Managing severe loin pain in pregnancy

Spontaneous Renal Rupture During Pregnancy: A Contemporary Literature Review and Guide to Management

Importance

Spontaneous renal rupture is a rare pregnancy complication, which requires a high index of suspicion for a timely diagnosis to prevent a poor maternal or fetal outcome.

Objective

This review highlights risk factors, pathophysiology, symptoms, diagnosis, management, and complications of spontaneous renal rupture in pregnancy.

Evidence Acquisition

A literature search was carried out by research librarians using the PubMed and Web of Science search engines at 2 universities. Fifty cases of spontaneous renal rupture in pregnancy were identified and are the basis of this review.

Results

The first case of spontaneous renal rupture in pregnancy was reported in 1947. Rupture occurs more commonly on the right side and during the third trimester. Pain was a reported symptom in every case reviewed. Treatment usually consists of stent or nephrostomy tube placement. Conservative management has been reported.

Conclusions

When diagnosed early and managed appropriately, maternal and fetal outcomes are favorable. Preterm delivery is the most common complication.

Relevance

Our aim is to increase the awareness of spontaneous renal rupture in pregnancy and its associated complications in order to improve an accurate diagnosis and maternal and fetal outcomes.

What not to expect when you're expecting - Postpartum proximal ureteric rupture: A case report

Introduction

Spontaneous ureteric rupture is an extremely rare cause of acute abdominal pain in the intrapartum and postpartum period. We present the case of a right ureteric rupture diagnosed immediately postpartum.

Case

A 23-year-old woman in her second pregnancy (who had had a previous caesarean section) developed acute-onset right-flank pain 12 h after vaginal delivery. A contrast computerized tomography scan suggested a ureteric injury; ureteroscopy diagnosed a proximal ureteric rupture and a stent was placed.

Discussion

This case outlines an extremely rare cause of abdominal pain in the peripartum. There can be serious complications, including urinoma, abscess and sepsis, and therefore the diagnosis should not be delayed.

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Ureteric rupture is a rare cause of acute abdominal pain in the postpartum period.

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Pregnancy physiology can increase the risk of spontaneous ureteric rupture.

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CT scan is the imaging modality of choice for the diagnosis of ureteric rupture.

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Complications of ureteric rupture include urinoma, abscess and sepsis.

Urolithiasis in pregnancy

Urolithiasis in pregnancy is a major health concern and can potentially affect the well-being of both mother and foetus. Management of this condition often entails simultaneous multidisciplinary involvement of obstetrician, radiologist and urologist. Additionally, adverse effects with usage of anaesthesia, radiation, medications and surgery on mother and foetus, limit utilisation of the full armamentarium of diagnostic and therapeutic modalities that are commonly used in non-pregnant women. This review was conducted using an electronic literature search of peer reviewed journal articles. Clinical studies were identified in the bibliographic database- PubMed (Medline), Ovid and eMedicine(WebMD) using the keywords: hydronephrosis, urolithiasis, kidney stone, urinary tract infection, pregnancy and ultrasound, incidence and epidemiology of renal stones.

Renal stones in pregnancy

Diagnosis and treatment of renal stones during pregnancy is a complex problem. Risks to the fetus from ionising radiation and interventional procedures need to be balanced with optimising clinical care for the mother. Management of such patients requires a clear understanding of available options, with a multidisciplinary team approach. In this review, we discuss the role of different diagnostic tests including ultrasound, magnetic resonance urography, and computerized tomography. We also provide an update on recent developments in the treatment of renal stones during pregnancy. Expectant management remains first-line treatment. Where definitive treatment of the stone is required, new evidence suggests that ureteroscopic stone removal may be equally safe, and possibly better than traditional temporising procedures.

Kidney stones and pregnancy

Kidney stones are common and do not spare the pregnant population. Although a simple stone event is usually straightforward in the general population, it is complex during pregnancy. Acute nephrolithiasis is associated with a unique set of complications during pregnancy and, because of imaging limitations, diagnosis is challenging. Multidisciplinary care is the key in proper management decisions. The pathophysiology of kidney stone formation in the pregnant state is also unique. Herein, we discuss the complexity of kidney stones and pregnancy.

Management of urinary calculi in pregnancy: a review

Nephrolithiasis during pregnancy can represent a clinical dilemma because of potential risks to both mother and fetus. While the incidence of symptomatic nephrolithiasis during pregnancy varies between 1 in 244 to 1 in 2000 pregnancies, the actual incidence is likely to be higher. A significant proportion of patients with asymptomatic renal calculi are detected incidentally in the nonpregnant population compared with pregnant women. Factors that contribute to the diagnostic challenges include anatomic and physiologic changes to the female urinary tract during pregnancy and the limitations on the use of ionizing radiation. The treatment of such patients requires a multidisciplinary team approach involving the urologist, obstetrician, and radiologist. The potential hazards of intervention (either surgical or medical) and anesthesia need to be considered carefully.