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Review Question - QID 107218

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QID 107218 (Type "107218" in App Search)
A 32-year-old G2P2 at 33 weeks and 4 days of gestation presents to the emergency room with low-grade fever, mild low back pain, and dysuria for 1 day. She has a history of urinary tract infections, including one during this current pregnancy that was treated successfully with cephalexin. On examination, she is nontoxic but mildly uncomfortable; she has CVA tenderness on her right side. Her urinalysis is positive for leukocyte esterase and nitrites, and she is admitted to the hospital for IV antibiotics with ceftriaxone. Her present condition places her at increased risk for which of the following:

Low birth weight

0%

0/18

Pre-eclampsia

6%

1/18

Postpartum hemorrhage

0%

0/18

Preterm labor

94%

17/18

Post-term labor

0%

0/18

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This patient presents with a clinical history consistent with pyelonephritis. Pyelonephritis increases the risk for preterm labor.

Infectious complications within pregnancy are a high-yield topic for USMLE. One needs to know the specific antibiotics that are safe in pregnancy, and the indications for their use. In this instance, the patient presents with pyelonephritis and receives IV cetriaxone, a first-line agent for mild-moderate pyelonephritis during pregnancy. Having pyelonephritis places her at increased risk for developing preterm labor. Interestingly, because the recurrence rate for pyelonephritis is so high, some experts recommend continuous prophylaxis with an oral agent for the duration of pregnancy after completing an IV course.

Delzell and Lefevre review urinary tract infections during pregnancy. They state that the most common organism isolated is E. Coli. Owing to the risk of subsequent cystitis and pyelonephritis, even asymptomatic women during pregnancy should be screened for infection and treated if found.

Wing et al. conducted a retrospective review of cases of pyelonephritis over an 18-year period. They confirmed the risk for subsequent pre-term birth in this patient group. They also found increased risk for acute kidney injury, development of sepsis, and respiratory insufficiency.

Incorrect answers:
Answers 1-3, 5: There is no known association between pyelonephritis and low birth weight, pre-eclampsia, postpartum hemorrhage, or post-term labor.

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