The assessment and management of acute Pyelonephritis in pregnancy

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Urinary tract infection (UTI) incorporates a range of conditions including acute pyelonephritis or kidney infection. It is almost invariably caused by bacteria (Brown et al 2005, Le 2004). The incidence of this disease in pregnancy has decreased in recent years (Dawkins et al 2012), possibly due to improved antenatal care. However, it remains one of the most common complications in pregnancy (Hill et al 2005) affecting 1-2% of pregnant women (Dawkins et al 2012, Hill et al 2005, McCormick 2008). Acute Pylonephritis is the most serious urinary tract infection in pregnancy (Le 2004, McCormick et al 2008) and successful treatment usually requires hospital admission (Jolly and Wing 2010). It is most often seen in nullparous and younger women and there appears to be a link with lower socioeconomic status, diabetes and sickle cell disease, although not with ethnicity (Hill et al 2005, Jolley et al 2012). It is more common in the 2nd and 3rd trimester (Archabald et al 2009, Hazhir 2007, Hill et al 2005) as the presence of urinary pathogens seems to increase as pregnancy advances (Hill et al 2005). There does appear to be an association between repeated urinary tract infections and sexual activity (Bernard et al 2011, Pfau and Sacks 1992).

If not effectively treated, acute pyelonephritis may have serious consequences for both the mother and fetus. Urinary tract infections in pregnancy may lead to septic shock, anaemia, respiratory insufficiency, fluid balance disorders, renal scarring, acute kidney injury, chronic renal insufficiency and death (Hill et al 2005, Jolley and Wing 2010, Jolley et al 2012, Kumar et al 2009, Nwoko et al 2012, Vasquez and Vilar 2010). They have also been associated with pre-labour rupture of membranes, preterm labour