Management optimization of pregnant women with acute pyelonephritis

Close metadata

THE AIM OF THE STUDY

Was to justify the advisability of gestagens’ application in pregnant women with acute pyelonephritis (OP) and to evaluate their effectiveness in prevention of obstetric complications.

MATERIAL AND METHODS

The study included 145 pregnant women with OP. In group 1 (n=70) gestagens (micronized progesterone 100 mg or dydrogesterone 10 mg every 12 hours, orally) were used daily in a complex of therapeutic measures. In group 2 (n=75), a standard therapy was carried out: infusion, antibacterial, antispasmodic, herbal medicine, kidney stenting according to indications. 3rd group (n=50) represented by women with a physiological pregnancy development. The complex of examination included ultrasound examination with Doppler’s measurement, examination of serum steroid hormones’ concentration (progesterone, cortisol, dehydroepiandrosterone sulfate) and gravid proteins (trophoblastic beta-1-glycoprotein, placenta-specific alpha-1-microglobulin) by enzyme immunoassay.

RESULTS

Incidence of acute pyelonephritis during pregnancy leads to desynchronization of steroid hormones’ synthesis and gravid proteins, disorders of the utero-placental blood flow, which increase the number of placenta premature maturation (38.7%), pathology of amniotic fluid (32.0%), fetal growth retardation (24, 0%), gestational arterial hypertension (34.7%), preeclampsia (32.0%), and premature childbirth (28.0%). It has been proven that usage of gestagens allows timely and safely to correct the hormonal and hemodynamic disorders, preventing further progression of placental dysfunction and its negative impact on pregnancy development and its outcome.

CONCLUSION

The additional usage of gestagens in a complex of therapeutic applications in pregnant women with OP increases the effectiveness of therapy by reducing the incidence of complications and early termination of pregnancy. In pregnant women with OP who received progestogens, it is advisable to carry out further careful dynamic control of urine bacterial tests.

Keywords:

acute pyelonephritis

pregnancy

placental dysfunction

gestagens

Authors:

Khvorostukhina N.F.

Razumovsky Saratov State Medical University

Plekhanov A.A.

Razumovsky Saratov State Medical University

Kharlamov A.V.

Chernyshevsky Saratov National Research State University

Novichkov D.A.

Razumovsky Saratov State Medical University

Received:

28.04.2020

Accepted:

02.07.2020

List of references:

Olenev AS, Novikova VA, Radzinskii VE. World conceptual approaches to reduce maternal mortality. Akusherstvo i ginekologiya: novosti, mneniya, obuchenie. 2018;3:5-17. (In Russ.). https://www.elibrary.ru/item.asp?id=38468382
Schneeberger C, Geerlings SE, Middleton P, Crowther CA. Interventions for preventing recurrent urinary tract infection during pregnancy. Cochrane Database Syst Rev. 2015;26:7:CD009279. https://doi.org/10.1002/14651858.CD009279.pub3
Zhdanova AN, Pryanichnikova MB. Evaluation of the rationale of nefrectomy in pregnant women with purulent gestational pyelonephritis. Aspirantskii vestnik Povolzh’ya. 2019;1-2:157-162. (In Russ.). https://www.elibrary.ru/item.asp?id=41071796
Valent AM, Peticca K, DiMatteo A, Banks S, Shah R, Chernicky L, Weitz B, Armistead C, Hill J, Towers C, Lewis D, Magann EF, Chauhan SP, Hook JWV. Pyelonephritis in pregnancy: prediction of prolonged hospitalization and maternal morbidity using Prognostic Scoring Systems. Am J Perinatol. 2017;34:12:1212-1218. https://doi.org/10.1055/s-0037-1602418
Zanatta DAL, Rossini MM, Trapani Júnior A. Pyelonephritis in pregnancy: clinical and laboratorial aspects and perinatal results. Rev Bras Ginecol Obstet. 2017;39:12:653-658. https://doi.org/10.1055/s-0037-1608627
Gomi H, Goto Y, Laopaiboon M, Usui R, Mori R. Routine blood cultures in the management of pyelonephritis in pregnancy for improving outcomes. Cochrane Database Syst. Rev. 2015;13:2:CD009216. https://doi.org/10.1002/14651858.CD009216.pub2
Zyryanov AV, Frank MA, Gaitova MR, Murzin MO. Ozone therapy in the complex treatment of acute gestational pyelonephritis. Ural’skii Meditsinskii zhurnal. 2018;11:166:9122-126. (In Russ.). https://www.elibrary.ru/item.asp?id=36536681
Lokshin KL, Shirshov VN, Popko AS, Demidko YuL, Luchenkova ND. The current state of antibiotic resistance and the composition of pathogens of urinary tract infections in pregnant women. Vestnik urologii. 2018;6:2:13-20. (In Russ.). https://www.elibrary.ru/item.asp?id=35223424
Madan I, Than NG, Romero R, Chaemsaithong P, Miranda J, Tarca AL, Bhatti G, Draghici S, Yeo L, Mazor M, Hassan SS, Chaiworapongsa T. The peripheral whole-blood transcriptome of acute pyelonephritis in human pregnancy. J Perinat Med. 2014;42:1:31-53. https://doi.org/10.1515/jpm-2013-0085
Kokrdová Z, Pařízek A, Koucký M, Pašková A, Boudová B. Septic shock in pregnancy on the basis of an acute pyelonephritis. Ceska Gynekol Summer. 2016;81:4:286-288. https://pubmed.ncbi.nlm.nih.gov/27882751/?from
Lokshin KL. Upper urinary tract draining in acute gestational pyelonephritis: What for? Whom? For how long? Vestnik urologii. 2019;7:3:35-40. (In Russ.). https://elibrary.ru/item.asp?id=41213552
Styazhkina SN, Chernenkova ML, Abdullina IR, Mullakhetova LM, Omelina LV. Condition of placentae at gestational pyelonephritis. Modern problems of science and education. 2015;1-1. 22.04.20. (In Russ.). https://www.science-education.ru/ru/article/view?id=17686
Schneeberger C, Geerlings SE, Middleton P, Crowther CA. Interventions for preventing recurrent urinary tract infection during pregnancy. Cochrane Database Syst Rev. 2015;26:7:CD009279. https://doi.org/10.1002/14651858
Docheva N, Romero R, Chaemsaithong P, Tarca AL, Bhatti G, Pacora P, Panaitescu B, Chaiyasit N, Chaiworapongsa T, Maymon E, Hassan SS, Erez O. The profiles of soluble adhesion molecules in the «great obstetrical syndromes». J Matern Fetal Neonatal Med. 2018;1:1-24. https://doi.org/10.1080/14767058.2018.1427058
Khvorostukhina NF, Plekhanov AA, Stepanova NN, Novichkov DA. Method for preventing placental dysfunction in acute gestational pyelonephritis. Patent RF 2694514. Byul. 2019;20:13. (In Russ.). https://www.elibrary.ru/item.asp?id=39270152
Styazhkina SN, Vorob’eva AV, Makshakova NP, Sukhikh NV, Simanova AA. Gestational pyelonephritis: etiology, diagnostics, treatment. Tsentral’nyi nauchnyi vestnik. 2017;2:8:25:50-52. (In Russ.). https://www.elibrary.ru/item.asp?id=29006651
Zanatta DAL, Rossini MM, Trapani Júnior A. Pyelonephritis in pregnancy: clinical and laboratorial aspects and perinatal results. Rev Bras Ginecol Obstet. 2017;39:12:653-658. https://doi.org/10.1055/s-0037-1608627
Plekhanov AA, Khvorostukhina NF, Stepanova NN, Satueva EY, Mamedova MM. The influence of gestational pyelonephritis on the course and outcome of pregnancy. Modern problems of science and education. 2018;4. 21.04.20). (In Russ.). https://www.elibrary.ru/item.asp?id=36344959
Sevruk ES, Gustovarova TA. The possibilities of predicting acute gestational pyelonephritis by knowledge of etiopathogenesis. Smolenskii meditsinskii al’manakh. 2019;3:127-131. (In Russ.). https://elibrary.ru/item.asp?id=41213552.
Khvorostukhina NF, Stepanova NN, Novichkov DA, Mamedova GE. Features of hormonal homeostasis in miscarriage and premature birth. Mezhdunarodnyj zhurnal eksperimental’nogo obrazovaniya. 2015;12-13:445-446. (In Russ.). https://elibrary.ru/item.asp?id=25013538
García-Blanco A, Diago V, Serrano De La Cruz V, Hervás D, Cháfer-Pericás C, Vento M. Can stress biomarkers predict preterm birth in women with threatened preterm labor? Psychoneuroendocrinology. 2017;83:19-24. https://doi.org/10.1016/j.psyneuen.2017.05.021
Carp HJA. Progestogens and pregnancy loss. Climacteric. 2018;21:4:380-384. https://doi.org/10.1080/13697137.2018.1436166
Khvorostukhina NF, Salov IA, Novichkov DA. Prevention of placental dysfunction in pregnant women with acute appendicitis. Rossiiskii vestnik akushera-ginekologa. 2016;16:2:11-17. (In Russ.). https://www.elibrary.ru/item.asp?id=25769739
Khvorostukhina NF, Salov IA. Pregnancy and acute surgical diseases of the abdominal cavity: diagnostics, treatment, obstetric tactics. Saratov: Publishing house of Saratovskii state medical university. 2018;304. (In Russ.). https://www.elibrary.ru/item.asp?id=37118702
Belokrinitskaya TE, Frolova NI, Kolmakova KA, Pletneva VA. Infectious diseases in pregnancy as a risk factor of development the heavy preeclampsia. Sibirskoe meditsinskoe obozrenie. 2018;2:110:45-51. (In Russ.). https://www.elibrary.ru/item.asp?id=32880514
Khvorostukhina NF, Salov IA, Novichkov DA. Ways to reduce perinatal losses in pregnant women with acute pancreatitis. Akusherstvo i gynekologiya. 2017;5:50-57. (In Russ.). https://www.elibrary.ru/item.asp?id=29299509
Patel SS, Ludmir J. Drugs for the treatment and prevention of preterm labor. Clin Perinatol. 2019;46:2:159-172. https://doi.org/10.1016/j.clp.2019.02.001
Romero R, Yeo L, Miranda J, Hassan SS, Conde-Agudelo A, Chaiworapongsa T. A blueprint for the prevention of preterm birth: vaginal progesterone in women with a short cervix. J Perinat Med. 2013;41:1:27-44. https://doi.org/10.1515/jpm-2012-0272

Close metadata