Managing stones in pregnancy: an update
نویسندگان
چکیده
• Stone formation is a multifactorial process, and the incidence appears to be increasing among women. • Overall, the risk of stone formation during pregnancy does not appear to be increased. • Common presentations of stones in pregnancy include nonspecific flank or abdominal pain, fever, recurrent or persistent urinary tract infections, or microscopic hematuria. • Imaging investigations of a pregnant woman with a suspected stone include ultrasound as the initial evaluation with an evolving second line role for MRI and low-dose CT depending on the stage of pregnancy. • A multidisciplinary management strategy should include participation of a perinatologist and urologist. • The majority of pregnant women with a symptomatic upper tract stone pass their stone without intervention. • Indications for intervention include intractable pain, pre-eclampsia, threatened pre-term labor, sepsis or renal failure. • Medical expulsive therapy with α-blockers are contraindicated in pregnancy. • For distal ureteral stones requiring intervention, ureteroscopy and laser lithotripsy has evolved as a definitive treatment option. • When temporary urinary drainage of an obstructed upper tract is required percutaneous drainage under ultrasound guidance is preferred during the first trimester, while in the second orthird trimesters retrograde ureteral stent placement may also be considered.
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