Asthma and Renal Disease in Pregnancy

Question 1

Do all pregnant women have UTIs?

Answer 1

No but asymptomatic bacteriuria is very common in sexually active and pregnant women, especially in diabetics. Women have an MSU very regularly for protein but attention should be paid to white cells and nitrites too as the dilation of renal calyces and ureters increases the risk of pyelonephritis.

Question 2

How should UTI’s be treated during pregnancy?

Answer 2

Cefalaxin (500mg TDS PO)
Nitrofurantoin (avoid in 3rd trimester)
Trimethoprim (avoid 1st trimester)

Question 3

Why is pylonephritis more common in pregnancy?

Answer 3

More common due to dilation of calyces and ureters and common bacteriuria

Question 4

What complications can occur due to pyelonephritis in pregnancy?

Answer 4

IUGR
Foetal death
Premature labour

Question 5

How does pylonephritis present in pregnancy?

Answer 5

Malaise 
Back pain 
Frequency 
Raise temperatures 
Tachycardia
Vomiting

Question 6

How should pylonephritis be managed in pregnancy?

Answer 6

Blood and urine cultures
IV antibiotics – cefuroxime 1.5g/8hr IV
If septic stat dose of Gentamicin

If two or more confirmed UTIs in pregnancy then perform renal USS and consider antibiotic prophylaxis for the duration of pregnancy

Question 7

What can commonly cause AKI’s in pregnancy?

Answer 7

Sepsis, haemolysis (HEELP), hypovolaemia, volume contraction, and drugs

Question 8

How is asthma effected by pregnancy?

Answer 8

Usually remained unchanged during pregnancy but may worsen. If severe or poorly controlled during pregnancy it may result in foetal growth restriction and preterm labour.

Question 9

How should asthma be managed in pregnnacy?

Answer 9

Prevent acute attacks (but rare in pregnancy due to high steroid)
Follow standard guidelines for treatment
Most medication is safe but do not start leukotriene receptor antagonists
Check inhaler technique and encourage cessation of smoking