Conservative Management of Acute Hydronephrosis of Pregnancy: Two Centers Experience
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- Category: Vol. 80, September 2012
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Conservative Management of Acute Hydronephrosis of Pregnancy: Two Centers Experience,TAREK R. ABBAS and MAHMOUD M. OSMAN
Abstract
Objectives: This study is aiming to detect the value of conservative management of acute hydronephrosis of preg-nancy by facilitating postural drainage of the affected kidney.
Patients and Methods: This prospective study was carried out from March 2011-March 2012, in two centers: [Bab Alshaaria University Hospital (Cairo), and Assiut University Hospital (Assiut)]. One thousand two hundred pregnant women managed till full term, 86 of them (7.1%) presented with unilateral loin pain and were in the third trimester of pregnancy at presentation (13 patients at 28 weeks, 39 patients at 30 weeks, and 34 patients at 32 weeks). Age range was 18-39 years.
Seventy six patients (88.3%) presented with right-sided loin pain and 10 (11.7%) had pain in the left loin. There was no evidence of incipient urinary tract infection (UTI). Ultra-sound scan (USS) confirmed presence of ipsilateral mild to moderate hydronephrosis with no evidence of renal/ureteric calculus.
All were refractory to routine enteral or parenteral anal-gesia over 72 hours.
They were managed in a semiprone position while in bed, with the affected side up and non-dependant. Head end of their bed was kept raised by 10º throughout this period of conservative management; initiated in the hospital and con-tinued at home until term.
Results: Eighty of the 86 women (93%) had symptomatic improvement. None required regular analgesia and went to term without further intervention (e.g. nephrostomy, stenting .... ). Follow-up by Ultrasound scan (USS) at three months post-partum revealed complete resolution of hydro-nephrosis.
Conclusions: Postural drainage of the kidney is highly effective in the management of acute symptomatic hydroneph-rosis of pregnancy in the majority of cases (93%), and if used diligently, it will help to prevent the need for invasive uro-radiological intervention.