Complications of pregnancy: pyelonephritis in pregnancy: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Complications of pregnancy: pyelonephritis in pregnancy

Sample item

A woman at 24 weeks has a temperature of 39 degrees C, right flank pain, vomiting and tenderness at the costovertebral angle. Urine microscopy shows many pus cells and bacteria. What is the best management?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Admission with intravenous antibiotics and fluids

Acute pyelonephritis in pregnancy is admitted for IV fluids and a parenteral antibiotic such as ceftriaxone after sending a urine culture, followed by suppressive therapy. It carries risks of septic shock, ARDS and preterm labour, and the right side is more often involved because of uterine dextrorotation and ureteric compression.

Option by option

  • A. Immediate ultrasound-guided percutaneous nephrostomy

    Nephrostomy is reserved for obstruction not responding to antibiotics, which is not present.

  • B. Oral nitrofurantoin as an outpatient for 7 days

    Oral nitrofurantoin is for lower urinary tract infection and does not reach adequate tissue levels in the kidney.

  • C. A single oral dose of fosfomycin as an outpatient

    A single-dose oral regimen is inadequate for pyelonephritis.

  • D. Admission with intravenous antibiotics and fluids (correct)

    Correct. Systemic illness in pregnancy requires admission and intravenous antibiotics.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, Admission with intravenous antibiotics and fluids. Acute pyelonephritis in pregnancy is admitted for IV fluids and a parenteral antibiotic such as ceftriaxone after sending a urine culture, followed by suppressive therapy.

Why is "Immediate ultrasound-guided percutaneous nephrostomy" not the answer?

Nephrostomy is reserved for obstruction not responding to antibiotics, which is not present.

Why is "Oral nitrofurantoin as an outpatient for 7 days" not the answer?

Oral nitrofurantoin is for lower urinary tract infection and does not reach adequate tissue levels in the kidney.

Why is "A single oral dose of fosfomycin as an outpatient" not the answer?

A single-dose oral regimen is inadequate for pyelonephritis.

What concept does this question test?

It tests Complications of pregnancy: pyelonephritis in pregnancy in OBG. It carries risks of septic shock, ARDS and preterm labour, and the right side is more often involved because of uterine dextrorotation and ureteric compression.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Complications of pregnancy: pyelonephritis in pregnancy?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.