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Acute pyelonephritis is one of the most common medical complications of pregnancy. Not only is this disease an important cause of maternal morbidity, but the acute disease may also play a significant role in the natural history of chronic pyelonephritis. The purpose of this paper is to evaluate the clinical importance of pyelonephritis during pregnancy, the frequency of pyelonephritis, and its relationship to prematurity. Major causes of neonatal mortality are preexisting factors such as previous catheterization, urinary tract disease, preeclampsia, and anemia during pregnancy, culture, sensitivity test, and treatment. Clinical observations were accomplished on 90 cases of acute pyelonephritis admitted to Ewha Womans University Hospital during the 53 months period from Jan. 1, 1972 to May 31, 1976. The following results were obtained; 1. The incidence of pyelonephritis during pregnancy and puerperium was 1.26%. 2. The frequency of pyelonephritis decreased with increasing age and was highest at the age of 26-30 (54.4%). It was most common in primipara (51%) and was more common in the second and third trimester (54%). The major preexisting factors were instrumentation (35.6%), urinary tract disease, and preeclampsia in that order. 3. The most significant organisms found in the pyelonephritis were colifoum organisms (47%), and of these, E. coli was the most predominant. 4. the most common clinical symptoms were high fever, chills, flank pain and tenderness, nausea, vomiting, and bacteriuria. The disease, when unilateral, was more frequently right-sided and initial high fever (above 38.5℃) was usually seen in the late afternoon and evening(8PM) 5. There did not seem to be an increased tendency of prematurity in the offspring of pyelonephritis patients (incidence of 7.4%). 6. In treating active pyelonephritis particularly during pregnancy, parenterally administered ampicillin (2gm/day, I.V or I.M.) was probably the most effective treatment. Most of the clinical symptoms disappeared within seven to eight days. 7. Complications; There were 3 cases of spontaneous abortion in the first trimester of pregnancy and 1 stillborn case which accompanied abruptio placenta totalis at the 34 week point of pregnancy. 8. Recurrence; There were three cases of recurrence (3.3%) and those had had inadequate antibiotic treatment previously. They were cured after 3-4 weeks of further antibiotic treatment. 9. For complete cure, at least 2 to 3 weeks of further antibiotic treatment and follow up were needed after clinical improvement.
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