During pregnancy, many women experience a condition such as gestational pyelonephritis. This pathology occurs due to infection in the kidneys. The inflammatory process is accompanied by painful sensations. Few women promptly seek medical help for fear of the harmful effects of drugs on the fetus. In fact, such neglect can adversely affect the baby.
General information
Pyelonephritis is an inflammatory process in the kidney that develops as a result of infection. Women in position have a greater predisposition to this disease due to poor outflow of urine and pinching of the outlet channel of the growing uterus. Pyelonephritis is manifested by a sharp increase in temperature, painful discomfort in the lumbar region. Doctors usually recommend antibiotic therapy to fight the infection. With proper treatment, the expectant mother has every chance of giving birth to a healthy baby.
What is the difference between gestational pyelonephritis? During pregnancy, the uterus increases every day and puts pressure on the surrounding organs. The ureter itself is often pinched. This is the channel through which urine flows from the kidney directly to the bladder. Slowing down the process provokes its stagnation and enlargement of the kidney. This condition is typical for pregnancy. Sometimes an infection enters the kidney through the bladder, and poor fluid outflow favors this process.
If a future mother was diagnosed with chronic pyelonephritis before pregnancy, and now has developed gestational, the risk of complications is quite high. Such women should be constantly monitored by a doctor and clearly follow all his prescriptions.
Classification of gestational pyelonephritis
The disease can occur in any trimester of pregnancy, in women in childbirth this condition is diagnosed extremely rarely. Usually, pathology develops in the first half of the term. Many experts attribute this to the inability of the body to quickly adapt to new conditions.
The acute and chronic form of this disease is distinguished. Most often during pregnancy, a second variant of the pathology is observed, which can be detected by a characteristic change in the composition of urine. It is difficult to treat, and in some cases serves as a reason for abortion.
Acute gestational pyelonephritis is manifested by severe 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 in all seriousness. The disease at the 16-24th week of pregnancy, regardless of the form of the course, can cause a miscarriage.
Doctors also distinguish primary and secondary pyelonephritis. In the first case, the disease occurs against the background of complete well-being, that is, without any prerequisites from other organ systems. The secondary variant of the disease is characterized by the presence of a purulent focus, from which the pathogenic flora is introduced not only into the kidneys, but also into the lungs and genitals of the woman. With a sharp deterioration in well-being, we can talk about the development of a septic state.
The classification of the disease affects exclusively the choice and tactics of therapeutic measures. Its pathogenesis remains the same in all cases.
The main causes of the development of the disease
In a pregnant woman, by the end of the first trimester, the concentration of estradiol in the blood increases sharply, as well as the level of progesterone. Such hormonal changes affect the tone of the muscles of the bladder, calyx and renal pelvis. The flow of urine gradually slows down, refluxes appear. All these changes increase the pressure of the enlarged uterus on the urinary tract, stagnation occurs. This picture contributes to the penetration of pathogenic flora and its subsequent reproduction. Bacteria (streptococci, protea, enterococci) gradually rise to the level of the kidneys and provoke their inflammation.
Gestational pyelonephritis during pregnancy is not always diagnosed. Of particular importance are: the state of the woman’s immune system, individual hormonal differences. Experts identify a number of factors contributing to the development of this disease:
- Bacteriuria preceding pregnancy.
- Refluxes
- Abnormalities of the kidneys and bladder at the congenital level.
- Chronic ailments.
- Urolithiasis disease.
In addition, with some distinctive features of pregnancy (narrow pelvis, polyhydramnios, large fetus), the risk of developing pyelonephritis increases several times.
What symptoms indicate a pathology?
- Many women often have no complaints, and pathological changes are detected during laboratory tests (white blood cells and bacteria in the urine). When sowing, the rapid growth of E. coli is usually determined, less often - staphylococcus.
- Gestational pyelonephritis in pregnant women can be accompanied by severe pain in the lumbar region, discomfort increases with prolonged stay on the legs.
- With exacerbation, the temperature rises.
- Rapid urination is typical for a normal pregnancy. In the case of pyelonephritis, urges can be imperative, and urination itself can be painful.
- A frequent companion of the disease is high blood pressure.
- Swelling of the legs in women in position is considered normal. This is not always associated with pathology of the urinary system. Such a symptom may indicate a violation of the venous outflow. Swelling with pyelonephritis usually worsens, puffiness of the face occurs.
- Headaches, fatigue, a feeling of weakness in the morning - all these signs only complement the clinical picture.
What is dangerous pyelonephritis for a pregnant woman?
A disease such as gestational pyelonephritis, the symptoms of which we examined above, automatically puts a pregnant woman at risk. Why? The inflammatory process in the body increases the load on the cardiovascular system and kidneys. 30% of women with this diagnosis develop gestosis (late toxicosis).
In this condition, blood circulation in the kidneys, brain, and placenta noticeably worsens. Blood becomes thick, and the amount of oxygen in it decreases. All this affects the nutrition of the fetus and the condition of the woman herself.
Among the main negative consequences for this disease, experts include the following:
- The threat of interruption is the most common complication of gestational pyelonephritis.
- Premature birth.
- Multiple bleeding.
- Detachment of the placenta.
- Anemia.
The appearance of a particular complication depends mainly on the severity of the inflammatory process and the timeliness of contacting a doctor.
Gestational pyelonephritis during pregnancy: effects on the fetus
The inflammatory process in the kidneys often affects the baby in the womb. Chronic lack of oxygen and essential nutrients entails fetal malnutrition. This means that the child is born weak and with little weight. In approximately half the cases, doctors report hypoxia. In 30% of women with this diagnosis, premature babies are born .
Of the other complications often encountered: fetal hypothermia, intrauterine infection, asphyxia with simultaneous damage to the central nervous system.
Diagnosis of the disease
The most important and informative test for this pathology is urinalysis. The presence of an inflammatory process is indicated by a large number of leukocytes, the presence of pathogenic microflora, and the appearance of protein.
There may also be signs of infection in the blood (white blood cell count 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 drug therapy suitable for a particular woman.
Diagnostics also involves 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 condition of the baby inside the womb. For this, ultrasound of the fetus, CTG and Dopplerometry are prescribed.
How to treat pyelonephritis in pregnant women?
If the expectant mother has symptoms characteristic of inflammation of the kidneys, you should immediately seek help from a doctor. Timely diagnosis and quality treatment reduce the risk of abnormal development of the fetus, exclude the likelihood of termination of pregnancy.
First of all, women are recommended the so-called positional therapy. It is aimed at reducing the compression of the ureters and accelerating the outflow of urine. Expectant mothers are not recommended to sleep on their backs; it is better to prefer the option on their left side. During the day, you should take a knee-elbow pose 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 fluid consumed per day can be increased to two to three liters. This may be the most common still water, stewed fruit or jelly. Strong tea and coffee should be discarded for a while.
Many diuretic herbs during pregnancy are strictly contraindicated. It is forbidden to use bearberry, licorice, parsley. It is better to drink cranberry / lingonberry fruit drinks, brew birch leaves. The real find for many women in a position with such a diagnosis is a decoction of oats. This tool does not increase the tone of the uterus, but has an anti-inflammatory effect and prevents constipation. To prepare it, you need to take a glass of cereal, 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 eating directly.
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 drugs. In any case, the tactics of combating this ailment are chosen by the doctor in the hospital, since all women with this diagnosis are hospitalized without fail.
In the first trimester, the so-called barrier function of the placenta is usually not fully formed. At this time, an important stage of the laying of the main systems of the child’s organs takes place, therefore, drug exposure is undesirable. If changes are detected only in urine tests, it is most likely possible to limit oneself to the above recommendations. In the case of active inflammation, which is accompanied by fever and pain, the use of penicillins is allowed (drugs "Amoxicillin", "Amoxiclav").
From the second trimester, it is allowed to take antibiotics of the cephalosporin group (Suprax, Cefazolin), macrolides (Vilprafen, Sumamed). From the fifth month (with an active inflammatory process), the agent "Gentamicin" is used strictly according to the doctor's prescription.
Treatment of gestational pyelonephritis also involves detoxification therapy, the use of vitamin complexes and sedatives. Particular attention is paid to the prevention of fetal hypoxia. In case of acute need, urine flow is restored through catheterization and stenting of the ureter.
What should be changed in nutrition?
Particular attention in the treatment of the disease is given to the diet of the pregnant woman. Doctors recommend eliminating spicy (spices, garlic, onions) and pickled products (cucumbers, tomatoes, mushrooms). For some time you will have to give up coffee, alcohol is completely prohibited.
To avoid water retention in the body, doctors advise to reduce the consumption of table salt. This recommendation is primarily for women with high blood pressure.
The diet for gestational pyelonephritis is distinguished by its vitamin nature. Women in position should eat more fruits and vegetables in raw form, make juices from them. Sour-milk products (cottage cheese and low-fat sour cream) are considered a good choice. During recovery, the diet should be varied with lean protein products (these are sea fish, chicken breasts).
Preventive actions
To prevent the development of gestational pyelonephritis, it is extremely important for expectant mothers to include several items in their daily routine:
- Moderate physical activity. Doctors recommend taking small walks daily (about 1 hour).
- Special exercises for pregnant women. Today, many sports centers conduct classes for women in a position that strengthens the muscles of the back and improves the tone of all systems of internal organs.
- If there is a history of diseases of the urinary system, you must follow a special diet that promotes the outflow of urine.
- A large amount of liquid is recommended per day.
- Empty the bladder at least once every three to four hours.
Attentive attitude to your own health and prevention of gestational pyelonephritis is the key to the birth of a strong baby. Such an insidious disease should not be neglected. If primary symptoms appear, it is better to consult a doctor and take all necessary measures to eliminate the pathology. Be healthy!