strong baby.

Thank you

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Pyelonephritis is a disease that is characterized by inflammation of the tissue of the kidneys and intrarenal segments of the urinary tract.. Pyelonephritis can be acute and chronic. The greatest danger is chronic pyelonephritis, which can cause significant impairment of kidney function.

Of all diseases of the urinary system in pregnant women, pyelonephritis occurs most often.. At the same time, the incidence of pyelonephritis among pregnant women is higher than among the general population. This fact is explained by some features of the body of a pregnant woman and the influence on the activity of the organs of the genitourinary system of a developing pregnancy. In this article, we will talk about the most common causes of pyelonephritis in pregnant women, as well as methods for diagnosing, treating and preventing this disease.

What is pyelonephritis?

Pyelonephritis is considered as an inflammation of the interstitial tissue of the kidneys and renal segments of the urinary tract.. This is the main difference between pyelonephritis and diseases such as glomerulonephritis, in which the active elements of the kidneys - nephrons - are damaged. Despite this, chronic pyelonephritis can also lead to dysfunction of the nephrons and their destruction. It does this by spreading inflammation from the tissues surrounding the nephrons (interstitial tissue) to the nephrons themselves.

Causes of pyelonephritis in pregnant women

According to modern estimates, pyelonephritis occurs in 6-10% of pregnant women.. The reasons for such a high incidence of pyelonephritis in pregnant women are very diverse. We will try to understand the mechanism of development of pyelonephritis and answer the question why pregnant women are at greater risk of getting pyelonephritis.

Pyelonephritis is a typical urinary tract infection. In this case, the direct cause of the disease are microbes that multiply in the tissues of the body. Under normal conditions, the human body has some defense mechanisms that prevent infection from entering. Regarding the urinary tract, this is the tone of the bladder, ureters and urethra, timely excretion of urine, normal blood circulation in the kidneys. Pregnancy is a special state of a woman's body, while pregnancy is characterized by serious changes in the work of all the internal organs of a woman. In particular, under the action of progesterone (a hormone that supports pregnancy), the smooth muscles of all internal organs woman's body. A decrease in the tone of the ureters, bladder and urethra contributes to an easier penetration into the female urinary tract infection.

The enlarging uterus during pregnancy puts significant pressure on the kidneys, ureters, and bladder. This leads to a violation of blood circulation in these organs and a delay in the excretion of urine.

Another important frequent occurrence of pyelonephritis during pregnancy is the relative decrease in the function of the immune system of a pregnant woman (this is necessary for the normal course of pregnancy).

How does pyelonephritis proceed? Symptoms of the disease

The course of pyelonephritis depends on the type of development of the disease. Acute pyelonephritis develops quickly, but also passes quickly (subject to quality treatment). The main symptoms of acute pyelonephritis are pain in the lumbar region (most often unilateral pain), fever, cloudy urine. Due to the fact that pyelonephritis rarely develops as a separate disease, and is most often associated with cystitis (inflammation of the bladder), other symptoms of the disease may include pain in the lower abdomen, irregular urge to urinate, pain during urination, etc. If these and others are detected diseases, you need to go to the hospital immediately. Pyelonephritis requires mandatory observation by a doctor.

Chronic pyelonephritis develops almost asymptomatically. The most pronounced manifestations of the disease may appear during its exacerbation. At such times, the symptoms of chronic pyelonephritis resemble those of acute pyelonephritis. In pregnant women, lower back pain with pyelonephritis should be distinguished from the characteristic pain that occurs during pregnancy due to the increasing load on the spine.

Can pyelonephritis cause complications?

The long course of pyelonephritis leads to significant destruction of the renal tissue, which in turn can cause extremely serious complications. In particular, the destruction of nephrons and the replacement of active kidney tissue with connective tissue over time leads to the development of kidney failure. Damage to the intrarenal blood vessels is the cause of the development of renovascular hypertension. The occurrence of hypertension during pregnancy is especially dangerous.

In acute pyelofrit, the development of phlegmon or kidney abscess is possible, but these complications are quite rare. Most often, if left untreated, acute pyelonephritis becomes chronic.

Risk levels for pyelonephritis during pregnancy

The development of pyelonephritis during pregnancy is a very undesirable and dangerous complication. The type of development of the disease and the level of disturbance in the general condition of the body of a pregnant woman must be taken into account to calculate the risk of pyelonephritis for the development of pregnancy. The risk of pyelonephritis during pregnancy is associated primarily with the development of renal failure and arterial hypertension in a pregnant woman. These and other consequences of pyelonephritis can aggravate the course of pregnancy (toxicosis, eclampsia).

It is customary to distinguish three degrees of risk of pyelonephritis in pregnant women:
- I degree of risk is typical for acute uncomplicated pyelonephritis that developed during pregnancy. In the case of timely and high-quality treatment, this type of pyelonephritis does not pose a serious threat to the health of the mother and child. Pregnancy and childbirth proceed normally.

II degree of risk is typical for pregnant women suffering from exacerbation of chronic pyelonephritis. In such cases, pyelonephritis can cause pregnancy complications, occurring in 20-30% of cases. In the absence of complications, the development of pregnancy may be favorable. The presence of severe complications can cause pregnancy loss.

III degree of risk is typical for pyelonephritis complicated by renal failure and arterial hypertension. At the III degree of risk, pregnancy is allowed only if there is a stable remission of the disease and the preservation of normal function of at least one of the kidneys. In all other cases, pregnancy is contraindicated due to the real risk to the woman herself.

Diagnosis of pyelonephritis during pregnancy

Timely diagnosis of pyelonephritis is extremely important for obtaining good treatment results and eliminating the risk of the disease to the health of the mother and child.

In order to suspect acute pyelonephritis, it is sometimes enough for a doctor to ask the patient about the symptoms of the disease. To clarify the diagnosis and for the diagnosis of chronic pyelonephritis occurring, as mentioned above, asymptomatically conduct an additional examination:

A general and biochemical blood test shows signs of inflammation: an increase in the number of leukocytes, an increase in the erythrocyte sedimentation rate, as well as a moderate increase in the concentration of urea and creatinine;

Urine analysis according to Nechiporenko shows the content of leukocyte immune cells in the urine, an increase in the number of which in the urine indicates inflammation of the urinary tract;

A general urine test shows the presence of leukocytes, bacteria, proteins in the urine (this analysis can detect even asymptomatic pyelonephritis);

The Zemnitsky test is performed to test the ability of the kidneys to concentrate urine. Renal failure is characterized by a decrease in the concentration ability of the kidneys;

An ultrasound examination of the kidneys is performed to establish morphological (structural) changes in the kidneys. Ultrasound can also be used during pregnancy without much risk to the fetus.

Treatment of pyelonephritis during pregnancy

The main method of treatment of pyelonephritis during pregnancy is the appointment of antibiotics. When using an antibiotic, it is important to consider the effect of this drug on the fetus. Most antibiotics are known to be harmful to the fetus.

In the first trimester of pregnancy, semi-synthetic penicillins (ampicillin, amoxicillin / clavulanate) can be used to treat mild forms of pyelonephritis. In the second and third trimester of pregnancy, in addition to semi-synthetic penicillins, macrolides (erythromycin, azithromycin), cephalosporins can be used. In no case should you take tetracyclines, aminoglycosides, sulfonamides - these drugs are extremely toxic to the fetus. In the event of pyelonephritis in the postpartum period, other antibiotics can be used in the treatment, however, breastfeeding for the entire period of treatment is prohibited. The total duration of treatment for pyelonephritis is 7-10 days.
The effectiveness of the treatment is then monitored by repeated analyses.

Prevention of pyelonephritis during pregnancy

Prevention of pyelonephritis during pregnancy should be given special attention. One of the methods for preventing pyelonephritis is the observance of personal hygiene measures by a pregnant woman, quality nutrition, walking in the fresh air (without the risk of hypothermia).

Recently, the prevention of the occurrence or exacerbation of pyelonephritis has been carried out using herbal antiseptics. One of these drugs is Canephron N.

It is also effective to take Cordyceps under the supervision of a doctor, which has a stimulating effect on the immune system while not having side effects.

Taking any medication, changing or stopping treatment must be agreed with the attending physician.

Bibliography:

Safronova L.A. Pyelonephritis and pregnancy. Russian Medical Journal, 2000;8,18:778–781.
Delzell J.E.Jr., Lefevre M.L. Urinary tract infections during pregnancy. Am Fam Physician. 2000;61:713–721.

Before use, you should consult with a specialist.

Reviews

Pregnancy 6 weeks, I was in the hospital with acute pyelonephritis, antibiotics were dripping, antibiotics were given with pills, I didn’t know that I was pregnant, what could be the consequences for the fetus, please tell me

I had pyelonephritis at the 4th week of pregnancy, they put me in the hospital, they pierced me with an antibiotic, I was terribly worried about the child. One doctor even advised me to make a vacuum if I was very worried, they say you will still give birth, etc. Then, after an antibiotic, a thrush began, which I struggled with unsuccessfully throughout my pregnancy. She gave birth to a perfectly healthy baby, who is already 13 years old. So, don't be afraid, girls, get treated, everything will be fine.

I called an ambulance about severe swelling. But there was no pain. They put me in the hospital. The examination showed protein 18, but in the morning it was already 8. Ultrasound of the kidneys is excellent. There is no pain. The fetus is active. The diagnosis was pyelonephritis. walk less often. is it worth it to be treated.

Olga, don’t worry and don’t take any medicines, I myself had the same protein, bacteria, leukocytes, I was pricked with everything possible and pills and injections (antibiotics), nothing helped me, one woman advised me to eat pickles more often and the more the better and retake the tests, I didn’t believe it, but I tried it, you won’t believe the following tests were perfect, everything disappeared by itself

Hello, please tell me what to do with my pregnancy with a period of 7 months and they found pyelonephritis in me, they are now in the hospital, but they said the risk is not big, but I'm still afraid for my baby, can there be any complications for her, for her health? And I never had problems with the kidneys, where could he come from? For prevention, I drank Canephron N, but apparently he didn’t help me ... what should I do?

Pyelonephritis - inflammation of the renal structures (pelvis, calyces, parts of the tubular apparatus) - is acute and chronic. The acute form most often occurs in girls, as a complication of childhood infections, tonsillitis. Due to vague or latent symptoms, it can be skipped and imperceptibly become chronic.

Great difficulty is chronic pyelonephritis during pregnancy. If before her the disease was a danger only for a woman, now it harms the health of the unborn child.

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

In the primary process, the symptoms appear immediately after infection of the kidney tissue, and the secondary inflammation lasts for years, and can go unnoticed. The infection enters and replenishes from neighboring organs.

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

It is also important to establish the presence of urinary tract obstruction (obstacles to the outflow of urine) for the choice of treatment.

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

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

Causes 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 transmit the pressure of the growing uterus from the abdominals to the ureters and bladder. The compression is stronger than in subsequent pregnancies. This contributes to the development of the mechanism of urinary stagnation and increases the risk of infection.

Other reasons:

hormonal changes - an increase in the level of progesterone by a period of 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 blood circulation in the tissues;
the placenta actively produces estrogens, they contribute to the reproduction of pathogenic flora;
dilated ovarian veins also contribute to compression of adjacent ureters, anatomically the most “convenient” conditions for infection are created in the right kidney, so chronic pyelonephritis is more often recorded on the right;
enlarged uterus in case multiple pregnancy, narrowed pelvis or large fruit causes the most pronounced compression of the ureters, women with these features are more likely to become infected;
reduced physical activity- a woman, preparing to become a mother, often suffers from toxicosis in the early stages of pregnancy, then it becomes difficult to wear an enlarged belly, her own weight grows, manifests itself varicose veins veins on the legs, so the usual way of life is replaced by weakness, increased fatigue, it pulls to lie down more.

The "peak" level of progesterone in a pregnant woman is recorded at the 17th-18th week, and estrogen - at the 13th-14th

All together creates and maintains vicious circle contributing to the penetration of infection and chronicity of the course of inflammation in the kidneys.

What pathogens should be feared?

Infection occurs with microorganisms that come from the external environment (exogenous) and own bacteria from chronic foci with tonsillitis, sinusitis, cholecystitis, colitis, caries.

Ways of infection:

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

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

Sources of the disease are often conditionally pathogenic microorganisms that inhabit the intestines and bladder. They become overly active, exhibit aggressive properties, and multiply rapidly.

In the urine of pregnant women are found:

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

Much less common causative agents of pyelonephritis are:

yeast-like fungi;
chlamydia;
mycoplasma;
ureoplasm.

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

Symptoms of pyelonephritis in pregnant women

Signs of chronic pyelonephritis of a non-obstructive type are difficult to identify. They are more often masked by the 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 fever. Possibly identifying signs renal pathology with ultrasound.

The presence of obstruction significantly aggravates 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, irradiation to the groin is possible;
an increase in temperature to 38 degrees and above;
frequent urination with cutting, burning.

A similar condition is provoked by any options for reducing immune defense:

transferred influenza or SARS;
stress and anxiety;
improper nutrition.

Pain forces a woman to maintain a forced position (pressing her knees to her stomach)

The manifestation of pain syndrome depends on the timing of pregnancy:

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

If chronic pyelonephritis has a long course, then a pregnant woman may have high blood pressure. The diastolic pressure is much higher than normal level. Hypertension of renal origin is characterized by a severe course, a poor response to drugs. A woman has a clinic of hypertensive crises:

headache;
nausea and vomiting;
dizziness;
heartbeat;
pain in the region of the heart.

How dangerous is pyelonephritis for a pregnant woman?

In the first trimester, with an exacerbation of chronic pyelonephritis, a rather strong intoxication occurs. It, along with intense pain, can lead to miscarriage, as the tone of the uterus increases sharply.

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

The following adverse effects are considered complications from chronic pyelonephritis:

preeclampsia;
spontaneous miscarriage in the early stages (up to 22 weeks) or premature birth;
placental insufficiency, hypoxia, detachment and death of the fetus - urinary retention and acute expansion of the pelvic-cup volume causes a spasm of the capillary network, narrowing of the arteries, respectively, the nutrition of the placenta worsens;
development of anemia - typical for the second trimester;
polyhydramnios;
renal hypertension;
accelerated formation of renal failure against the background of a wrinkled kidney;
infectious-toxic shock with massive bacterial reproduction.

What disorders can occur in the fetus?

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

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

The most severe consequences are:

the formation of congenital malformations and developmental anomalies that cause oxygen deficiency (hypoxia) and maternal anemia;
the risk of intrauterine infection increases when bacteria enters with blood;
death at different stages and terms of pregnancy.

To less severe, but very significant include a sharply reduced immunity of the baby. This prevents him from adapting to an independent life after birth, constantly threatens with oncoming infections, and hinders 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 lean women, the edge of the kidneys can be palpated. Pain on palpation and a positive symptom of Pasternatsky (tapping on the lower back) suggest pyelonephritis.

During pregnancy, all women must regularly take 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, an increased content of bacteria.

If bacteriuria is detected, they are sent for a bacteriological analysis of urine to determine sensitivity to antimicrobial drugs. This helps in choosing the right treatment.

By using ultrasound establish the disturbed sizes of the kidneys and their structures, stone formation in the urinary tract

X-ray examination with contrast or against the background of an air bladder in pregnant women is not used due to increased exposure of the uterine area. But after giving birth, a woman needs to complete the examination in order to have a complete picture 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 as much as possible.

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

bed rest for maximum sparing of the kidneys with symptoms of intoxication;
it is recommended to sleep on a healthy side;
therapeutic exercises during the 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.

With pyelonephritis, exercises are shown in the knee-elbow position

In the case of a light current, the above measures are sufficient. But with severe pain, high temperature and other signs of intoxication, drugs with antibacterial action are prescribed. Broad-spectrum antibiotics that can destroy different types microorganisms. The course of treatment depends on the effectiveness. For pregnant women, they try to limit themselves to a seven-day use of an antibiotic in injections.

Antispasmodics are used to relieve pain.

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

To enhance the flushing action, plant diuretics are prescribed (Canephron, Brusniver). Recommend some herbal decoctions from the advice of traditional healers. Plants should not increase the tone of the uterus. They are best used in the remission stage, to prevent exacerbation.

The composition of kidney tea can be included after the permission of the doctor:

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

Calamus roots are harvested in autumn or early spring.

With 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 life of the mother. At any stage of pregnancy, an operation is performed to remove the kidney under general anesthesia.

It is better for a woman who has had an exacerbation of chronic pyelonephritis to give birth in a specialized maternity ward. May need emergency help, C-section.

How to avoid exacerbation of pyelonephritis?

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

maintain the motor regime as much as possible (morning exercises, walking for walks, swimming);
nutrition should be complete, contain necessarily fruits, vegetables, protein of meat and fish;
drinking regimen in the amount of two liters per day will help flush the urinary system;
dress warmly in chilly weather;
avoid delaying bladder emptying, regularly go to the toilet every 3-4 hours;
do not self-medicate, contact your obstetrician-gynecologist in a timely manner, take tests and tell the truth about disturbing disorders.

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

On the way from two strips on a pregnancy test to the delivery room, a woman can be in for a lot of trouble. One of them is gestational pyelonephritis (otherwise - pyelonephritis of pregnant women). In this article, we will take a closer look at the treatment of pyelonephritis during pregnancy, the causes and symptoms of this disease.

Why does pyelonephritis often develop during pregnancy?

Pyelonephritis is very dangerous for both the expectant mother and the fetus!

Hormonal restructuring in the body begins from the moment of conception, and already at 8-12 weeks of gestation, progesterone and other hormones cause lengthening, expansion and decrease in the tone of the ureters, and as a result, stagnation and an increased risk of infection.
As the pregnant uterus grows, it begins to compress the urinary tract, especially if the pelvis is narrow and the child is large or not alone.
Hormonal changes cause the ovarian veins to expand, which as a result compress the ureter. This can also affect the left kidney, but, due to the anatomical features of the location of the veins, the right one often suffers. The outflow of urine is disturbed, the renal pelvis is stretched up to hydronephrosis.
Estrogens, actively synthesized by the placenta, contribute to the reproduction of pathogenic flora, especially Escherichia coli.

Why is gestational pyelonephritis dangerous?

In women with this disease, the risk of toxicosis in the second half of pregnancy is significantly increased.
Miscarriages and stillbirths are more common.
In children whose mother suffered pyelonephritis during pregnancy, signs of hypoxia and intrauterine infection are more often found.

How is pyelonephritis manifested in pregnant women?

Some women have no complaints, and changes are detected only during laboratory examination - leukocytes and bacteria in the urine. When sowing, the growth of Escherichia coli is most often determined, less often - Klebsiella and Staphylococcus aureus, Proteus. Pyelectasis may be detected on ultrasound.
There are frequent complaints of aching pain, heaviness in the lower back, usually asymmetrical, often there is an increase in pain during prolonged stay on the legs. Some note the chilliness of the lower back.
With exacerbation, the temperature may rise. More often - a slight subfebrile condition, especially in the evening hours, but in some cases there are rises to 38-39 С.
Frequent urination and nocturia are typical for a normal pregnancy, but with pyelonephritis, the urge can become imperative, and urination is painful.
A frequent companion of pyelonephritis is high blood pressure. Moreover, if blood pressure above 140/90 mm is usually a signal of trouble. rt. pillar, then for a pregnant woman 130/80 is already a bit too much.
Swelling of the legs is noted by pregnant women quite often, this is not necessarily associated with the pathology of the urinary system, but can be a sign of a violation of the venous outflow, however, with pyelonephritis, the swelling increases, puffiness of the face often appears, and the hands swell.
Headaches even with normal pressure, fatigue, a feeling of weakness and weakness, especially in the morning, completes the picture.

How to treat gestational pyelonephritis?

positional therapy. It is aimed at reducing compression of the ureters and improving the outflow of urine. A woman is not recommended to sleep on her back, the best option- on the left side. Repeatedly during the day (from 4 to 7-10 times) you need to take a knee-elbow position and stay in this position for at least 5, preferably 10-15 minutes. It is not necessary to feel ridiculous, bored or shy. Reading a book, playing blocks with an older child, even working on a laptop in this position can be done without any problems.
Drinking mode. If there are no significant edema and high blood pressure, it is advisable to increase the amount of fluid consumed to 2-3 liters per day. It is assumed that it will be exactly water, kissels and compotes, and not strong tea or coffee at all.
Phytotherapy. Many diuretic herbs, which are successfully used at other times, are contraindicated during pregnancy. Do not use bearberry, yarrow, parsley, licorice, juniper berries. You can drink cranberry and lingonberry fruit drinks, nettle, birch leaf. A real find- decoction of oats: it does not increase the hypotension of the ureters, like many other herbs, does not increase the tone of the uterus, it has a direct anti-inflammatory effect, and the ability of the mucus contained in the decoction to improve stool and prevent constipation is an additional bonus during pregnancy. It is advisable to use cereals for decoction, and not flakes. To prepare a decoction, take 1 glass of oats per liter of water, boil over low heat for 2-3 hours (the volume of the boiling mass is reduced by about half), filter and drink half a glass three times a day before meals. If you want to add honey or jam - please. If there is no desire to brew herbs on your own, the official preparation kanefron is allowed for use in pregnant women - a combination of centaury herbs, lovage and rosemary.

Drug therapy

With pyelonephritis, a pregnant woman will definitely be prescribed antibiotics. However, do not worry - many drugs in this group are completely safe for the fetus.

In the first trimester, the barrier function of the placenta has not yet formed, an important stage in the laying of the main organs and systems is taking place, so the medicinal effect in this period is undesirable. If only changes in urine tests are detected, it may be possible to limit oneself to the above remedies. If the inflammation is active, there is pain, fever, significant bacteriuria, then you will have to resort to antibiotics, at this stage it is permissible to use penicillins - amoxicillin, amoxiclav.
From the second trimester, you can, in addition, take antibiotics from the group of cephalosporins of the 2nd and 3rd generation (suprax, ceftriaxone, cefazolin); furadonin (only up to 36 weeks and not longer than 10 days).
Macrolides: josamycin (vilprafen) and azithromycin (sumamed), erythromycin are also safe, but most pathogens of pyelonephritis (with the exception of perhaps staphylococcus) do not work.
From 4 months, the appointment of nitroxoline (5-NOC) is acceptable.
From the 5th month, with active inflammation and strictly according to the doctor's prescription, gentamicin is used.
Levomycetin, biseptol, tetracyclines and fluoroquinolones (nolicin, ciprofloxacin) during pregnancy are strictly prohibited at any time.

Pyelonephritis during pregnancy is a common but not harmless complication. Every now and then a pregnant woman is sent to take a urine test - believe me, this is not a whim, do not neglect these examinations.

Which doctor to contact

Often, gestational pyelonephritis can be suspected by an obstetrician-gynecologist based on the results of a urinalysis. He usually refers the patient to a therapist. In difficult cases, consultation with a nephrologist or urologist is required.