Intrauterine pregnancy presenting with fever. What do you do? — First Trimester Pregnancy Emergencies in the ED January 5, 2019

Posted by Andy Jagoda, MD in: What's Your Diagnosis , trackback

Late in your shift, you evaluate a 26-year-old woman who has a confirmed intrauterine pregnancy at 11 weeks’ gestation and presents for fever, dysuria, and right flank pain. An ultrasound was performed in triage that showed bilateral mild hydronephrosis.

Several questions flood your mind. What do you make of that finding, which antibiotics would be safe for treatment, and can she be managed as an outpatient?

Comments »

1. Michael Myers - January 5, 2019

Keflex and yes on outpt

2. RAUL CANTU - January 5, 2019


3. Shahnaaz - January 5, 2019

I am a paramedic and not a Dr, however here goes nothing.

This lady may have had an untreated UTI, possible before pregnancy, that had caused this buildup with fluids in the kidneys. Secondary to this less urine output is a result of this infection. Infection hence the fever. The pregnancy is still in forstirst trimester so the anatomy of mom should not had changed to that extent that the pressure had increased in the kidney tubes area.

No information of urine strip test, minus any other blood tests results givan. A young mother and I dont know whats the gravida history or if a chronic medical history exist. This is the time when the neural tubes and the vital organs are developed and transformation from embriotic stages to fetus… to give an antibiotic?

sure I assume their are those that is less harmful during pregnancy, however, UTI are ussually gram neg and these culprits requires specific antibiotics that is gram neg specific…
The OS is closed hence nothing will go to the mothers womb. However can an infection travel thru the umbilical cord? Possibly.
Again I am not a Dr, but more info are required and yes I am certain this young mother would require an antibiotic.

4. Lois Ann Welsh - January 5, 2019

I believe pyelo in pregnancy, especially when it presents with fever, would warrant admission to prevent sepsis, etc as pregnant women are at increased rick for such complications. Treatment empirically is ceftriaxone or cefepime for mild pyelo. For severe pyelo, zosyn or a penem. You basically give broad spectrum abx until the urine culture comes back. Then you can tailor treatment

5. Gabriel Cabrera - January 5, 2019

Pyelo. Hydronephrosis can be normal during pregnancy as a result of hormonal changes.

6. Malkhaz Jalagonia - January 5, 2019

She probably has Pyelonephritis. Urinary culture is needed. Treatment should be started with antibiotic before the result is known. In my country (Georgia) E. coli is often resistant to Amoxicillin and Amoxicillin-Clavulinate, so I start treatment with Ceftriaxone and wait for clinical response and antibiotic susceptibility testing result.

7. Kenneth Dowler - January 5, 2019

It depends on clinical presentation and vitals. If she appears well, no signs of sepsis and vss, she can probably be managed as o.p. on ampicillin.

8. W. K. A. P. Priyaranganie - January 6, 2019

Clinically it looks like pyelonephritis. However other causes of fever. History, examination, investigations will help to rule out other causes. Urine analysis, culture and ABST, and elevated infective markers will confirm the diagnosis. This patient should be managed as inward patient. Renal functions need to be checked.Intrvenous coamoxiclave would be enough until antibiotic sensitivity result available.

9. Jeff Finkelstein - January 6, 2019

Get a formal US, IV antibiotics, admit to OB

10. Julie Carson - January 6, 2019

Admission with IV antibiotics

11. kelly common - January 7, 2019

hydronephrosis is a common finding in pregnancy, however, the fever is most likely a urinary tract infection, so amp or amox or cephalexin as an outpatient.

12. Ldawg - January 7, 2019

Labs/Cx, IV ceftriaxone, bedside US to document transureteral jets and pelvic US. Admit for complicated UTi.

13. Julie A Zimmer MSN, APRN, FNP-BC-C - January 8, 2019

With symptoms and no labs dx more difficult as fever is involved. That coupled with flank pain and mild hydro, obvious concern for Pyelonephritis. Is so EB guidelines recommend admit pregnant patients for hydration and abx. Urine culture must be sent, and if Pylo tx IV ampicillin and gentamicin. For labs I would want CBC, BMP and blood cultures x’s 2. OB to follow.

14. Pa615 - January 14, 2019

Most likely would admit but would definitely call her OB to discuss case. Also would check if she had prior urine culture sensitivities to determine which antibiotics would be acceptable

15. Pa615 - January 14, 2019

Even with this limited info would likely admit but would definitely call her OB to discuss case. Also would check if she had prior urine culture sensitivities to determine what antibiotics would be appropriate as well as safe in pregnancy

16. Jill Biediger - January 21, 2019

Admit to OB with IV abx, pending culture results

17. boogerman - February 6, 2019

2nd or 3rd gen cef, discharge with 24 hour Ob f/u. Likely pyelo, but cannot rule out septic miscarriage or some other catastrophic diagnosis.

18. OBan, PAC - May 31, 2019

likely pyelo, has to be admitted for IV abx, rocephin until cultures back

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