14.     Acute Pyelonephritis in pregnancy.  

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a. has reduced in incidence in recent decades True
b. carries significant hazard to the baby True
c. treatment should await identification of the infecting organism and its sensitivity False
d. is usually due to chlamydia False
e. may cause sickle cell crises True

The incidence has decreased considerably due to screening for asymptomatic bacteruria (see MCQ5, question 31). 

In severe cases the mother runs a high fever.

Babies tolerate fever badly and fetal death in utero may occur if the temperature is not brought down promptly. 

Apart from IV antibiotics, rehydration and analgesia, nursing measures should be instituted with tepid sponging and the use of cooling fans. 

Premature labour may also ensue. 

The infecting organism is usually a coliform. 

Infection is a common cause of sickle cell crises - see MCQ4, question 1.

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