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Am J Perinatol 2017; 34(12): 1212-1218
DOI: 10.1055/s-0037-1602418
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pyelonephritis in Pregnancy: Prediction of Prolonged Hospitalization and Maternal Morbidity using Prognostic Scoring Systems

Amy M. Valent
1   Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
,
Katie Peticca
2   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Alexandra DiMatteo
3   Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia
,
Shimeka Banks
4   Department of Obstetrics and Gynecology, Baptist Health Systems, Flowood, Mississippi
,
Ronak Shah
5   Department of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, Little Rock, Arkansas
,
Lindsey Chernicky
6   Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, Tennessee
,
Beth Weitz
6   Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, Tennessee
,
Casey Armistead
7   Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Alabama
,
James Hill
8   Department of Obstetrics and Gynecology, Baylor College of Medicine, San Antonio, Texas
,
Craig Towers
6   Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, Tennessee
,
David Lewis
9   Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Louisiana
,
Everett F. Magann
5   Department of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, Little Rock, Arkansas
,
Suneet P. Chauhan
10   Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Sciences Center at Houston, Houston, Texas
,
James W. Van Hook
11   Department of Obstetrics and Gynecology, University of Toledo, Toledo, Ohio
› Author Affiliations
Further Information

Publication History

06 July 2016

22 March 2017

Publication Date:
25 April 2017 (online)

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Abstract

Objective This study aims to evaluate the usefulness of prognostic scoring systems to differentiate women admitted for pyelonephritis who develop maternal morbidity and require prolonged hospitalization.

Study Design Multicenter retrospective cohort study to compare the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Modified Obstetric Early Warning System (MOEWS) to predict prolonged hospitalization (> 4 days) and composite maternal morbidity for all pregnant women admitted with pyelonephritis between 2012 to 2013. One-way analysis of variance for continuous variables, Fisher's exact test for categorical variables, and receiver operating characteristic curves were used.

Results Among 123 pyelonephritis cases analyzed, 25 (20%) required prolonged hospitalization. Women with prolonged hospitalization had higher rates of composite maternal morbidity, required diagnostic imaging, and had delayed administration of intravenous antibiotics (292 ± 381 vs. 218 ± 233 min, p = 0.002). APACHE II and MOEWS scores calculated from data collected within the first 24 hours of admission had a modest ability to discriminate maternal morbidity (APACHE II: area under the curve [AUC], 0.72; 95% confidence interval [CI], 0.58–0.86 and MOEWS: AUC, 0.71; 95% CI, 0.56–0.85).

Conclusion We observed that one in five pregnancies admitted for treatment of pyelonephritis requires hospitalization for over 4 days with significant maternal morbidities. Prognostic scoring systems may be useful clinical tools to assess these patients systematically and improve morbidity.

Keywords

pyelonephritis - prognostic scoring systems - morbidity - prolonged hospitalization - pregnancy

Note

This research was presented as an oral presentation at the 82nd Annual Central Association of Obstetricians & Gynecologists 2015 Meeting; October 21–24, 2015; Charleston, SC.


 

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