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

The development of pulmonary injury in cases of antepartum pyelonephritis is rare but serious. To date, factors that might identify patients at risk have not been determined. We compared 11 patients with pyelonephritis and pulmonary injury with 119 patients with pyelonephritis only. Pulmonary injury was more likely to occur in the more severe cases; however, the presence of a maternal heart rate greater than 110 beats/min and a fever to 103 degrees F 12 to 24 hours before the occurrence of respiratory symptoms in a gestation greater than 20 weeks was highly predictive of pulmonary injury. The most significant predictive factors associated with pulmonary injury were elements of treatment such as fluid overload, use of tocolytic agents, and, to a lesser extent, choice of antibiotic. Therefore, if tocolytic agents are considered at all in the management of acute pyelonephritis in pregnancy, they should be used only in patients with documented cervical change. In addition, urinary output should be monitored very closely. These data also may suggest a cause of the pulmonary edema that is occasionally seen in the management of premature labor with the use of tocolytic agents and fluids in the presence of a possible occult infection.
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PMID:Pulmonary injury associated with antepartum pyelonephritis: can patients at risk be identified? 201 49

We contacted 256 members of the Society for Pediatric Urology to determine their experience with patients who had undergone augmentation cystoplasty and who later became pregnant and delivered a baby. There were 15 pregnancies in 15 patients. Urinary tract infection or pyelonephritis complicated 9 of the 15 pregnancies (60%) and 4 patients experienced premature labor. Serum creatinine levels remained stable throughout pregnancy in 14 patients. Delivery was vaginal in 10 patients, each of whom had the native continence mechanism intact, and by cesarean section in 5, of whom 3 had had prior surgical reconstruction of the vesical neck. There were no intraoperative or postoperative complications. As a consequence of this study, we recommend that patients who have had an enterocystoplasty alone should not be at an increased risk for incontinence from a vaginal delivery. Conversely, patients who have undergone augmentation cystoplasty and either vesical neck reconstruction or placement of an artificial genitourinary sphincter to attain continence should undergo cesarean section delivery to avoid the potential for disruption of the continence mechanism.
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PMID:Management of pregnancy after augmentation cystoplasty. 237 20

The possibility that infection can cause premature labor is appealing. If true, antibiotics treat the cause, in contrast to tocolytic agents, which treat symptoms. There is strong evidence that infection is a factor in premature labor. Historical data from the preantibiotic era in patients with pyelonephritis and pneumonia support this. Vaginal bacterial colonization studies and amniotic fluid studies indicate that a portion of women with preterm labor have an identifiable microbiologic profile. Preliminary reports on antibiotic intervention in asymptomatic women and women in premature labor are encouraging. This may be the dawn of a new era in the diagnosis and treatment of preterm labor.
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PMID:Infection and premature labor. 271 21

A number of organisms, including Mycoplasma, group B Streptococcus, Bacteroides, Neisseria gonorrhoeae and Chlamydia trachomatis, have been isolated more frequently from patients in premature labor than from controls. Prophylactic antibiotic treatment in some studies lowered the incidence of prematurity. Silent chorioamnionitis has been noted in 15% of patients in premature labor. Untreated pyelonephritis is clearly associated with premature labor; however, the association of asymptomatic bacteriuria, appropriately treated pyelonephritis and premature labor is less clear. Some microorganisms have been demonstrated to produce phospholipase A2 and possibly prostaglandins, which might be the mechanism for some of the associations between premature labor and bacteria.
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PMID:Microorganisms and premature labor. 327 13

Bacteriuria during pregnancy may result in serious complications, including development of acute pyelonephritis in the third trimester and premature labor. Because uninfected women commonly experience symptoms associated with urinary tract infections and many bacteriuric women are asymptomatic, all pregnant women should be screened by quantitative urine cultures. The goal of antimicrobial therapy is complete elimination of bacteria from the urinary tract. Major indications for complete urologic evaluation are failure of a patient with signs of acute upper-tract infection to improve on appropriate treatment and bacterial persistence after initial sterilization of the urine. Either problem may require surgical intervention.
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PMID:Complications and treatment of urinary tract infections during pregnancy. 353 10

Uterine unicollis bicornis with one rudimentary horn is a rare event. A case is presented of an infected rudimentary system existing with an intrauterine pregnancy. The differential diagnosis of appendicitis, chorioamnionitis, premature labor, and pyelonephritis makes management of such cases difficult. The successful outcome of one such case is presented.
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PMID:Uterine horn abscess complicating pregnancy. 371 39

Four pregnancies in three patients with spinal cord injury are presented. The major complications encountered include anemia, pyelonephritis, decubiti, premature labor, precipitate labor, and autonomic hyperreflexia. Autonomic hyperreflexia, a severe mass autonomic reflex response to labor, is associated with tachycardia, hypertension, headache, diaphoresis, and severe anxiety. It is probably due to increased norepinephrine release, as very high urinary metanephrines were measured in the latter two cases presented. Maternal and fetal physiology in labor are altered. Despite severe maternal and fetal stress responses, no fetal depression was observed.
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PMID:Pregnancy after spinal cord injury: altered maternal and fetal response to labor. 685 24

The first part consisted of a prospective study dealing with a series of 170 pregnancies during which cyto-bacteriological examination of urine was carried out in the 3rd, 5th, 7th and 9th months of pregnancy. Whenever bacteriuria was found it was treated. Those women found to be infected in pregnancy were re-examined bacteriologically and radiologically after delivery. A control series consisted of 200 pregnant women whose urines were not examined in this way unless they had clinical signs. In the first series 39 out of 170 women had at least one positive cyto-bacteriological test. 56 out of 638 examinations were abnormal. 50 had asymptomatic bacteriuria. No patient had any sign of acute pyelonephritis. In the control series 16 of the women had at least one positive cyto-bacteriological test. In all 21 tests were carried out (18 before signs of cystitis developed and 3 before symptoms of acute pyelonephritis). Treating asymptomatic bacteriuria is worth while because it helps to lower the incidence of pyelonephritis. There did not seem to be any relationship between premature labour, fetal mortality and maternal urinary pathology. Tests carried out at two definite intervals in pregnancy would seem to be a sufficient screening for preventing pyelonephritis and would be acceptable from the cost angle.
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PMID:[Importance of systematic research of urinary infection in pregnant women and the cost of its detection. Proposal for a practical approach]. 688 22

To evaluate the impact of renal infection on pregnancy outcome, we studied a group of pregnant women with asymptomatic renal bacteriuria and another group who had acute pyelonephritis. In 248 women with asymptomatic bacteriuria, infection was localized by the antibody-coated bacteria method. These women were prospectively matched with abacteriuric control subjects and we found no adverse effects of treated renal or bladder infection. Specifically, the number of women with hypertension and anemia in each group was similar, and infants born to these women were comparable regarding perinatal mortality, mean gestational age, and birth weight, as well as indices of maturity. A total of 487 women with acute pyelonephritis were evaluated in a case-control study and observations of the correlation of maternal anemia and pyelonephritis were confirmed. Women with antepartum infection had no increased adverse perinatal outcome; however, in some women with intrapartum infection, pyelonephritis appeared to have initiated premature labor. We concluded that treated renal infection, whether symptomatic or asymptomatic, does not significantly modify pregnancy outcome.
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PMID:Renal infection and pregnancy outcome. 731 97

In the Swiss Study "HIV and pregnancy" we observed 153 singleton pregnancies of HIV-positive women. 23 (15%) of those ended with a premature delivery. For drug addicts (n = 100), the incidence of prematurity, 20%, significantly higher than in those free of drugs (n = 53) with 5.6%. The most frequent cause of prematurity was premature labor or rupture of the membranes (n = 13), followed by maternal illness (n = 8) and fetal complications (n = 2). Women with premature delivery tended to have lower CD4 cell counts than those with term delivery (29.4% vs 12.0% with < 200 CD4 cells/microliters). Low CD4 cell counts and drug consumption are two independent but cumulative risks for severe infections. 16 of the 153 women (12 with, 4 without drug consumption) had severe infections during pregnancy; in 4 cases (25%), this led to prematurity. The most common infection was pneumonia (14/16), further one case of pyelonephritis and one of cerebral toxoplasmosis. Two of these 16 infants (12.5%) were HIV-positive. We could not confirm a relationship between prematurity and vertical HIV transmission. Of the HIV-classified children, 3/18 (16.7%) premature infants and 16/74 (21.6%) term infants were infected.
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PMID:[Premature labor in HIV infected women. Swiss "HIV and Pregnancy" Study Group]. 778 79


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