MO117THE IMPACT OF GESTATIONAL AGE ON ANATOMICAL AND PHYSIOLOGICAL CHANGES OF THE UPPER URINARY TRACT DURING PREGNANCY

Abstract

Abstract Background and Aims Ureterohydronephrosis (UHN) is a common anatomical change during the evolution of pregnancy, especially after 20th week of pregnancy. Factors responsible for dilation of pyelocaliceal system are hormonal changes, progressive obstruction and modification of the route of uterine and iliac vessels in the pelvic area. The main symptom of UHN is lumbar pain which is controlled in most of the cases by conservatory treatment.The aim of study was to o evaluate the stages of UHN during pregnancy depending on gestational age and to highlight the involvement of the pregnant uterus, as well as monitor the symptomatology and adequate management of these anatomical and physiological changes, that can associate variable complications, with maternal-fetal risk, during pregnancy. Method We performed a descriptive, transversal study for examination of pregnant women with symptomatic hydronephrosis. A total number of 104 patients, hospitalized in the Obstetrics and Gynecology Department of the Constanta County Emergency Hospital, were included, with nephrological monitoring using biological and imagistic examination for each pregnancy. Results The frequency of UHN in our study was 58% (60 cases) from the total number of 104 pregnant women. Regarding the gestational age, UHN was most commonly seen in the third trimester in 44 cases, followed by second trimester with 14 cases and first semester with only 2 cases. The right UHN was seen in all cases and the left UHN was seen in only 68 % of the cases. Our data showed that grade III of UHN reached a peak between 28 and 31 weeks of pregnancy and occurred in 37 (49%) pregnant women. Analyzing the parity, it was observed that 56% of the primiparous women developed UHN and 59% of the multiparous patients, showing us that the association with parity is not statistically significant. The majority of our patients (96.66%) were symptomatic, and the most common accuse on presentation was the lumbar pain. According to the visual analog scale (VAS) of the lumbar pain, the group could be distributed as follows: 17% with severe pain, 37 % with moderate pain and 13 % with mild pain. Eight pregnant women (13.33%) from our study developed UHN due to passage of ureteral stone, although, the majority got complicated with urinary tract infection (asymptomatic bacteriuria, acute cystitis, acute pyelonephritis) and even acute kidney injury (4 cases- 6,66%).97% of the symptomatic UHN responded to antispastic and analgesic therapy, antibiotics and adequate hydration. From our study group, only 2 patients (3,33%) with severe symptomatic UHN needed ureteral stent insertion, because initially they did not respond to medical, conservative treatment. Conclusion Uretrohydronephrosis is a common anatomical change in pregnancy and is depending on the gestational age. Parity did not influence the development of hydronephrosis in our study group. The most common symptom of ureterohydronephrosis during pregnancy is the lumbar pain, which can have different types of intensity (usually moderate to severe). Conservatory treatment during symptomatic, complicated ureterohydronephrosis is efficient in most cases, otherwise urological interventions with ureteral stent insertion must be initiated, because are effective and safe.