ULTRASONOGRAPHIC EVALUATION OF CENTRAL AND END-ORGAN HEMODYNAMICS IN ANTEPARTUM PYELONEPHRITIS

OBJECTIVE: Our purpose was to evaluate central and end-organ hemodynam ic effects of antepartum pyelonephritis. STUDY DESIGN: Daily duplex ul trasonographic assessments of maternal cardiac output and resistive in dex values of the maternal renal and uterine arteries and the fetal um bilical arteries were performed in pregnant women admitted for acute p yelonephritis. For comparison, the same measures were repeated within 2 weeks after discharge. RESULTS: Thirty-seven women with antepartum p yelonephritis underwent serial 2-dimensional real-time and Doppler eva luation of maternal heart and duplex Doppler evaluation of maternal re nal and uterine and fetal umbilical arteries. Significant differences in temperature, mean arterial pressure, and heart rate were observed d uring hospitalization compared with the follow-up visit. Total periphe ral resistance was significantly decreased and cardiac output increase d during acute infection. In women with unilateral signs and symptoms an increased resistive index was observed in the symptomatic kidney co mpared with the nonsymptomatic side; this difference disappeared on th e follow-up study. No changes were observed in maternal uterine or fet al umbilical arteries. CONCLUSIONS: Uncomplicated pyelonephritis is as sociated with measurable depression of systemic vascular resistance. T his likely represents an effect of infection that in the extreme would be the septic shock syndrome. It seems reasonable to attribute the in creased resistive index of the symptomatic kidney to local effects of infection.