DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20194351

A retrospective study on maternal and perinatal outcome in pregnancy requiring DJ stent and PCN during pregnancy

Liji David, Swati Rathore, Neeraj Kulkarni, Batiston Decruse Waanbah, Benedict Paul Samuel, Partho Mukherjee

Abstract


Background: Gestational hydronephrosis (GH) is result of dilatation effect of the progesterone and mechanical compression of the gravid uterus. Management during pregnancy is challenging as routine radiological investigations and surgical treatments cannot be applied due to the potential harm to the fetus. Intervention is indicated in women who fail to respond to conservative management. Acute hydronephrosis and renal colic are common etiologies for loin pain, and can lead to severe form of urinary tract infection affecting perinatal outcome. Ureteric stenting and percutaneous nephrostomy (PCN) during pregnancy are safe, requiring no intra-operative imaging, and inserted under local anaesthesia. It provides good symptom relief, low complication rate, efficient and safe modality for women with refractory symptoms.

Methods: A retrospective study of pregnant women admitted under obstetric units with acute hydronephrosis requiring DJ stenting and/or PCN. Aim was to evaluate the course and pregnancy outcomes in a tertiary center of Southern India over a period of five years.

Results: Descriptive statistical analysis was done in 12 women with acute hydronephrosis in pregnancy. 66.7% were nulliparous and mean gestational age at admission was 31 weeks. Diagnosis was done by USG. One-fourth had pyelonephritis and calculus being the main pathology (n=9;75%).Women requiring DJ stent and PCN were 41.6% and 58.4% respectively. 41.7% had preterm labour. 66.7% delivered vaginally, birth weight was more than 2.5kg in 50%.

Conclusions: Maternal and neonatal outcome mainly depends on the early diagnosis. In this study we emphasize on the importance of multidisciplinary team approach in the management of women with acute hydronephrosis. DJ stent and PCN are efficient and safe modalities in women with refractory symptoms.


Keywords


DJ stent, Hydroureteronephrosis, PCN, Perinatal outcome, Pregnancy, Preterm

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References


Goldfarb RA, Neerhut GJ, Lederer E. Management of acute hydronephrosis of pregnancy by ureteral stenting: risk of stone formation. J Urol. 1989;141(4):921-2.

Brown MA. Urinary tract dilatation in pregnancy. Am J Obstet Gynecol. 1991;164(2):642-3.

Puskar D, Balagović I, Filipović A, Knezović N, Kopjar M, Huis M, et al. Symptomatic physiologic hydronephrosis in pregnancy: incidence, complications and treatment. Eur Urol. 2001;39(3):260-3.

Rasmussen PE, Nielsen FR. Hydronephrosis during pregnancy: a literature survey. Eur J Obstet Gynecol Reprod Biol. 1988;27(3):249-59.

Clayton JD, Roberts JA. The effect of progesterone on ureteral physiology in a primate model. J Urol. 1972;107(6):945-8.

Fabrizio MD, Gray DS, Feld RI, Bagley DH. Placement of ureteral stents in pregnancy using ultrasound guidance. Tech Urol. 1996;2(3):121-5.

Sonnenberg E, Casola G, Talner LB, Wittich GR, Varney RR, D’Agostino HB. Symptomatic renal obstruction or urosepsis during pregnancy: treatment by sonographically guided percutaneous nephrostomy. AJR Am J Roentgenol. 1992;158(1):91-4.

Navalón Verdejo P, Sánchez Ballester F, Pallas Costa Y, Cánovas Ivorra JA, Ordoño Domínguez F, Juan Escudero J, et al. Symptomatic hydronephrosis during pregnancy. Arch Esp Urol. 2005;58(10):977-82.

Ferguson T, Bechtel W. Hydronephrosis of pregnancy. Am Fam Physician. 1991;43(6):2135-7.

AJ W, LR K, AC N, AW P, CA P. Pathophysiology of urinary tract obstruction. In: Campbell’s Urology. 9th ed. Philadelphia PA: Saunders Elsevier; 1219.

Stothers L, Lee LM. Renal colic in pregnancy. J Urol. 1992;148(5):1383-7.

Andreoiu M, MacMahon R. Renal colic in pregnancy: lithiasis or physiological hydronephrosis? Urol. 2009;74(4):757-61.

Eckford SD, Gingell JC. Ureteric obstruction in pregnancy- diagnosis and management. Br J Obstet Gynaecol. 1991;98(11):1137-40.

Parulkar BG, Hopkins TB, Wollin MR, Howard PJ, Lal A. Renal colic during pregnancy: a case for conservative treatment. J Urol. 1998;159(2):365-8.

Zwergel T, Lindenmeir T, Wullich B. Management of acute hydronephrosis in pregnancy by ureteral stenting. Eur Urol. 1996;29(3):292-7.

Khoo L, Anson K, Patel U. Success and short-term complication rates of percutaneous nephrostomy during pregnancy. J Vasc Interv Radiol. 2004;15(12):1469-73.

Akpinar H, Tüfek I, Alici B, Kural AR. Ureteroscopy and holmium laser lithotripsy in pregnancy: stents must be used postoperatively. J Endourol. 2006;20(2):107-10.

Semins MJ, Trock BJ, Matlaga BR. The safety of ureteroscopy during pregnancy: a systematic review and meta-analysis. J Urol. 2009;181(1):139-43.

Spencer JA, Chahal R, Kelly A, Taylor K, Eardley I, Lloyd SN. Evaluation of painful hydronephrosis in pregnancy: magnetic resonance urographic patterns in physiological dilatation versus calculous obstruction. J Urol. 2004. Available at: https://www.auajournals.org/doi/abs/10.1097/01.ju.0000102477.19999.b2.

Song G, Hao H, Wu X, Li X, Xiao Y, Wang G, et al. Treatment of renal colic with double-J stent during pregnancy: a report of 25 cases. Zhonghua Yi Xue Za Zhi. 2011;91(8):538-40.

Cheriachan D, Arianayagam M, Rashid P. Symptomatic urinary stone disease in pregnancy. Aust N Z J Obstet Gynaecol. 2008;48(1):34-9.