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Query: UMLS:C0034186 (pyelonephritis)
 6,144 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hypertensives in pregnancy are not so grossly distinct and different from adult hypertensives if reference is made to the underlying arterial anomalies and malformations of the parenchyma and their incidence. It is, however, in this group that the limited way in which the active remnant of parenchyma, once constrained by these anomalies, can compensate for the changes in pressure and volume sensitivity imposed by pregnancy is most evident; these changes may be caused by pyelonephritis of pregnancy (genuine but rare), eclampsia of the primigravida, progressive hypertension in the multigravida, or certain cases of late hypertension, menopausal hypertension, or hypertension as a late result of a simple juvenile eclampsia. This series contains a particularly high percentage (21%) of cases of hypertension due to unilateral renal arterial ischaemia which are curable.
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PMID:[Renal arteries and renal parenchyma in arterial hypertension in pregnancy]. 82 57

Comparative evaluation of renal performance was conducted in 68 pregnant patients with nephropathies, stages I-II (first group) and in 53 pregnant females with nephropathy, stage III, associated with eclampsia (second group). Out of those 53 women, 28 patients suffered from combined gestosis in presence of chronic pyelonephritis and 25, in presence of chronic arterial hypertension. 20 females with normal pregnancy served as controls. In those with pregnancy complicated by nephropathies, stage I-II, the author revealed higher levels of blood plasma osmolality and its constituents in parallel with a significant decrease in concentration and clearance parameters of renal function. The latter resulted in statistically reliable increase in the urine concentration and clearance values. To avoid errors in the infusion therapy it was found necessary to carry out testing of renal functioning with the use of dosaged fluid load.
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PMID:[Urinary concentration and clearance indicators in pregnant women with gestosis]. 274 58

Plasma antithrombin III (AT III) activity was examined retrospectively in patients with preeclampsia-eclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia-eclampsia. Levels of AT III were greater than 1 SD below normal pregnant control in each case of preeclampsia-eclampsia syndrome. The degree of reduction in plasma AT III activity was correlated with the severity of disease. AT III activity was within normal limits in patients with chronic hypertension. AT III activity dropped prior to the appearance of clinically evident disease in three patients who were followed from an early gestational age. In no instance was low plasma AT III activity associated with normal pregnancy. Coincidental disease, including pyelonephritis and a viral syndrome, were associated with markedly decreased levels of plasma AT III activity in otherwise normal pregnancies. Plasma AT III activity may be valuable as a tool in diagnosing preeclampsia-eclampsia, as a screening test for preclinical preeclampsia-eclampsia, and as an indicator of severity of disease.
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PMID:Plasma antithrombin III activity: an aid in the diagnosis of preeclampsia-eclampsia. 706 16

All maternal deaths which occurred in relation to labour at the Department of Obstetrics and Gynaecology, University Hospital, Graz, between 1963 and 1978 were reviewed and analysed. 24 mothers died over this 15-year period. The maternal death rate was 0.34 per thousand. In all cases a post mortem examination was performed. The youngest woman was 19, the oldest 42 years old. Most of the decreased mothers were primiparae. The main cause of maternal death was post-partum haemorrhage, followed by infection of the uterus especially after Caesarean section. Three mothers died of liver distrophy. The remaining causes were eclampsia (2 cases); pulmonary artery embolism after Caesarean section (2 cases); irreversible shock from amniotic fluid and air embolism (one case each); uraemia due to glomerulo- or pyelonephritis (one case each); malignant melanoma (one case). It is demonstrated that special risk factors are advanced maternal age, low social status and lack of antenatal care.
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PMID:[Clinical pathological analysis of peripartum maternal mortality (author's transl)]. 726 12

528 pregnancies of primiparous girls 13-17 years old who gave birth during 1988-90 at the obstetrical ward of the city of Pleven, Bulgaria, were evaluated. The pregnancy outcome and neonatal results were compared with those of 100 controls. These 528 births amounted to 5.48% of a total of 9635 births at the clinic. These girls were of low socioeconomic status, 14.2% were illiterate or had low educational attainment, and 56.42% were of Gypsy origin, without skills, and from rural areas. Only 32.89% of the Bulgarian girls had an official marriage license. Anemia was found in 13.64%, kidney infection (without symptoms of bacteriuria, pyelonephritis) in 6.44%, preeclampsia in 2.46%, and eclampsia in 0.76%. The most frequent occurrence was premature rupture of the membrane (9.85%). Term deliveries numbered 433 and preterm deliveries 95. There was a statistically significant difference between the two groups with respect to term and preterm deliveries (p 0.01). Dystocia amounted to 2.8% and instrumental delivery to 1.70% among these adolescent girls. The rate of premature delivery reached 17.99%, and cesarean section was performed in 5.44%. There was a significant difference between the two groups with respect to vaginal delivery (p 0.01) and cesarean section (p 0.01). 44% of 16-year old girls underwent cesarean section; and there was a significant difference in the rate of cesarean section between 14-year-old and 17-year-old girls (p 0.05) as well as between 16-year-old and 17-year-old girls (p 0.01). 71.95% of newborns had a birth weight of less than 3000 g. There was also a significant difference between the groups with regard to term and prematurely born neonates (p or = 0.01). Intrauterine growth retardation reached 2.46% because of the inadequate uterine size of girls 13-14 years old, insufficient weight gain during pregnancy (under 9 kg), and complications (preeclampsia and eclampsia). The rate of stillbirths was 7.63%, attributed to prematurity and malformation of the fetus. Maternal mortality reached 1.89% owing to pregnancy complications (eclampsia) among 17-year old girls because of low socioeconomic status and complete lack of prenatal care.
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PMID:[Pregnancy and labor in young girls]. 779 32

The analysis of 24 patients with recurrent eclampsia showed that (i) the first attack complicated the second or later pregnancies in nine cases, (ii) there was one or more apparently normal gestations before the second eclampsia in one-third of the patients, (iii) total maternal and neonatal mortality were twice those of general eclampsia, (iv) four autopsies revealed chronic pyelonephritis and cardiac hypertrophy in addition to the characteristic glomerular and hepatic lesions, (v) all six deaths were due to brain damage, and (vi) chronic hypertension was diagnosed in half of the survivors. The results of this study demonstrate that (i) one or several normal pregnancies after eclampsia do not cancel the possibility of another attack, (ii) recurrent eclampsia is an extremely severe event even though most clinical data are no different from general eclampsia, (iii) underlying diseases seem to play a decisive role, and (iv) some aspects of recurrent eclampsia challenge single cause pathogenic mechanisms.
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PMID:Recurrent eclampsia. Clinical data, morbidity and pathogenic considerations. 836 33

The procedures and examinations included in currently practiced prenatal care have not been subjected to systematic, scientifically rigorous evaluation. The World Health Organization (WHO) Antenatal Care Randomized Controlled Trial is evaluating a new prenatal care regimen with demonstrated efficacy in improving maternal and newborn outcomes. Program activities include screening for health conditions that increase the risk of specific adverse pregnancy outcomes, therapeutic interventions known to affect these outcomes beneficially, and education of pregnant women regarding potential health emergencies and appropriate responses. The study's hypothesis is that the tests, clinical procedures, and follow-up actions associated with this approach, delivered over the course of four visits during pregnancy, are more effective than the traditional prenatal care package in terms of specific maternal and perinatal results without being more expensive. This paper addresses the rationale, design, and methodology of this trial. 53 prenatal care clinics in four well-defined geographic areas (Khon Kaen Province, Thailand; Havana, Cuba; Rosario, Argentina; and Jeddah, Saudi Arabia) have been randomized to the two arms of the study. By the end of 1997, 24,000 women presenting for prenatal care at these sites had been enrolled. The primary maternal outcome is the morbidity indicator index, defined as the presence of at least one of the following conditions: pre-eclampsia or eclampsia during pregnancy or within 24 hours of delivery, postpartum anemia, or severe urinary tract infection/pyelonephritis. The primary fetal outcome is the rate of low birth weight. A comprehensive cost-effectiveness analysis and provider satisfaction evaluation will be performed concurrently with the trial. Data collection will be completed in 1998.
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PMID:The WHO antenatal care randomised controlled trial: rationale and study design. 980 22

Pre-eclampsia associated with chronic pyelonephritis is not uncommon, but recurrent eclampsia in two successive pregnancies associated with chronic pyelonephritis is very rare. We present one such rare case where a patient had recurrent eclampsia with chronic pyelonephritis.
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PMID:Recurrent eclampsia in a woman with chronic pyelonephritis. 1116 45

Adolescent pregnancy increases the risk of pregnancy complications, low birth weight (LBW), and infant mortality. Complications include urinary tract infections, acute pyelonephritis, and preeclampsia. Full eclampsia is often fatal, thus preeclamptic women are delivered immediately. LBW (below 2500 g) is caused by prematurity and intrauterine growth retardation, both of which factors are associated with adolescence. In 1989, approximately 7% of all live births in the US were LBW (5.7% White and 13.5% Black). A large sample of births in 1975-78 found increased risk of neonatal mortality for the infants of adolescents, possibly owing to higher rates of LBW. In 1991, a random sample of 389 adolescent mothers who had given birth in 1983 indicated a 54% rate of depression, and even higher rates existed among those with 2 or more pregnancies. Additional risk factors include socioeconomic circumstances (poor housing, nutrition, and cultural deprivation). In a 1991 study of adolescent mothers, 80% of Blacks and 57% of Whites lived in female-headed households. Of the total, 1% of Blacks and 25% of Whites were married and living together. 45% of Whites and 58% of Blacks lived in poverty. Only 44% of these women used prenatal care in the 1st trimester, and 11% had no regular source of health care at 15-18 months after childbirth. A 1989 study of 253 pregnant women aged 19 or younger showed that 52.2% admitted drinking alcohol, 31.6% admitted using marijuana, and 13.8% admitted using cocaine during pregnancy. Nutritional problems included skipping meals and eating junk food, as well as not getting enough food, although they were entitled to government food stamps. Immaturity and lack of knowledge also contributed to poor health. Prenatal clinics, school-based clinics, and hospitals have to encourage prenatal care (e.g., the Johns Hopkins University comprehensive maternity-care program for adolescents), treat depression, assess their concrete needs regarding services and eligibility, and recognize that adolescents have cognitive and emotional limitations.
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PMID:Health effects of adolescent pregnancy: implications for social workers. 1231 42

Critical illness is an uncommon but potentially devastating complication of pregnancy. The majority of pregnancy-related critical care admissions occur postpartum. Antenatally, the pregnant patient is more likely to be admitted with diseases non-specific to pregnancy, such as pneumonia. Pregnancy-specific diseases resulting in ICU admission include obstetric hemorrhage, pre-eclampsia/eclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, amniotic fluid embolus syndrome, acute fatty liver of pregnancy, and peripartum cardiomyopathy. Alternatively, critical illness may result from pregnancy-induced worsening of pre-existing diseases (for example, valvular heart disease, myasthenia gravis, and kidney disease). Pregnancy can also predispose women to diseases seen in the non-pregnant population, such as acute respiratory distress syndrome (for example, pneumonia and aspiration), sepsis (for example, chorioamnionitis and pyelonephritis) or pulmonary embolism. The pregnant patient may also develop conditions co-incidental to pregnancy such as trauma or appendicitis. Hemorrhage, particularly postpartum, and hypertensive disorders of pregnancy remain the most frequent indications for ICU admission. This review focuses on pregnancy-specific causes of critical illness. Management of the critically ill mother poses special challenges. The physiologic changes in pregnancy and the presence of a second, dependent, patient may necessitate adjustments to therapeutic and supportive strategies. The fetus is generally robust despite maternal illness, and therapeutically what is good for the mother is generally good for the fetus. For pregnancy-induced critical illnesses, delivery of the fetus helps resolve the disease process. Prognosis following pregnancy-related critical illness is generally better than for age-matched non-pregnant critically ill patients.
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PMID:Clinical review: Special populations--critical illness and pregnancy. 2223 12


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