Journal of Womens Health, Issues and Care ISSN: 2325-9795

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Conservative Management Protocol of Acute Hydronephrosis of Pregnancy: Two Centers Experience

Conservative Management Protocol of Acute Hydronephrosis of Pregnancy: Two Centers Experience

Objectives: This study is aiming to detect the value of conservative management protocol of acute hydronephrosis of pregnancy by facilitating both good hydration and postural drainage of the affected kidney. Patients and Methods: This prospective study was carried out from March 2010– 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 second and third trimesters of pregnancy at presentation ( 9 at 22 weeks, 13 patients at 28 weeks, 30 patients at 30 weeks, and 34 patients at 32 weeks) mean age 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 evidence of associated urinary tract infection (UTI) in 12 (13.9%) cases. Ultrasound scan (US) confirmed presence of ipsilateral mild to moderate hydronephrosis with no evidence of renal / ureteric calculus. All were refractory to routine enteral analgesia over 72 hours. They were managed by good i.v fluid hydration and maintaining them in a semiprone lateral position in bed, with the affected side up and elevated head of the bed was kept by 20º during the period of conservative management until term and delivery. Results: Eighty of the 86 women (93%) had symptomatic improvement. None required further regular analgesia and completed pregnancy to term without further invasive interventions (e.g. D.J stenting, Percutaneous Nephrostomy). Follow-up by Ultrasound scan at three months post-partum revealed complete resolution of hydronephrosis. Conclusions: Conservative management of acute symptomatic hydronephrosis of pregnancy is highly effective in the majority of cases (93%), and if used carefully, it will avoid the need for more invasive uro-radiological intervention.

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