Pyelonephritis in pregnancy - Causes, Symptoms and Treatment .MF .
pyelonephritis - a kidney disease characterized by inflammation of interstitial kidney tissue, followed by the defeat of the cups and pelvis.When pregnancy is most often affects the right kidney.In general, pyelonephritis develops in about 7% of pregnant women and call it in a scientific way "gestational pyelonephritis", ie pyelonephritis, which developed during pregnancy.Given that gestational pyelonephritis may lead to serious complications during pregnancy - is a particular problem.
What is the cause of the disease?Why pyelonephritis often develops during pregnancy it?The main reason for the development of gestational pyelonephritis - mechanical.During pregnancy, the uterus gradually increases in size, "squeezing" the adjacent organs, including the ureters - the excretory ducts of the kidney, which is removed from the kidney mochu.Takim, the urine can not normally pass through the ureters.For this reason, pyelonephritis often occurs during the second half of pregnancy, when the maximum size of the u
Another important factor contributing to the development of gestational pyelonephritis - is hormonal changes during pregnancy.Changing the ratios of hormones in the body, primarily estrogen and progesterone, leading to deterioration of ureteral peristalsis and as a result - promoting urine difficult.
Thus, all of these physiological factors lead to stagnation of urine in the renal pelvis, which is a favorable backdrop for the reproduction of pathological microorganisms - coliform bacteria, staphylococci, streprotokokkov and so on.All this leads to the development of infectious-inflammatory processes in the kidney, that is pyelonephritis.
most of all to the gestational pyelonephritis are situated pregnant, who had already been ill with pyelonephritis or cystitis.In addition to precipitating factors include lowered immunity, hypothermia and lack of exercise.
As a rule, the main symptoms of the disease manifest themselves, starting from 22-24 weeks of pregnancy.How expressions are with the symptoms of the disease depends primarily on the shape of pyelonephritis, acute or chronic.
In acute pyelonephritis pregnant condition worsens - the temperature rises, there is a weakness, lethargy, fever, severe headache, muscle aches, nausea, vomiting, decreased appetite.
characteristic appearance of pain in the lumbar region.Depending on what kind of impressed by kidney-pain can be left or right lower back.With bilateral pyelonephritis, ie, in the defeat of both kidneys, the pain will be on both sides.
In chronic pyelonephritis symptoms little expression.Disturb dull aching pain in the region poyanichnoy, weakness, lethargy, headache.
Given the nature of the pain of pyelonephritis, when the self-test it is often confused with the threat of miscarriage.In any case, even for minor symptoms, pregnant should immediately contact your obstetrician-gynecologist and give details of their complaints.
For diagnosis the doctor prescribes a series of laboratory and instrumental studies:
- complete blood count helps identify inflammatory changes, increased white blood cell count, erythrocyte sedimentation rate;in severe pyelonephritis decreased hemoglobin;
- biochemical analysis of blood (may increase the level of urea and creatinine);
- urinalysis;urine Nechiporenko and Zimnitsky.When pyelonephritis urinalysis detected protein and white blood cells, may also be a small amount of blood;
- bacteriological examination mochi- make for a precise definition of infectious agent and its sensitivity to antibiotics;
- ultrasound of the kidneys - the affected kidney will then be increased with a modified structure;
- consulting nephrologist;
- cystochromoscopy instrumental method studies the kidneys and upper urinary tract to determine the degree of violation of the passage of urine;
- ureteral catheterization - perform both diagnostic (reveal the degree of impairment of passage of urine) and for therapeutic purposes.Research performed under ultrasound guidance.
volume of diagnostic tests in each case determined solely by obstetrician-gynecologist after inspection pregnant.In acute pyelonephritis and exacerbation of chronic diseases of the pregnant form is sent for treatment and observation in hospital.
Treatment is carried out in the hospital together with nephrologists.First, where to start treatment of pyelonephritis - a restoration of the passage of urine.To this end, spend "positional therapy".Pregnant women are placed on the opposite side in the kidney patient bent the knee-elbow position.The foot end of the bed is raised.This position contributes to the deviation of the pregnant uterus and the pressure on the ureters decreases.If during the day the situation is not improving, based on data of US, ureteral catheterization is carried out under the affected kidney ultrasound.In most cases such manipulations lead to a positive effect.
But if the result is not resort to puncture percutaneous nephrostomy (urine drainage from the kidney through the catheter, which is injected directly into the affected kidney).In rare cases, complicated with purulent pyelonephritis, when the state threatens the life of the mother and fetus are doing kidney decapsulation (remove the fibrous capsule of the affected kidney) or nephrectomy (kidney removed).At the same time, it decides to continue with the pregnancy.In most cases, have to terminate the pregnancy, given the high probability of septic complications.
Medical treatment for pyelonephritis prescribe mandatory.The main group of drugs, which is most effective for the treatment of pyelonephritis - is antibiotics.In pregnancy, the doctor have to very carefully refers to the selection of any antibacterial drugs, because the antibiotic should be not only effective but also safe for the fetus.Preference is given to penicillin antibiotics (ampicillin, oxacillin), cephalosporins (Tseporin, Supreks), aminoglycosides (Netilmetsin) and macrolides (erythromycin).It is strictly contraindicated during pregnancy antibiotics streptomycin and tetracycline.In any case, specific drug doctor can designate only after determining the type of agent and its sensitivity to antibiotics.The course of antibiotic treatment is not more than 10-14 days.
To enhance the effects of antibiotics prescribed antimicrobials in parallel (5-NOC).Also spend infusion therapy (Haemodesum, Laktosol).All pregnant women, regardless of the form of pyelonephritis, prescribe antispasmodics (No-spa, Baralgin), desensitizing drugs (Diazolin, Tavegil, Suprastin), sedatives or motherwort tincture of valerian, vitamin B, C and PP.
Chronic pyelonephritis is no need to be hospitalized, if the urine is normal.Pregnant give general advice regarding lifestyle and dietary habits.
For a quick recovery during the exacerbation of the pregnant woman should stick to bed rest.Outside exacerbation of chronic pyelonephritis, on the contrary, should lead sedentary lives.It is necessary to exclude from your diet spicy, fried, smoked and salted edu.Polezno drink natural fruit drink, in particular, berry juice, fruit drinks and juices.It is also recommended to drink teas with a diuretic effect, and kidney diuretic fitosbory that are sold in pharmacies.
For lovers of traditional medicine also has an effective herbal remedies, which can be used in combination to the main treatment of pyelonephritis in the acute phase or as disease prevention.It is called Kanefron N. The drug has anti-inflammatory, antispasmodic and diuretic effect.If there are no allergic reactions, the pregnancy can be used long enough.
Complications of pyelonephritis in pregnancy:
- intrauterine infection of the fetus;
- intrauterine fetal death;
- premature birth;
- the development of preeclampsia, a complication of pregnancy, which leads to high blood pressure, edema and proteinuria;
- renal shortcomings in the pregnant, the development of severe septic complications that can lead to the death of both mother and fetus.
- active lifestyle during pregnancy, frequent walking, walking at least 30 minutes a day;
- in the presence of the past chronic diseases of the urinary system - compliance with a special diet number 7 throughout pregnancy;
- regular bladder emptying (at least once every 3-4 hours) during pregnancy;
- fluid intake of at least 2 liters a day (in the absence of edema!).
1. Can I have the most, if the pregnancy revealed gestational pyelonephritis?
- can, medicine is not an indication for caesarean section.
2. do ultrasound of the kidneys.Diagnosed with pyelonephritis.The doctor has appointed Kanefron Augmentin.Mozhno and if I do take Augmentin, whether it is dangerous for the fetus?
- Augmentin quite toxic drug for pregnant women, it is usually not naznachayut.V any case, this issue should be discussed with your doctor after the results of urine culture.
3. possible to cure only kanefron pyelonephritis?
- can not, Kanefron used only in combination to the basic treatment.
4. I have already several times aggravated by pregnancy pyelonephritis.What do you recommend not to resort more to antibiotics?
- Drink plenty of fluids, if there is no edema, and often empty the bladder.Drink Kanefron if the doctor will recommend.
5. I discovered a small protein in the urine, but no white blood cells and blood.What is pyelonephritis?
- Such an analysis is not very informative, it may be preeclampsia.You need to pass urine on Nechiporenko and Zimnitsky.
6. I was diagnosed with chronic pyelonephritis set in childhood.Can I get pregnant and give birth?
- If there is no renal insufficiency - possible.
7. I on the background of chronic pyelonephritis pressure rose sharply.What to do?
- Urgently address to the gynecologist and admitted to the hospital.
8. I found the red blood cells in the urine.The doctor insisted that I went to the hospital.But is it necessary?
- When haematuria, and other changes in the urine - hospitalization is required.
Obstetrician-gynecologist, Ph.D.Christina Frambos