Maternal Hydronephrosis in Pregnancy: Poor Association with Symptoms of Flank Pain

ABSTRACT

The purpose of our investigation was to determine the association between flank pain and maternal hydronephrosis during pregnancy. Eighty-one gravidas were evaluated longitudinally with renal ultrasound in each trimester and postpartum. Each was asked about symptoms of flank pain, and then a renal ultrasound was performed. We defined hydronephrosis as a mean pelvic-calyceal measurement of 10 mm or greater. None of the cohort had hydronephrosis in the first trimester, and four had hydronephrosis in the second trimester; almost all maternal hydronephrosis was seen initially in the third trimester. Seventeen (21%) of 81 women had hydronephrosis; 14 on the right side and three bilateral. Nine women reported significant flank pain, and three of these had hydronephrosis. Fourteen women with hydronephrosis reported no flank pain. There was no association observed between flank pain and hydronephrosis (p = 0.39). All women with hydronephrosis had complete resolution at 6 weeks postpartum. During pregnancy, the association between maternal hydronephrosis and flank pain symptoms is poor. In the clinical evaluation of pregnant women with flank pain, hydronephrosis should not be considered etiologic in the absence of other clinical evidence.

Pregnancy - hydronephrosis - renal ultrasound

REFERENCES

• 1 Peake S L, Roxburgh H B, Langlois S L. Ultrasonographic assessment of hydronephrosis of pregnancy.  Radiology. 1983;  146 167-170
• 2 Cietak K A, Newton J R. Serial qualitative maternal nephrosonography in pregnancy.  Br J Radiol. 1985;  58 399-404
• 3 Murao F. Ultrasonic evaluation of hydronephrosis during pregnancy and puerperium.  Gynecol Obstet Invest. 1993;  35 94-98
• 4 Anderson I H, Jones G R, Standen J R. Ultrasonographic assessment of hydronephrosis of pregnancy.  J Can Assoc Radiol. 1983;  34 29-31
• 5 Woo J S, Wan C W, Ma H. Pregnancy hydronephrosis-a longitudinal ultrasonic evaluation.  Aust N Z J Obstet Gynaecol. 1984;  24 9-13
• 6 Fried A M, Woodring J H, Thompson D J. Hydronephrosis of pregnancy: a prospective sequential study of the course of dilatation.  J Ultrasound Med. 1983;  2 255-259
• 7 Spencer J A, Chahal R, Kelly A, Taylor K, Eardly I, Lloyd S N. Evaluation of painful hydronephrosis in pregnancy: magnetic resonance urographic patterns in physiological dilatation versus calculous obstruction.  J Urol. 2004;  171 256-260
• 8 Nielsen F R, Rasmussen P E. Hydronephrosis during pregnancy: four cases of hydronephrosis causing symptoms during pregnancy.  Eur J Obstet Gynecol Reprod Biol. 1988;  27 245-248
• 9 Puskar D, Balagovic I, Filipovic A et al.. Symptomatic physiologic hydronephrosis in pregnancy.  Eur Urol. 2001;  39 260-263
• 10 Fainaru O, Almog B, Gamzu R, Lessing J B, Kupferminc M. The management of symptomatic hydronephrosis in pregnancy.  BJOG. 2002;  109 1385-1387
• 11 Zwergel T, Lindenmeier T, Wullich B. Management of acute hydronephrosis in pregnancy by ureteral stenting.  Eur Urol. 1996;  29 292-297