MP50-01 UROLITHIASIS IN PREGNANCY: DOES AN ANTEPARTUM STONE ADMISSION INCREASE THE RISK OF PRETERM DELIVERY?

Abstract

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II1 Apr 2018MP50-01 UROLITHIASIS IN PREGNANCY: DOES AN ANTEPARTUM STONE ADMISSION INCREASE THE RISK OF PRETERM DELIVERY? Max Drescher, Robert Blackwell, Parth Patel, Spencer Hart, Alexander Kandabarow, Paul Kuo, Ahmer Farooq, Thomas Turk, and Kristin Baldea Max DrescherMax Drescher More articles by this author , Robert BlackwellRobert Blackwell More articles by this author , Parth PatelParth Patel More articles by this author , Spencer HartSpencer Hart More articles by this author , Alexander KandabarowAlexander Kandabarow More articles by this author , Paul KuoPaul Kuo More articles by this author , Ahmer FarooqAhmer Farooq More articles by this author , Thomas TurkThomas Turk More articles by this author , and Kristin BaldeaKristin Baldea More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1612AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The impact of antepartum stone formation and subsequent interventions on obstetric outcomes are debated in the literature. Antepartum urolithiasis can result in the need for ureteral stent or nephrostomy tube placement; however, in recent years, definitive management with flexible ureteroscopy has increased in popularity. In this study we assess current management of antepartum stone events and evaluate the risk of UTI and preterm labor. METHODS A retrospective review of the Healthcare Cost and Utilization Project State Inpatient Database including all pregnant women admitted for a delivery to participating hospitals in California and Florida during 2008-2011. Antepartum stone admissions were identified, as were retrograde intervention (ureteral stenting/ureteroscopy) or percutaneous nephrostomy tube (PCNT) placement. Descriptive statistics were performed, as was multivariable logistic regression to identify predictors of UTI and preterm delivery. RESULTS Antepartum urolithiasis admissions were experienced by 3,904 (0.14%) of the 2,750,776 included deliveries. Stone related admissions occurred predominantly during the second (30.0%) and third trimesters (65.0%). The majority of stone patients were managed conservatively (71.4%), while 803 (20.6%) underwent retrograde intervention and 312 (8.0%) underwent PCNT placement. Preterm delivery rates increased from a baseline 7.0% for patients without a stone, to 9.1% for conservatively managed, 11.2% for retrograde intervention, and 19.6% for PCNT patients. On multivariable analysis after controlling for relevant clinical variables, conservative management (adjusted odds ratio (aOR) 1.3), retrograde intervention (aOR 1.5), and PCNT placement (aOR 2.3) each independently increased the risk of preterm delivery (all p<0.001). The presence of UTI at the time of delivery was the strongest predictor of preterm delivery (aOR 3.2). Compared to patients without a stone admission, we identified an increased incidence of UTI for patients undergoing a retrograde procedure (aOR 9.3); the risk of UTI was highest among patients who underwent PCNT placement (aOR 21.2). CONCLUSIONS Antepartum urolithiasis is a condition that affects 1 in 714 women and is associated with increased risk of UTI and preterm labor. UTI at delivery was the strongest predictor of preterm delivery in our study. Intervention with ureteral stent or nephrostomy tube placement independently increase these risks, however our analysis demonstrates that PCNT placement is associated with the greatest risk of UTI and preterm delivery. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e675 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Max Drescher More articles by this author Robert Blackwell More articles by this author Parth Patel More articles by this author Spencer Hart More articles by this author Alexander Kandabarow More articles by this author Paul Kuo More articles by this author Ahmer Farooq More articles by this author Thomas Turk More articles by this author Kristin Baldea More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...