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

Amy M. Valent; Katie Peticca; Alexandra DiMatteo; Shimeka Banks; Ronak Shah; Lindsey Chernicky; Beth Weitz; Casey Armistead; James Hill; Craig Towers; David Lewis; Everett F. Magann; Suneet P. Chauhan; James W. Van Hook

doi:10.1055/s-0037-1602418

American Journal of Perinatology, Inhaltsverzeichnis

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

¹Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon

,

Katie Peticca

²Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania

,

Alexandra DiMatteo

³Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, Virginia

,

Shimeka Banks

⁴Department of Obstetrics and Gynecology, Baptist Health Systems, Flowood, Mississippi

,

Ronak Shah

⁵Department of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, Little Rock, Arkansas

,

Lindsey Chernicky

⁶Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, Tennessee

,

Beth Weitz

⁶Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, Tennessee

,

Casey Armistead

⁷Department of Obstetrics and Gynecology, University of South Alabama, Mobile, Alabama

,

James Hill

⁸Department of Obstetrics and Gynecology, Baylor College of Medicine, San Antonio, Texas

,

Craig Towers

⁶Department of Obstetrics and Gynecology, University of Tennessee Medical Center, Knoxville, Tennessee

,

David Lewis

⁹Department of Obstetrics and Gynecology, Louisiana State University Health Sciences Center, Shreveport, Louisiana

,

Everett F. Magann

⁵Department of Obstetrics and Gynecology, University of Arkansas for the Medical Sciences, Little Rock, Arkansas

,

Suneet P. Chauhan

¹⁰Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Health Sciences Center at Houston, Houston, Texas

,

James W. Van Hook

¹¹Department of Obstetrics and Gynecology, University of Toledo, Toledo, Ohio

› Institutsangaben

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

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Referenzen

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