Outcome of pregnancy in women with a history of vesico‐ureteric reflux

Abstract

OBJECTIVES To review the evidence relating to the outcome of pregnancy in women with vesico‐ureteric reflux (VUR) or a previous history of VUR and to identify the factors contributing to morbidity in pregnancy, with particular emphasis on the role of renal scarring. METHODS Searches were carried out in Medline, Pubmed and MD Consult using various combinations of the keywords including: vesicoureteral reflux and pregnancy, maternal vesicoureteral reflux, vesicoureteral reflux in adulthood, reflux nephropathy and pregnancy. All data quoted in this review are from original articles. RESULTS The published studies showed that women with VUR that was not associated with renal scarring had no increase in the incidence of gestational hypertension, pre‐eclampsia or fetal morbidity, regardless of whether their VUR was diagnosed in childhood or adulthood. However, women with VUR and normal kidneys did have higher incidence of urinary tract infection during pregnancy, which was not modified by ureteric re‐implantation. Renal scarring was the primary risk factor for morbidity during pregnancy and this risk was independent of the presence or absence of VUR at the time of pregnancy. CONCLUSION The evidence does not support the practice of correcting low‐grade VUR in girls with unscarred kidneys because this will reduce their risk of complications in pregnancy. The presence of renal scarring rather than the presence or absence of reflux is the principal determinant of morbidity during pregnancy.

Vesicoureteral reflux: From prophylaxis to surgery

“…A subset of girls with persistent VUR after puberty will undergo corrective surgery, as reflux in adult females carries an increased propensity for maternal and fetal morbidity during pregnancy, especially with presence of scars/dysplasia. 9 Finally, patient and family's preferences may affect the decision to undergo a surgical treatment after discussion and informed consent.…”

Risk of Adverse Pregnancy Outcomes in Women with CKD

“…[13][14][15][16] Other diseases such as IgA or reflux nephropathy usually display a good prognosis, at least in the presence of normal kidney function. [17][18][19][20][21][22][23] Despite rising interest, few large cohorts of nonselected patients with CKD encompassing the most frequently encountered disorders in clinical practice are available.…”

Laparoscopic Ureteral Reimplantation underneath Broad Ligament Tunnel for Female Vesicoureteral Stenosis: A Technical Innovation

“…One of the consistent and most surprising findings is that women who had undergone ureteral reimplantation had a higher incidence of urinary tract infection than those managed conservatively (65 vs. 15%) [23]. Mansfield et al [24] and Hollowell [25] also speculated that this difference could not be simply explained on a selection basis and believed that ureteral reimplantation might increase the risk of urinary tract infection. Furthermore, women undergoing ureteral reimplantation showed a higher incidence of obstructive renal failure (5%) during pregnancy compared to the general population (1/10,000) [18,24].…”