Does the risk of serious complications warrant hospitalization for all pregnant women with pyelonephritis?

OBJECTIVE: To determine the incidence of serious complications from pyelonephritis in pregnancy despite an aggressive management approach including hospitalizalion. METHODS: All women diagnosed with acute pyelonephritis during pregnancy since June 1993 have been evaluated. All underwent aggressive therapy including IV antibiotics and hospitaliJ.ation. Medical history, presentation characteristics, hospital course and pregnancy outcome were analy/ed. Specific medical complications examined included sepsis, pulmonary edema, ARDS, persistent fever, and need for diagnostic/therapeutic techniques (renal ultrasound, IVP, stents, etc.) Immediate pregnancv complications evaluated included spontaneous abortion or IUFD during their hospital course. RESULTS: 168 women with acute pyelonephritis in pregnancy have been evaluated to date. 90% became afebrile within 72 hours and recovered uneventfully. Although 10% required further evaluation for persistent fever (9% renal U/S, 1% IVP), only one woman (0.6%) had obstruction requiring intervention (nephrostomy). Bacteremia was common (13%) but sepsis occurred in only one case (0.6%). Respirator)- complications were likewise quite infrequent (pulmonary edema 1%, ARDS 0.6%). No immediate pregnancy complications occurred. Overall, serious complications occurred in <2% of women diagnosed with acute pyelonephritis in pregnancy. CONCLUSION: Serious complications are rare when pyelonephriiis in pregnancy is treated aggressively with hospitali/ation and IV antibiotics. Other management approaches (outpatient therapy, oral antibiotics) must be cautiously scrutinized for any increase in complication rates.