UTIs are common in pregnancy due to urinary stasis and dilation of the urinary tract. E. coli is the primary cause. Presentations include cystitis with suprapubic pain and dysuria, or pyelonephritis with fever and loin pain. Treatment involves antibiotics and treating asymptomatic bacteriuria. Renal impairment in pregnancy increases risks of pre-eclampsia, growth restriction, and premature delivery. Severe impairment over creatinine of 250 μmol/L is at high risk of permanent loss of renal function. Venous thromboembolism is a major risk in pregnancy due to increased clotting factors and decreased mobility, with manifestations of deep vein thrombosis and pulmonary embolism.

2. • UTI is defined as the presence of at least
100,000 organisms per milliliter of urine in an
asymptomatic patient.
• more than 100 organisms/mL of urine with
accompanying pyuria (> 7 white blood cells
[WBCs]/mL) in a symptomatic patient.

3. • Infections result from ascending colonization of
the urinary tract, primarily by existing vaginal,
perineal, and fecal flora.
• urinary retention caused by the weight of the
enlarging uterus
• urinary stasis due to progesterone-induced
ureteral smooth muscle relaxation.
• Blood-volume expansion is accompanied by
increases in the glomerular filtration rate and
urinary output

4. • Loss of ureteral tone combined with increased
urinary tract volume results in urinary stasis,
which can lead to dilatation of the ureters, renal
pelvis, and calyces.
• Urinary stasis and the presence of vesicoureteral
reflux predispose some women to upper urinary
tract infections (UTIs) and acute pyelonephritis.

5. • E.coli is the most common cause of urinary tract
infection (UTI).
• Cesarean delivery
• Preeclampsia

6. Presentation
• Cystitis(1%)- suprapubic pain,
frequency,dysuria,urgency,haematuria, proteinuria.
• Pyelonephritis(2%)- fever,rigor ,tachycardia, loin pain
,vomiting
Management
• The urine should be cultured at the booking visit, and
asymptomatic bacteriuria is treated.
• In pyelonephritis, treat with intravenous antibiotics.

7. • Affect 0.2% of pregnant women.
• Dependent on the degree of hypertension and
renal impairment.
• Creatinine level is more than 200 mmol/L.
• Occurs in late pregnancy

8. • Aetiology:
• 1. reflux nephropathy
• 2. diabetes
• 3. systemic lupus erythromatosus (SLE)
• 4.Glomerulonephritis.
• 5. polycystic kidney disease.
• Classification:
• mild, moderate or severe depending on the serum
creatinine.
• creatinine depends on the muscle mass i.e. a figure
representing moderate impairment in an 85-kg may
represent severe impairment for a 50-kg woman.

9. • - mild impairment (creatinine < 125 μmol/l):
tolerate pregnancy well with no renal function
deterioration.
• - severe renal impairment (creatinine > 250
μmol/l): at increased risk of permanent loss of
function during and after pregnancy and even
end stage of renal failure.

10. • 1. PET, IUGR, spontaneous and iatrogenic premature
delivery.
• - severe renal impairment + hypertension have < 50 %
chance of successful pregnancy because of severe,
early-onset of PET with severe IUGR.
• - premature delivery is justified in rapidly worsening
renal function to avoid dialysis even in the absence of
PET.
• 2. severe renal impairment → polyhydramnios and risk
of cord prolapse due to fetal polyuria in response to high
osmotic load from increased maternal urea.
• 3. nephrotic syndrome and heavy protienuria → severe
hypoalbuminria with associated risks of pulmonary
oedema and thrombosis.

11. MANAGEMENT
• Ultrasound for fetal growth
• Measurement of renal
function
• Screening for urinary
infection
• Control of hypertension
• Dialysis (severe)
PRESENTATION
• tiredness
• swollen ankles, feet or
hands (due to water
retention)
• shortness of breath
• nausea
• blood in the urine

12. • Pregnancy increases the risk of venous
thromboembolism (VTE) 4- to 5-fold over that in
the nonpregnant state.
• The 2 manifestations of VTE are deep venous
thrombosis (DVT) and pulmonary embolus (PE).
• Blood clotting factors are increased,fibrinolytic
activity is reduced and blood flow is altered by
mechanical obstuction and immobility.

13. • Women with inherited prothrombotic conditions
and those with a family or personal history are
prone to thromboses.
• Pulmonary embolus is important cause of
maternal death.

14. • DVT: leg pain and discomfort (the left is more
commonly affected), swelling, tenderness,
oedema, increased temperature and a raised
white cell count. There may also be abdominal
pain.
• PE: dyspnoea, pleuritic chest pain, haemoptysis,
faintness, collapse.

15. DIAGNOSIS
• In non-pregnant women
Chest x-ray
Arterial blood gas analysis
Computed tomography
VQ scanning
urgent compression
duplex ultrasound scan.
MANAGEMENT
• Treated with
subcuatneous LMWH.
• Doses are adjusted
according to the anti-
Factor 10a.
• Treatment should be stop
before labour and
restarted and continued
into the puerperium.