The identification of pregnant women with renal colic who may need surgical intervention

Abstract

Background Renal colic is a surgical emergency in pregnancy that is caused by a range of non-obstetric factors and known to occur more frequently during the second and third trimesters. Several studies have reported that up to 70–80% of stones pass spontaneously during pregnancy. There are some patients will not pass their stones and will ultimately require surgical intervention. Through retrospective analysis of the clinical data of 212 pregnant women with renal colic, the predictive factors of pregnant women with renal colic in need of surgical intervention were determined. Methods We conducted a retrospective review of 212 pregnant women presenting with renal colic between 1st January 2009 and 31st December 2020. Univariate and multivariate analyses identified a range of predictive variables for surgical intervention. In addition, we used receiver operating characteristic curve analysis to evaluate the predictive power of our model and created a nomogram for clinical application. Results Of the 212 patients presenting with acute renal colic in pregnancy, 100 patients (47.2%) underwent surgical intervention and 112 patients (52.8%) were treated conservatively. Univariate analysis identified significant differences between the two groups with regards to fever, the duration of pain, white blood cells, C-reactive protein, ureteral stone size, hydronephrosis, and stone location. Multivariate analysis further identified a number of independent predictors for surgical intervention, including fever, a duration of pain ≥ 4 days, a ureteral stone size ≥ 8 mm, and moderate or severe hydronephrosis. Conclusions We identified several independent predictors for surgical intervention for renal colic in pregnancy. Fever, a duration of pain ≥ 4 days, a ureteral stone size ≥ 8 mm, and moderate/severe hydronephrosis, play significant roles in predicting surgical intervention. Our nomogram can help to calculate the probability of surgical intervention in a simple and efficient manner. Prospective studies are now required to validate our model.

Is Ultrasound-Guided Percutaneous Nephrostomy Efficacious and Safe in Pregnant Patients?: A Single Center Experience

“…The prevalence of stones during pregnancy can vary, occurring in approximately 1 in 200 to 1 in 5000 cases 17 . Spontaneous passage of stones may be observed in 48-84% of cases 18 .…”

The use of ultrasound in assessing acute renal pain caused by pregnancy

“…Patients who have renal stones are prone to passing stones that obstruct the ureters due to companion pyeloureteric dilation, which is associated with pregnancy and progesterone-related ureteral muscle laxity. Renal stones can pass down to the ureter spontaneously in about 70 to 80% of cases, among them about 50% of cases will expel the stones during the postpartum period (4,6,7)). However, some cases may not pass the stones and require further surgical intervention.…”

“…Pain lasting more than 4 days and fever. Small stones less than 4mm can be treated medically and expectantly when the spontaneous passage rate reaches 50% or more (4).…”

“…It may lead to preterm delivery, premature rupture of membranes due to hazards of pain severity and frequent vomiting. Maternal systemic sepsis and acute renal injury are possible outcomes (4).…”