Background:   This presentation describes the management of a patient at 28 weeks gestation, admitted for pyelonephritis, who ended up in respiratory failure.

Case: She had complaints of fever, headache, and back pain.  Vital signs were : 37.3 138 20 96/50.  She had gram negative rods on the gram stain from her urine sample, so she was admitted for pyelonephritis.    to our OB High Risk Unit for continuous fetal monitoring, antibiotic and analgesic therapy. 

Her temperature rose to 39.5 and she was tachypneic.  Her hemoglobin dropped to 6.8, so she was transfused.  A chest x-ray diagnosed right lower lobe pneumonia.  Her oxygen saturation rates (O2 sats) were 70-80%, and adult respiratory distress syndrome (ARDS) was suspected.  The patient was transferred to the ICU, due to the concern that she may have to be intubated for ventilatory support.

Escheria coli grew in her urine culture.  She continued with tachypnea, labored breathing, and developed a productive cough.  She was considered critically ill and in respiratory failure, but was able to be sustained on oxygen therapy without intubation.  She eventually was weaned to  room air, with 02 sats>95%.

The patient was discharged after a week, still pregnant, with orders for monthly urine cultures, and suppressive therapy.  Her only readmission was when she was in labor at 40 weeks gestation.  She had normal vital signs at that point, and had no oxygen requirements.  She delivered a healthy term baby with apgars of 8 and 9.

Conclusion: There is a paucity of recent literature regarding the relationship between pyelonephritis and respiratory distress in pregnancy.  Nonetheless,  we seem to be encountering this problem more frequently.  The association of pyelonephritis and respiratory distress in pregnancy was first described in 1984 (Cunningham FG, etal).  Pyelonephritis alone is estimated to occur in 1-2% of all pregnancies. Some studies suggest that one out of every fifty women admitted for pyelonephritis will develop some respiratory distress.  Unfortunately, the etiology for the mechanism of the syndrome remains unknown.

Respiratory distress in pregnancy is associated with a high rate of perinatal morbidity and mortality.  It is fortunate that this patient had access to an institution where she could have Maternal Fetal Medicine and Pulmonology consults.  Her management prevented artificial ventilation, which would increase her statistical risk.  Providing care for this patient, and others like her has increased our awareness of the possible consequences of urinary tract infections in pregnancy.

Keywords: pyelonephritis, respiratory failure, ARDS