Gestational pyelonephritis in pregnancy. Treatment of gestational pyelonephritis

During pregnancy, many women face a disease such as gestational pyelonephritis. This pathology arises from the penetration of infection into the kidneys. Inflammatory process is accompanied by painful sensations. Few women seek help from a doctor in time, fearing the harmful effects of drugs on the fetus. In fact, such neglect can negatively affect the baby.

General information

Pyelonephritis is an inflammatory process in the kidney that develops as a result of infection. Women in the situation have a greater predisposition to this disease due to a poor outflow of urine and pinching the outflow channel by a growing uterus. Pyelonephritis is manifested by a sharp increase in temperature, painful discomfort in the lumbar region. To combat infection, doctors usually recommend antibiotic therapy. With proper treatment, the future mother has every chance of giving birth to a healthy baby.

What is the difference between gestational pyelonephritis? During pregnancy, the uterus, which increases every day, presses on the surrounding organs. Very often, the ureter itself is pinched. This is the channel by which the urine flows from the kidney directly to the bladder. The slowing down of the process provokes its stagnation and expansion of the kidney. This condition is typical for pregnancy. Sometimes through the bladder the infection gets into the kidney, and a bad outflow of fluid favors this process.

If the future mother had a diagnosis of pyelonephritis in chronic form before pregnancy, and now developed gestational, the risk of complications is high enough. Such women should be constantly observed by the doctor and clearly follow all of his prescriptions.

Classification of gestational pyelonephritis

The disease can occur in any trimester of pregnancy, in women in labor this condition is diagnosed extremely rarely. Usually pathology develops in the first half of the term. Many experts explain this by the inability of the body to quickly adapt to new conditions.

Isolate the acute and chronic form of this disease. Most often during pregnancy, there is a second variant of the pathology, which can be detected by a characteristic change in the composition of urine. It is difficult to give in to therapy, and in some cases serves as a reason for abortion.

Acute gestational pyelonephritis manifests itself as the strongest intoxication of the body, but does not pose a threat to the life of the fetus inside the womb. In any case, the treatment of this pathology should be approached with all seriousness. Disease at the 16-24th week of pregnancy, regardless of the form of the flow, can cause a miscarriage.

Also, doctors select primary and secondary pyelonephritis. In the first case, the disease occurs against a background of complete well-being, that is, without any prerequisites from other systems of organs. The secondary variant of the disease is characterized by the presence of a purulent focus, from which a pathogenic flora enters not only into the kidneys, but also into the lungs and genitals of the woman. With a sharp deterioration in the state of health, we can talk about the development of the septic state.

Classification of the disease affects only the choice and tactics of treatment. Its pathogenesis remains the same in all cases.

The main causes of the disease

At the pregnant woman approximately by the end of the first trimester in a blood the concentration of an estradiol, and also a level of a progesterone sharply increases. Such hormonal changes affect the tone of the musculature of the bladder, calyx and pelvis kidneys. The urine current gradually slows down, refluxes appear. All these changes increase the pressure of the enlarged uterus on the urinary tract, stagnation occurs. Such a picture promotes the penetration of pathogenic flora and its subsequent reproduction. Bacteria (streptococci, proteus, enterococci) gradually rise to the level of the kidneys and provoke their inflammation.

Gestational pyelonephritis in pregnancy is not always diagnosed. Of particular importance are: the state of the immune system of a woman, individual hormonal differences. Specialists identify a number of factors contributing to the development of this disease:

• Pregnancy pregnancy is bacteriuria.
• Refluxes.
• Abnormalities of the kidneys and bladder at the innate level.
• Chronic diseases.
• Urolithiasis disease.

In addition, with some distinctive features of pregnancy (narrow pelvis, polyhydramnios, large fetus), the risk of pyelonephritis increases severalfold.

What symptoms indicate a pathology?

1. In many women, complaints are often absent, and pathological changes are detected during a laboratory examination (white blood cells and bacteria in the urine). When sowing is usually determined by the rapid growth of E. coli, less often - staphylococcus.
2. Gestational pyelonephritis in pregnant women can be accompanied by severe pain in the lumbar region, discomfort increases with prolonged stays on the legs.
3. When exacerbation, the temperature rises.
4. Frequent urination is typical for a normally occurring pregnancy. In the case of pyelonephritis, the urge may be imperative, and urination itself may be painful.
5. A frequent companion of the disease is elevated blood pressure.
6. Swelling of the legs in women in the position is considered normal. This is not always due to the pathology of the urinary system. Such a symptom may indicate a violation of venous outflow. Puffiness with pyelonephritis usually increases, there is a puffiness of the face.
7. Headaches, fatigue, a sense of weakness in the morning - all these signs only complement the clinical picture.

What is dangerous pyelonephritis for a pregnant woman?

Such a disease, as gestational pyelonephritis, the symptoms of which we examined above, automatically puts the pregnant lady at risk. Why? Inflammatory process in the body increases the load on the cardiovascular system and the kidneys. In 30% of women with this diagnosis, gestosis develops (late toxicosis).

In this condition, blood circulation in the kidneys, brain, placenta is markedly worsened. The blood becomes dense, and the amount of oxygen in it decreases. All this affects the nutrition of the fetus and the condition of the woman herself.

Experts consider the following main negative consequences for this disease:

• The threat of interruption is the most common complication of gestational pyelonephritis.
• Premature birth.
• Multiple hemorrhages.
• Detachment of the placenta.
• Anemia.

The appearance of this or that complication depends mainly on the severity of the inflammatory process and the timeliness of contacting the doctor.

Gestational pyelonephritis in pregnancy: effects on the fetus

Inflammatory process in the kidneys often affects the baby in the womb. Chronic lack of oxygen and the necessary nutrients entails fetal hypotrophy. This means that the child is born weak and with a small weight. In about half of the cases, doctors report hypoxia. At 30% of women with this diagnosis, premature babies are born .

Other complications often occur: fetal hypothermia, intrauterine infection, asphyxia with simultaneous CNS damage.

Diagnosis of the disease

The most important and informative test for this pathology is urine analysis. The presence of inflammatory process indicates a large number of leukocytes, the presence of pathogenic microflora, the appearance of protein.

In the blood there may also be signs of infection (growth of leukocytes and ESR). To identify the type of bacteria that provoked inflammation, the doctor conducts urine culture on the flora and sensitivity to certain antibiotics. According to the results of this test, a specialist can prescribe a drug therapy suitable for a particular woman.

Diagnostics also means ultrasound. The study usually reveals an expansion of the internal parts of the kidney and an increase in the size of the organ. The doctor must make sure that gestational pyelonephritis does not affect the baby's condition inside the womb. To do this, appoint ultrasound of the fetus, CTG and Doppler.

How to treat pyelonephritis in pregnant women?

If the future mother has symptoms that are characteristic of inflammation of the kidneys, you should immediately seek help from a doctor. Timely diagnosis and quality treatment reduce the risk of abnormal fetal development, exclude the possibility of termination of pregnancy.

First of all, women are recommended so-called positional therapy. It is aimed at reducing the compression of the ureters and accelerating the outflow of urine. Future mothers are not recommended to sleep on their backs, it is better to prefer the option on the left side. During the day, you should hold the knee-elbow position and stay in this position for at least 10 minutes. At this time, you can read a book, work on a computer or play with an older child.

Therapy of gestational pyelonephritis also implies a change in the drinking regimen. If there are no serious edema and high blood pressure, the amount of liquid consumed per day can be increased to two or three liters. It can be the most ordinary still water, compotes or kissels. It is better to refuse strong tea and coffee for a while.

Many diuretic herbs during pregnancy are categorically contraindicated. It is forbidden to use bearberry, licorice, parsley. It is better to drink cranberry / cowberry fruit, make birch leaves. A real find for many women in the situation with such a diagnosis is a decoction of oats. This remedy does not increase the tone of the uterus, but it has an anti-inflammatory effect and prevents constipation. To make it, you need to take a glass of cereals, pour a liter of water, boil over low heat for about two hours, and then strain. The broth should be drunk three times a day before direct ingestion.

What medications can a doctor prescribe?

Therapy of gestational pyelonephritis includes antibacterial and anti-inflammatory treatment. The use of many antibiotics and some uroseptics during pregnancy is strictly contraindicated, which significantly complicates the choice of medications. In any case, the doctor chooses the tactic to fight this illness in a hospital, since all women with such a diagnosis are hospitalized without fail.

In the first trimester, the so-called barrier function of the placenta is usually not formed until the end. At this time there is an important stage in the laying of the main systems of the child's organs, so the drug effect is undesirable. If the changes are detected only in urine tests, most likely, it will be possible to confine oneself to the above recommendations. In the case of active inflammation, which is accompanied by fever and pain, penicillins ("Amoxicillin", "Amoxiclav" preparations) are allowed.

From the second trimester it is allowed to take antibiotics of the group of cephalosporins ("Suprax", "Cefazolin"), macrolides ("Vilprafen", "Sumamed"). From the fifth month (with an active inflammatory process), strictly according to the doctor's prescription, Gentamicin is used.

Treatment of gestational pyelonephritis also implies the conduct of detoxification therapy, the use of vitamin complexes and soothing agents. Particular attention is paid to the prevention of fetal hypoxia. If urgently needed, urine flow is restored by catheterization and stenting of the ureter.

What should I change in the diet?

Particular attention in the treatment of the disease is given to the ration of the pregnant woman. Doctors recommend to exclude sharp (spices, garlic, onions) and pickled products (cucumbers, tomatoes, mushrooms). For a while you will have to give up coffee, alcohol is completely banned.

To avoid delays in the body, doctors advise to reduce the intake of table salt. This recommendation primarily applies to women with high blood pressure.

The diet with gestational pyelonephritis is vitamin-rich. Women in the situation should more eat fruits and vegetables in their raw form, make them juices. A good choice are sour-milk products (cottage cheese and low-fat sour cream). During recovery, the diet should be diversified with lean protein foods (this is sea fish, chicken breasts).

Preventive actions

To prevent the development of gestational pyelonephritis, it is extremely important for future mothers to include several items in their daily routine:

1. Moderate physical activity. Doctors recommend daily small walks (about 1 hour).
2. Special gymnastics for pregnant women. Today, in many sports centers, classes are held for women in a position that strengthens the back muscles and improves the tone of all systems of internal organs.
3. If you have a history of urinary system diseases, you must follow a special diet that contributes to the outflow of urine.
4. A day is recommended to consume a large amount of liquid.
5. Emptying the bladder should be at least once every three to four hours.

Attentive attitude to one's own health and prevention of gestational pyelonephritis is the key to the birth of a strong baby. Do not neglect such an insidious disease. When there are primary symptoms, it is better to consult a doctor and take all the necessary measures to eliminate the pathology. Be healthy!