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A 32-year-old woman is admitted to the hospital with flank pain, fever, and nausea. She is 18 weeks pregnant. She reports dysuria and urinary frequency for 3 days before admission. She has no known allergies. Past medical history includes one episode of pyelonephritis two years ago (non-pregnant).
Observations & Examination Findings:
Investigations:
Learning prompts for the student:
1. What is the likely diagnosis ,differential diagnosis and immediate priorities?
2. What investigations would you make before/alongside antibiotics?
3. Why is the infection classified as “complicated” in this context?
4. Antibiotic selection: Which empiric IV antibiotic regimen is safe in pregnancy and recommended in national/local guidelines for pyelonephritis? What should be avoided?
5. What supportive management would you initiate?
6. What would be your follow up and preventative measures with recurrent UTIs?
7. Counselling: What information should be provided to the patient regarding antibiotic use in pregnancy and potential risks to the foetus?