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Background :The occurence of urinary tract infections (UTIs) in the course of a normal pregnancy should always be early diagnosed and treated, even asymptomatic as it could evolve to threatening pathological conditions, like sepsis with acute kidney injury, or preeclampsia. The aim of study was to establish a cartographic projection of the risk factors and etiopathogenesis of urinary tract infections diagnosed during pregnancy, with the purpose to control their severity and evaluate the therapeutic strategies used to reduce maternal and fetal risks. Material and methods: The study included 175 patients, pregnant women, diagnosed with UTIs hospitalized in the Nephrology Clinic and Obstetrics-Gynecology Clinic of the Emergency Clinical County Hospital of Constanta, in an interval of time of 4 years, between 2017-2021. Results: Out of the 247 patients recruited in our study, the distribution according to the trimester of pregnancy, there were : 72 pregnant women in the first trimester (41.14%), 35 in the second trimester (20.0%) and 68 in the third trimester (38.86%). The frequency of pregnant women who had other favorising conditions and detectable risk factors was 70.29%. The clinical manifestations of UTIs in our study group were distributed as follows : 36 (20.57%) asymptomatic bacteriuria, 56 (32.0%) acute cystitis, 44 (25.14%) recurrent lower urinary tract infections, and 39 (22.29%) acute pyelonephritis. There is an association (p ---lt--- 0.001) between the type of clinical form of UTIs and a certain trimester of pregnancy, for example the highest frequency of acute pyelonephritis (AP) was noticed in the third trimester of pregnancy (71.8%, 28/39). Out of 39 pregnant women with AP, 71.8% (28) had associated ureterohydronephrosis (UHN). E. Coli was present in 41.71% of pregnant women., followed by Klebsiella pneumoniae, Enterococcus faecalis and, less frequently, Staphylococcus aureus and Proteus mirabilis. The most frequently used antibiotics in pregnancy were: 2nd and 3rd generations of cephalosporins (42.29%), followed by ampicillin (34.29%); less used were amoxicillin with clavulanic acid (10.29%), quinolones (6.29%) and nitrofurantoin (6.86%). Most of the pregnant women (94.28%, 165/175) had remission of fever within 24-48 h of using appropriate antibiotic therapy. The recurrence rate was 22.28 %, (39/175). Conclusion All clinical forms of UTIs could be present during pregnancy, but the most common are lower urinary tract infections and the most involved germ is E. Coli. UHN is a factor that influences the occurence of UTIs, being the most common favorising condition.

Background and Aims Ureterohydronephrosis (UHN) is a common anatomical change during the evolution of pregnancy, especially after 20th week of pregnancy. Factors responsible for dilation of pyelocaliceal system are hormonal changes, progressive obstruction and modification of the route of uterine and iliac vessels in the pelvic area. The main symptom of UHN is lumbar pain which is controlled in most of the cases by conservatory treatment.The aim of study was to o evaluate the stages of UHN during pregnancy depending on gestational age and to highlight the involvement of the pregnant uterus, as well as monitor the symptomatology and adequate management of these anatomical and physiological changes, that can associate variable complications, with maternal-fetal risk, during pregnancy. Method We performed a descriptive, transversal study for examination of pregnant women with symptomatic hydronephrosis. A total number of 104 patients, hospitalized in the Obstetrics and Gynecology Department of the Constanta County Emergency Hospital, were included, with nephrological monitoring using biological and imagistic examination for each pregnancy. Results The frequency of UHN in our study was 58% (60 cases) from the total number of 104 pregnant women. Regarding the gestational age, UHN was most commonly seen in the third trimester in 44 cases, followed by second trimester with 14 cases and first semester with only 2 cases. The right UHN was seen in all cases and the left UHN was seen in only 68 % of the cases. Our data showed that grade III of UHN reached a peak between 28 and 31 weeks of pregnancy and occurred in 37 (49%) pregnant women. Analyzing the parity, it was observed that 56% of the primiparous women developed UHN and 59% of the multiparous patients, showing us that the association with parity is not statistically significant. The majority of our patients (96.66%) were symptomatic, and the most common accuse on presentation was the lumbar pain. According to the visual analog scale (VAS) of the lumbar pain, the group could be distributed as follows: 17% with severe pain, 37 % with moderate pain and 13 % with mild pain. Eight pregnant women (13.33%) from our study developed UHN due to passage of ureteral stone, although, the majority got complicated with urinary tract infection (asymptomatic bacteriuria, acute cystitis, acute pyelonephritis) and even acute kidney injury (4 cases- 6,66%).97% of the symptomatic UHN responded to antispastic and analgesic therapy, antibiotics and adequate hydration. From our study group, only 2 patients (3,33%) with severe symptomatic UHN needed ureteral stent insertion, because initially they did not respond to medical, conservative treatment. Conclusion Uretrohydronephrosis is a common anatomical change in pregnancy and is depending on the gestational age. Parity did not influence the development of hydronephrosis in our study group. The most common symptom of ureterohydronephrosis during pregnancy is the lumbar pain, which can have different types of intensity (usually moderate to severe). Conservatory treatment during symptomatic, complicated ureterohydronephrosis is efficient in most cases, otherwise urological interventions with ureteral stent insertion must be initiated, because are effective and safe.