Urology Book

Infectious Disease


Pyelonephritis in Pregnancy

Aka: Pyelonephritis in Pregnancy
  1. See Also
    1. Pyelonephritis
    2. Acute Cystitis in Pregnancy
    3. Urinary Tract Infection
  2. Symptoms
    1. Fever
    2. Chills
    3. Nausea
    4. Contractions
    5. Preterm Labor
    6. Acute Cystitis Symptoms
  3. Signs
    1. Fever
    2. Maternal Tachycardia
    3. Fetal Tachycardia
    4. Costovertebral angle tenderness to palpation
    5. Pelvic exam
  4. Labs
    1. Urinalysis
    2. Urine Culture with Sensitivity
      1. Consider Urinary Catheter sample
    3. Complete Blood Count
      1. Leukocytosis
    4. Chemistry Panel (basic metabolic panel)
    5. Consider straining urine for calculi
  5. Radiology
    1. Renal Ultrasound
      1. Hydronephrosis
  6. Management: Inpatient Antiobiotics
    1. Ceftriaxone (Rocephin) 1-2 grams IV or IM every 24 hours
    2. Unasyn 1.5-3g IV q6h
    3. Combination Protocol for 14 days
      1. Ampicillin 2 g IV every 6 hours
      2. Gentamycin 1.5 mg/kg (Maximum 80-100 mg) q8 hours
        1. Adjust dosing per kinetics for >1-2 days use
  7. Management: Other Inpatient Therapy
    1. Bedrest in semi-Fowler's position
      1. Place on side opposite affected Kidney
    2. Use cooling measures as needed for Temp > 102
    3. Intravenous hydration
    4. Maintain intravenous antibiotics
      1. Oral when affebrile without CVA pain for 48 hours
      2. Complete a total of 7-14 days
      3. Consider Urinary Tract Infection prophylaxis
  8. Management: Outpatient antibiotics
    1. Augmentin 875 mg PO bid for 14 days
    2. Macrodantin (risk of newborn Hemolysis after 38 weeks)
      1. Initial: 100 mg PO qid for 14 days
      2. Prophylaxis: 100 mg PO qhs until 6 weeks postpartum
    3. Keflex 250 mg PO qid for 14 days

pregnancy and pyelonephritis (C0747827)

Concepts Finding (T033)
ICD10 O23.0
English Pyelonephritis in pregnancy, pregnancy pyelonephritis, pregnancy and pyelonephritis, pyelonephritis pregnancy, pregnancy; pyelonephritis
Dutch zwangerschap; pyelonefritis
Derived from the NIH UMLS (Unified Medical Language System)

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