Management of Acute Symptomatic Hydronephrosis of Pregnancy by Postural Drainage

Sudhanshu Chitale,Vinayak R Chitale

doi:10.2174/1874303x01003010004

Abstract

Introduction & Objectives: Asymptomatic hydronephrosis is found in >90% of pregnant women, only a small proportion become symptomatic. Non-surgical management is the treatment of choice. In refractory cases surgical intervention is indicated. We present our experience with conservative management of acute symptomatic hydronephrosis of pregnancy by facilitating postural drainage of the obstructed symptomatic kidney. Material & Methods: 1750 women with full term pregnancy were managed in the unit over 5 yrs. 130 (7.4%) presented with unilateral loin pain and were in the third trimester of pregnancy at presentation (20@ 28 weeks, 58@ 30 weeks, and 52@ 32 weeks). 68 / 130 (52.3%) were multi-parous. Age range was 26-38 yrs. 115 (88.5%) presented with right-sided loin pain and 15 (11.5%) had pain in the left loin. There was no evidence of incipient urinary tract infection (UTI). Ultrasound 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 analgesia over 72 hrs. They were managed in a semi-prone 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 continued at home until term. Results: 121 of the 130 women (93.1%) had symptomatic improvement. None required regular analgesia and went to term without further intervention i.e. insertion of nephrostomy / stenting. Follow-up USS at three months post-partum revealed complete resolution of hydronephrosis. Conclusions: Postural drainage of the kidney is highly effective in the management of acute symptomatic hydronephrosis of pregnancy. In the majority of cases (93%), if used diligently, it will help prevent the need for invasive uro-radiological intervention.

Highlights

Introduction & ObjectivesAsymptomatic hydronephrosis is found in >90% of pregnant women, only a small proportion become symptomatic
Conservative measures are advocated in managing women with symptomatic hydronephrosis of pregnancy and intervention indicated only in those failing to respond to conservative management
We present our experience of managing such patients conservatively with particular emphasis on postural drainage of the affected kidney based on the well established and accepted fact that kidneys drain better while in prone position

Summary

Introduction

Introduction & ObjectivesAsymptomatic hydronephrosis is found in >90% of pregnant women, only a small proportion become symptomatic. We present our experience with conservative management of acute symptomatic hydronephrosis of pregnancy by facilitating postural drainage of the obstructed symptomatic kidney. Dilatation of the upper urinary tract involving the pelvicalyceal system and the upper two thirds of ureter is a physiological development during pregnancy. It is being detected earlier than expected and at earlier times than previously reported ; over 90% of women remain asymptomatic with it throughout their pregnancy. Conservative measures are advocated in managing women with symptomatic hydronephrosis of pregnancy and intervention indicated only in those failing to respond to conservative management. We present our experience of managing such patients conservatively with particular emphasis on postural drainage of the affected kidney based on the well established and accepted fact that kidneys drain better while in prone position

Methods

Results

Conclusion