Behandeling van pyelonephritis in de zwangerschap
Jun 20, 2018
Pyelonephritis affects about 7% of pregnant women.The disease can disrupt the normal course of pregnancy and fetal development.Considering the seriousness of pyelonephritis, every pregnant woman needs to take urine tests several times during the entire pregnancy in order to notice the harbingers of kidney disease in time.Table of Contents: Causes of Pyelonephritis in Pregnancy Symptoms of Pyelonephritis in Pregnancy Treatment of Gestational Pyelonephritis
Causes of Pyelonephritis in Pregnant Women
Pyelonephritis is an inflammation of the renal pelvis.Inflammation is caused by bacteria.Approximately in 80% of cases, pyelonephritis is provoked by a conditionally pathogenic flora: E. coli, enterobacter, klebsiel, strepto- and staphylococci.Less often, the culprits of the disease are mycoplasmas, chlamydia, Candida fungi.Bacteria get into the kidneys either from the lower urinary organs( urethra, bladder), or with the blood flow are recorded from the foci of chronic infection.
Changes in the female body during pregnancy contribute to the progression of the inflammatory process in the kidneys.So, hormonal changes with an increase in the synthesis of progesterone, lead to a decrease in the tone of the ureters, bladder, kidney cups and pelvis.This causes a slowing of the urine flow and its stagnation, which can be considered ideal conditions for the multiplication of bacteria.
In addition, the enlarged uterus exerts strong pressure on the ureters, which also causes a violation of the proper passage of urine. That's why pyelonephritis often occurs at the end of the second trimester( at 22-26 weeks), when the uterus is already greatly increasing in size.
When a pregnant woman develops pyelonephritis for the first time in her life, they talk about the development of gestational pyelonephritis.Also, there are situations where a woman had chronic pyelonephritis before conception of the child, and during pregnancy the disease worsened.Regardless of the form of the disease, the treatment used is the same.
Symptoms of pyelonephritis in pregnant women
Pyelonephritis in pregnant women can proceed in different ways.So, with acute pyelonephritis, the symptoms of the disease are expressed, overall health worsens.Chronic pyelonephritis is usually asymptomatic and it is possible to suspect the inflammatory process only if certain abnormalities are detected in urinalysis.
Acute pyelonephritis is accompanied by an increase in temperature, which can reach very high digits.A woman feels broken, tired.She can be bothered by chills, headaches.Simultaneously there is pain in the lower back, which can be more pronounced on the one hand.Pain is able to give to the lower abdomen, thigh, groin.If pyelonephritis is accompanied by inflammation of the lower urinary organs, the woman is also concerned about frequent urge to urinate, a burning sensation while doing so.
Chronic pyelonephritis can be felt only by a slight increase in temperature, rapid fatigue, discomfort in the lower back.In case of an exacerbation, the symptoms of pyelonephritis become more pronounced.Often, pregnant women do not suspect that they have a disease.In this case, women will learn from the doctor about the available pyelonephritis only after the results of the urinalysis.In the study of urine, leukocytes, bacteria, and also a small amount of protein are determined in it.
Pyelonephritis is not a harmless disease at all.The inflammatory process complicates the course of pregnancy, childbirth and even can lead to impaired fetal development.
The complications of pyelonephritis in pregnant women include:
- Late gestosis( toxicosis);
- Mild pregnancy;
- Infection of the fetus;
- Fetal hypotrophy.
Treatment of pyelonephritis during pregnancy
When an acute pyelonephritis is detected, the patient is hospitalized in a hospital .This is an obligatory condition, since a woman must comply with bed rest, and therapy should be carried out under the supervision of an obstetrician-gynecologist or nephrologist.
The basis of treatment consists in the appointment of antibacterial agents, only these drugs are capable of destroying the bacteria that caused pyelonephritis. In the treatment of pregnant women use the safest antibiotics, namely:
- Penicillins( Ampicillin, Oxacillin);
- Cephalosporins( Cefuroxime, Cefoperazone);
- Macrolides( Jozamycin, Azithromycin).
In the first trimester of pregnancy, when the fetal organs are still forming, in the treatment of the mother prefer penicillins .From the second trimester already appoint macrolides and cephalosporins.The duration of antibiotic treatment is on average ten to fourteen days.
Important! Together with antibiotics prescribe antiseptic drugs from the group of nitrofurans( Furagin).Plant uroantiseptics( Kanefron) are used as an additional treatment.One of these drugs without antibiotics to defeat pyelonephritis will not succeed.
If there is intoxication pregnant, detoxification therapy is carried out.To restore the passage of urine to a woman prescribed antispasmodics( Drotaverin, Papaverin).In addition, the best outflow of urine is facilitated by putting the pregnant woman on a healthy side with lifting the legs. For the same purpose, a woman is advised to take the knee-elbow position for ten minutes several times a day.At this time, you can flip through the magazine, watch the tablet to pass the time.
To accelerate recovery, you must follow a diet, limit the intake of meat and salt .Thus it is necessary to drink liquid in sufficient quantity.Especially it is necessary to pay attention to cranberry mors.This drink acidifies urine, which helps to inhibit microbes.Recommended to read:
Childbirth with pyelonephritis is performed through the birth canal.If a woman develops late gestosis and can not be eliminated by medications - the obstetrician-gynecologist conducts early childbirth. The question of termination of pregnancy is considered in renal failure or in the defeat of pyelonephritis of a single kidney.
Grigorova Valeria, medical reviewer