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Acute pyelonephritis in pregnancy — SCE Acute Medicine MCQ

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ModerateSepsis and Infectious EmergenciesAcute pyelonephritis in pregnancySCE Acute Medicine

A 26-year-old woman presents with fever, flank pain and vomiting. She is 24 weeks pregnant, HR 122, BP 96/60 mmHg and urine dip is positive for nitrites and leucocytes. Creatinine is normal and renal ultrasound shows no obstruction. What is the most appropriate next step in management?

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Correct answer: D — Admit for intravenous antibiotics and obstetric-aware sepsis monitoring

Pyelonephritis in pregnancy with systemic features requires admission, IV antibiotics and monitoring because maternal sepsis and preterm labour are risks. Trimethoprim is not first-line in pregnancy and outpatient treatment is unsafe here. Nitrofurantoin is unsuitable for pyelonephritis because it does not achieve renal tissue levels. Ultrasound is preferred initially when obstruction is a concern in pregnancy.

Reference: NICE NG109, BNF, RCOG sepsis in pregnancy guidance