Antepartum nephrolithiasis and the risk of preterm delivery

Drescher, Max; Blackwell, Robert H.; Patel, Parth M.; Kuo, Paul C.; Türk, Thomas; Baldea, Kristin G.

doi:10.1007/s00240-018-1085-3

Cited by 16 publications

(4 citation statements)

References 26 publications

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“…In one retrospective review of a large database of 3,904 obstetric patients with nephrolithiasis, those who underwent PCN placement had a preterm delivery rate of 19.6% from a baseline of 9.1% for women who had stones managed conservatively. Those who underwent ureteroscopy or ureteral stenting had a preterm delivery rate of 11.2% ( 37 ). Therefore, there may be a higher preterm delivery rate associated with PCN tube placement.…”

Section: Discussionmentioning

confidence: 99%

Management of Nephrolithiasis in Pregnancy: Multi-Disciplinary Guidelines From an Academic Medical Center

et al. 2021

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Introduction: The management of nephrolithiasis during pregnancy can be stressful for urologists due to concerns for investigations and treatments that may pose risk of fetal harm, and unfamiliarity with optimal management of these complex patients. In response, we created multi-disciplinary evidence-based guidelines to standardize the care for obstetric patients presenting with flank pain and suspicion for nephrolithiasis.Methods: A multi-disciplinary team involving Urology, Obstetric Anesthesiology, Obstetrics and Gynecology, Diagnostic Radiology, and Interventional Radiology from a single academic medical center was assembled. A PubMed search was performed using keywords of pregnancy/antepartum, nephrolithiasis/calculi/kidney stones, ureteroscopy, non-obstetric surgery, complications, preterm delivery, MRI, computerized tomography, renal bladder ultrasound (RBUS), and anesthesia to identify relevant articles. Team members reviewed their respective areas to create a comprehensive set of guidelines. One invited external expert reviewed the guidelines for validation purposes.Results: A total of 54 articles were reviewed for evidence synthesis. Four guideline statements were constructed to guide diagnosis and imaging, and seven statements to guide intervention. Guidelines were then used to create a diagnostic and intervention flowchart for ease of use. In summary, RBUS should be the initial diagnostic study. If diagnostic uncertainty still exists, a non-contrast CT scan should be obtained. For obstetric patients presenting with a septic obstructing stone, urgent decompression should be achieved. We recommend ureteral stent placement as the preferred intervention if local factors allow.Conclusions: We present a standardized care pathway for the management of nephrolithiasis during pregnancy. Our aim is to standardize and simplify the clinical management of these complex scenarios for urologists.

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Section: Discussionmentioning

confidence: 99%

Management of Nephrolithiasis in Pregnancy: Multi-Disciplinary Guidelines From an Academic Medical Center

et al. 2021

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“…[5][6][7][8] Larger population-level studies utilizing national insurance claims data estimate the prevalence of nephrolithiasis diagnoses from 0.14% to 0.8% of all deliveries. [9][10][11] Stone recurrence rates among pregnant women appear higher than the general population (29% recurrence rate, mean follow-up 51 months). 12 However, the prevalence of stone disease among pregnant women does not appear to be increasing over time in parallel to the growing prevalence of stone disease among women.…”

Section: Epidemiologymentioning

confidence: 88%

“…5,14,15 Though most patients can be managed conservatively, 26%-30% of symptomatic patients ultimately require acute intervention. 10,12,18 Rates of preterm labor for those requiring intervention are nearly triple those managed conservatively (14% vs 5%). 26 Ultimately, consideration of mode of intervention requires shared decision making with the patient, and multidisciplinary collaboration with experienced obstetricians, urologists, and anesthesiologists.…”

Section: Interventionmentioning

confidence: 99%

Nephrolithiasis in Pregnancy: Treating for Two

Dai

Nicholson

Chang

et al. 2021

Urology

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“…Drescher, et al 62 identificaron el riesgo de presentar infección del tracto urinario y parto pretérmino teniendo en cuenta los distintos manejos de la nefrolitiasis en la gestante, y concluyeron que la nefrostomía percutánea representó un mayor riesgo de infección del tracto urinario y de parto pretérmino (odds ratio [OR]: 2,3), a diferencia la colocación de stent ureteral (OR: 1,5) y del manejo conservador (OR: 1,3), que mostraron un menor riesgo para la génesis de estas complicaciones.…”

Section: Drenaje Renalunclassified

Nefrolitiasis en la paciente gestante: revisión de la literatura

Bohórquez-Rivero¹,

Restom-Arrieta²,

Sáenz-López³

et al. 2024

RECHOG

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La litiasis renal en la paciente gestante es una condición relativamente infrecuente; sin embargo, es la causa más común de dolor no obstétrico durante el embarazo. En el periodo de gestación se producen diversos cambios anatomofisiológicos en el tracto urinario, como la dilatación de los cálices renales, la pelvis renal y los uréteres por causa del efecto que ejerce la progesterona sobre el músculo liso uretral, y la compresión de los uréteres por el útero grávido. Estas modificaciones conducen a un aumento del flujo plasmático renal y de la tasa de filtrado glomerular, ocasionando hiperuricosuria e hipercalciuria. Del mismo modo, durante el embarazo también se produce un aumento de la secreción de inhibidores de cálculos, por lo cual la prevalencia de la formación de cálculos durante el embarazo es similar a la de las mujeres no embarazadas. El bajo índice de sospecha por parte del médico tratante puede entorpecer el diagnóstico y el tratamiento de esta patología, que también son limitados en la gestación debido a los potenciales riesgos teratogénicos. Se realiza una revisión narrativa de la literatura partiendo de la evidencia científica disponible en las diferentes bases de datos y de esta manera se pretende instruir al médico en los aspectos clave de dicho tema.

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Antepartum nephrolithiasis and the risk of preterm delivery

Cited by 16 publications

References 26 publications

Management of Nephrolithiasis in Pregnancy: Multi-Disciplinary Guidelines From an Academic Medical Center

Management of Nephrolithiasis in Pregnancy: Multi-Disciplinary Guidelines From an Academic Medical Center

Nephrolithiasis in Pregnancy: Treating for Two

Nefrolitiasis en la paciente gestante: revisión de la literatura

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