Urinary tract infections and kidney stones in pregnancy Quiz: Ace Your Exams
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A 36-year-old primigravid woman at 33 weeks’ gestation presents to the emergency department with a 12-hour history of worsening fever and right flank pain. There has been no increase in urinary frequency, though the patient already voids every hour and several times at night since entering the third trimester. There is no associated hematuria, loss of fluid, uterine contractions, vaginal bleeding, or decreased fetal movement. Temperature is 38.9°C (102.0°F), pulse is 118/min, respirations are 16/min, and blood pressure is 116/74 mmHg. On physical exam, there is right-sided costovertebral angle tenderness. The cervix is closed, thick, and high on digital pelvic examination. Urinalysis results are shown below. In addition to intravenous (IV) fluids, which of the following is the most appropriate next step in management?
| Laboratory value | Result |
| Urinalysis | |
| Color | Clear |
| Specific gravity | 1.013 |
| Glucose | Negative |
| Blood | Negative |
| Leukocyte esterase | Positive |
| Nitrites | Positive |
| Leukocytes | 15/hpf |
| Erythrocytes | 1-2/hpf |
| Casts | None |
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