Pyelonephritis

Question 1

Why are pregnant women at increased risk of pyelonephritis?

Answer 1

Progesterone slows ureteral peristalsis

This slowing can lead to urinary stasis, increasing the risk of infection.

Question 2

What is the effect of the uterus on the ureters during the third trimester of pregnancy?

Answer 2

• 1) Progesterone slows ureteral peristalsis, thereby ­ risk of urinary stasis and backup to kidney.
• 2) Compression of ureter(s) by uterus, notably in 3rd trimester, ­ risk of stasis.

Question 3

How is asymptomatic bacteriuria managed in pregnant women?

Answer 3

It is always treated

In non-pregnant women, asymptomatic bacteriuria may not require treatment.

Question 4

What is a classic drug used to treat asymptomatic bacteriuria and UTIs in pregnancy?

Answer 4

Nitrofurantoin

Nitrofurantoin is considered safe for use in pregnant women.

Question 5

Initial management of acute pyelo in pregnancy

Answer 5

IV Ceftriaxone

Question 6

Following symptomatic improvement, management of acute pyelo in pregnancy

Answer 6

Oral penicillins or cephalosporins (cephalexin)

Question 7

Nitrofurantoin is a classic drug used in pregnancy to treat

Answer 7

asymptomatic bacteriuria, standard UTIs, and cystitis in pregnancy