{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T18:51:26Z","timestamp":1791312686343,"version":"4.3.1"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Acute pyelonephritis in pregnancy is a serious clinical condition requiring timely decision-making between conservative therapy and renal drainage. However, the absence of standardized objective criteria may result in delayed intervention and increased maternal morbidity. This study introduces and evaluates the clinical utility of a novel 10-parameter risk stratification scale designed to standardize treatment decisions in acute gestational pyelonephritis (AGP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>MATERIALS AND METHODS:<\/jats:title>\n                    <jats:p>\n                      A single-center retrospective\u2013prospective comparative observational study was conducted on 451 pregnant women with AGP between 2023 and 2025. Patients treated before (2023) and after (2024\u20132025) implementation of a 10-parameter risk stratification scale were compared. Statistical analysis included the Chi-square test, Mann\u2013Whitney\n                      <jats:italic toggle=\"yes\">U<\/jats:italic>\n                      test, and Spearman correlation, with significance set at\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05. Where applicable, 95% confidence intervals (CIs) were calculated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Implementation of the risk scale was associated with improved clinical outcomes. The success rate of conservative therapy increased by 2.7% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.05). The rate of ureteral stenting decreased from 13.8% to 9.7% (difference \u22124.1%; 95% CI: \u22127.8% to \u22120.4%). The mean decision-making time decreased from 24.3 \u00b1 6.1 hours to 12.8 \u00b1 4.2 hours (mean difference \u221211.8 hours; 95% CI: \u221213.5 to \u221210.1;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>The 10-parameter risk assessment scale shows potential as a structured and objective framework, pending external validation for clinical decision-making in AGP. Its implementation is associated with reduced invasive interventions, improved efficiency in clinical decision-making, and better risk-based stratification of patients. However, findings should be interpreted with caution due to the single-center design, lack of multivariable adjustment, and absence of fetal outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jehp.jehp_648_26","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T13:01:26Z","timestamp":1788181286000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Management of acute pyelonephritis in pregnancy in emergency settings: A comparative study of conservative therapy and renal drainage"],"prefix":"10.4103","volume":"15","author":[{"given":"Kongyrov","family":"Yerlan","sequence":"first","affiliation":[{"name":"PhD Candidate, Al-Farabi Kazakh National University, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shalekenov","family":"Bulat","sequence":"additional","affiliation":[{"name":"Department of Clinical Disciplines, Al-Farabi Kazakh National University, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shalekenov","family":"Sanjar","sequence":"additional","affiliation":[{"name":"Department of Urology, Al-Farabi Kazakh National University, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apenova","family":"Ayagoz","sequence":"additional","affiliation":[{"name":"City Maternity Hospital No. 5, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duisenbayev","family":"Nurbol","sequence":"additional","affiliation":[{"name":"Department of General Surgery with a Cource in Urology, Kazakhstan-Russian Medical University, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kemelbekov","family":"Kanatzhan","sequence":"additional","affiliation":[{"name":"Department of Pediatric-1, South Kazakhstan Medical Academy, 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(2018\u20132022)","volume":"4","author":"Rodrigues","year":"2025","journal-title":"Bacteria"},{"key":"R7-20261006","first-page":"CD000490","article-title":"Antibiotics for asymptomatic bacteriuria in pregnancy","volume":"2019","author":"Smaill","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"R8-20261006","doi-asserted-by":"crossref","first-page":"861","DOI":"10.3390\/medicina60060861","article-title":"Percutaneous nephrostomy versus ureteral stent for severe urinary tract infection with obstructive urolithiasis: A systematic review and meta-analysis","volume":"60","author":"Moon","year":"2024","journal-title":"Medicina"},{"key":"R9-20261006","first-page":"e52146","article-title":"The management of symptomatic hydronephrosis in pregnancy","volume":"16","author":"Hosny","year":"2024","journal-title":"Cureus"},{"key":"R10-20261006","first-page":"e29029","article-title":"Pyelonephritis in pregnancy from the lens of an underserved 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