The case study describes a 42-year-old pregnant woman who went into refractory septic shock with multiple organ dysfunction after acute pyelonephritis with nephrolithiasis and hydronephrosis. The condition rapidly deteriorated to uroseptic and cardiogenic shock, requiring intensive care in the intensive care unit, including extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump (IABP), and continuous renal replacement therapy (CRRT). After nine days, the patient fully recovered and was discharged. The article emphasizes the importance of early identification of at-risk pregnant women with sepsis, the timing of interventions in obstructive urinary tract infections, and the use of mechanical circulatory support in critical conditions. Urinary tract infections during pregnancy are common and can lead to serious complications, including septic shock and multiple organ damage. Physiological and immune changes during pregnancy increase the risk of pyelonephritis, which can cause premature birth and endanger the health of both mother and fetus[1][2][3].