<prompt> Acute pyelonephritis in pregnancy most often complicates ___1st trimester2nd trimester3rd trimesterPuerperium  <response>: Acute pyelonephritis in pregnancy most often complicates 2nd trimester of pregnancy. Acute Pyelopnephritis: Most common in the second trimester, in nulliparous individual of young age. Most common organism: E.coli Streptococcus, S.aureus Enterobacter, Klebsiella Occurs more commonly in those with preexisting renal disease Symptoms and signs: Fever with chills, loin pain and vomiting. Renal angle tenderness may be present. Usually unilateral and more common on the right side. patients may develop acute respiratory distress syndrome due to endotoxin-mediated alveolar injury and hemolysis due to endotoxins leadinng to anemia. Management: Intravenous hydration, antibiotics Ref: Williams Obstetrics 25th edition Pgno: 1028 