In pregnancy, which symptom is a red flag indicating possible pyelonephritis or preterm labor?

• A. Fever
• B. Uterine tenderness
• C. Contractions
• D. Fetal movement

Answer: (A)

Fever signals a systemic infection, which in pregnancy is especially concerning because infections like pyelonephritis can set off uterine irritability and trigger preterm labor. A fever in a pregnant patient should prompt urgent evaluation for upper urinary tract infection, along with urinalysis, culture, and appropriate antibiotics, and close maternal-fetal monitoring. This systemic infection risk is why fever stands out as the red flag.

Uterine tenderness can occur with placental problems or uterine infection, but it isn’t as specific for infection that would lead to preterm labor. Contractions may be a normal sign of late pregnancy or a sign of actual labor, not necessarily infection. Fetal movement changes can indicate fetal well-being but are not specific indicators of infection that would raise concern for pyelonephritis or imminent preterm labor.