Question

An 18-year-old G1P0 woman at 16 weeks gestation was admitted four days ago because of back pain, chills and fever. She was placed on ceftriaxone intravenously but continues to have spiking fevers up to 102.0°F (38.9°C). Her urine culture shows E. coli. An IVP reveals a right ureteral obstruction secondary to calculi. Which of the following is the most appropriate next step in the management of this patient?

1) Double-J ureteral stent placement
2) Aggressive diuresis
3) Surgical exploration
4) Extracorporeal lithotripsy
5) Additional antibiotic coverage

Answer 1

The most appropriate next step for the pregnant woman with a ureteral obstruction from calculi is Double-J ureteral stent placement to relieve obstruction and aid in resolving the infection.

Step-by-step explanation:

The most appropriate next step in the management of an 18-year-old G1P0 woman at 16 weeks gestation, with right ureteral obstruction secondary to calculi and a persistent fever despite antibiotic treatment, is Double-J ureteral stent placement. This procedure will relieve the obstruction and allow urine flow from the kidney to the bladder, which can help resolve the infection and alleviate symptoms. Other options, such as aggressive diuresis or extracorporeal lithotripsy, are generally avoided during pregnancy due to potential risks to the fetus. Surgical exploration is usually reserved for cases where there is a lack of response to less invasive treatments or if there is a suspicion of other complications. Additional antibiotic coverage may be considered based on antimicrobial susceptibility testing, but it would not address the underlying obstruction caused by the stone.