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Low birth weight
0%
0/18
Pre-eclampsia
6%
1/18
Postpartum hemorrhage
Preterm labor
94%
17/18
Post-term labor
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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.
5.0
(3)
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