Objective. Pyelonephritis is a common cause of antepartum admission and maternal morbidity. Medical complications associated with pyelonephritis during delivery are not well described; thus the objective of this study was to estimate medical, infectious, and obstetric complications associated with pyelonephritis during the delivery admission. Study Design. We conducted a retrospective cohort study using the Nationwide Inpatient Sample (NIS) for the years 2008–2010. The NIS was queried for all delivery-related discharges. During the delivery admission, the ICD-9-CM codes for pyelonephritis were used to identify cases and were compared to women without pyelonephritis. A multivariable logistic regression model was constructed for various medical, infectious, and obstetric complications among women with pyelonephritis compared to women without, while controlling for preexisting medical conditions and demographics. Results. During the years 2008–2010, there were 26,397 records with a diagnosis of pyelonephritis during the delivery admission, for a rate of 2.1 per 1000 deliveries. Women with pyelonephritis had increased associated risks for transfusion, need for mechanical ventilation, acute heart failure, pneumonia, pulmonary edema, acute respiratory distress syndrome, sepsis, acute renal failure, preterm labor, and chorioamnionitis, while controlling for preexisting medical conditions. Conclusions. Pyelonephritis at delivery admissions is associated with significant medical and infectious morbidity. 1. Introduction Pyelonephritis during pregnancy has the potential to cause serious morbidity to the pregnant woman. It is the most common nonobstetric indication for antepartum hospitalization, and its associated risk factors, diagnosis, and management in the antepartum period are well described [1–4]. Serious morbidity associated with pyelonephritis in pregnancy is common. Sepsis and septic shock occur secondary to pyelonephritis more frequently than secondary to any other infectious process during pregnancy [5]. Acute respiratory distress syndrome complicates approximately 1–8.5% of pyelonephritis cases [6, 7]. Frequently, an admission to an intensive care unit is necessary. While the implications of pyelonephritis in the antepartum period are well described, there is little data about outcomes and complications when pyelonephritis occurs at the time of delivery [1–3, 8–11]. As these studies describe outcomes of pregnancies complicated by pyelonephritis, none of these describe specifically outcomes of patients who deliver during the admission during which they
References
[1]
F. G. Cunningham, G. B. Morris, and A. Mickal, “Acute pyelonephritis of pregnancy: a clinical review,” Obstetrics and Gynecology, vol. 42, no. 1, pp. 112–117, 1973.
[2]
L. C. Gilstrap III, F. G. Cunningham, and P. J. Whalley, “Acute pyelonephritis in pregnancy: an anterospective study,” Obstetrics and Gynecology, vol. 57, no. 4, pp. 409–413, 1981.
[3]
J. B. Hill, J. S. Sheffield, D. D. McIntire, and G. D. Wendel Jr., “Acute pyelonephritis in pregnancy,” Obstetrics and Gynecology, vol. 105, no. 1, pp. 18–23, 2005.
[4]
L. C. Gilstrap III and S. M. Ramin, “Urinary tract infections during pregnancy,” Obstetrics and Gynecology Clinics of North America, vol. 28, no. 3, pp. 581–591, 2001.
[5]
C. C. Snyder, J. R. Barton, M. Habli, and B. M. Sibai, “Severe sepsis and septic shock in pregnancy: indications for delivery and maternal and perinatal outcomes,” The Journal of Maternal-Fetal & Neonatal Medicine, vol. 26, no. 5, pp. 503–506, 2013.
[6]
F. G. Cunningham, M. J. Lucas, and G. D. V. Hankins, “Pulmonary injury complicating antepartum pyelonephritis,” American Journal of Obstetrics and Gynecology, vol. 156, no. 4, pp. 797–807, 1987.
[7]
L. Galajdova, “Pulmonary dysfunction in acute antepartum pyelonephritis and other pregnancy infections,” Journal of Obstetrics and Gynaecology, vol. 30, no. 7, pp. 654–658, 2010.
[8]
P. Sharma and L. Thapa, “Acute pyelonephritis in pregnancy: a retrospective study,” Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 47, no. 4, pp. 313–315, 2007.
[9]
E. H. Kass, “Pyelonephritis and bacteriuria. A major problem in preventive medicine,” Annals of internal medicine, vol. 56, pp. 46–53, 1962.
[10]
E. Farkash, A. Y. Weintraub, R. Sergienko, A. Wiznitzer, A. Zlotnik, and E. Sheiner, “Acute antepartum pyelonephritis in pregnancy: a critical analysis of risk factors and outcomes,” European Journal of Obstetrics Gynecology and Reproductive Biology, vol. 162, no. 1, pp. 24–27, 2012.
[11]
J. C. Dawkins, H. M. Fletcher, C. A. Rattray, M. Reid, and G. Gordon-Strachan, “Acute pyelonephritis in pregnancy: a retrospective descriptive hospital based-study,” ISRN Obstetrics and Gynecology, vol. 2012, Article ID 519321, 6 pages, 2012.
[12]
Healthcare Cost Utilization Project HCUP, “Overview of the Nationwide Inpatient Sample (NIS),” http://www.hcup-us.ahrq.gov/nisoverview.jsp, 2013.
[13]
A. H. James, C. D. Bushnell, M. G. Jamison, and E. R. Myers, “Incidence and risk factors for stroke in pregnancy and the puerperium,” Obstetrics and Gynecology, vol. 106, no. 3, pp. 509–516, 2005.
[14]
A. H. James, M. G. Jamison, M. S. Biswas, L. R. Brancazio, G. K. Swamy, and E. R. Myers, “Acute myocardial infarction in pregnancy: a United States population-based study,” Circulation, vol. 113, no. 12, pp. 1564–1571, 2006.
[15]
A. Belkin, A. Levy, and E. Sheiner, “Perinatal outcomes and complications of pregnancy in women with immune thrombocytopenic purpura,” The Journal of Maternal-Fetal & Neonatal Medicine, vol. 22, no. 11, pp. 1081–1085, 2009.
[16]
S. Yasmeen, P. S. Romano, M. E. Schembri, J. M. Keyzer, and W. M. Gilbert, “Accuracy of obstetric diagnoses and procedures in hospital discharge data,” American Journal of Obstetrics and Gynecology, vol. 194, no. 4, pp. 992–1001, 2006.
