Gestational pyelonephritis plays a major role in the development of life-threatening conditions in pregnant women: 30% of pregnant women with pyelonephritis have purulent-inflammatory complications, 10.3% develop bacteriotoxic shock. The main link in the pathogenesis of gestational pyelonephritis is a violation of urohemodynamics of the urinary tract with compression by the growing uterus, relaxation of their muscular apparatus under the influence of hormones and the obligatory condition — the presence of infectious agents. The article presents the peculiarities of the functioning of the urinary system during pregnancy and the principles of therapy of patients with acute gestational pyelonephritis and its life-threatening complication — urologic sepsis. A clinical observation is given as an example of management of pregnant women with urologic sepsis. It is shown that in time conservative treatment of a pregnant woman with adequately restored urine passage, coordinated work of a multidisciplinary team of doctors allowed to minimize severe septic complications in the patient, to obtain a favorable outcome of pregnancy and childbirth for both mother and newborn.