Management of Acute Symptomatic Hydronephrosis of Pregnancy by Postural Drainage
Abstract
Introduction & Objectives
Asymptomatic hydronephrosis is found in >90% of pregnant women, only a small proportion become symptomatic. Non-surgical management is the treatment of choice. In refractory cases surgical intervention is indicated.
We present our experience with conservative management of acute symptomatic hydronephrosis of pregnancy by facilitating postural drainage of the obstructed symptomatic kidney.
Material & Methods
1750 women with full term pregnancy were managed in the unit over 5 yrs. 130 (7.4%) presented with unilateral loin pain and were in the third trimester of pregnancy at presentation (20@ 28 weeks, 58@ 30 weeks, and 52@ 32 weeks). 68 / 130 (52.3%) were multi-parous. Age range was 26-38 yrs.
115 (88.5%) presented with right-sided loin pain and 15 (11.5%) had pain in the left loin. There was no evidence of incipient urinary tract infection (UTI). Ultrasound scan (USS) confirmed presence of ipsilateral mild to moderate hydronephrosis with no evidence of renal / ureteric calculus.
All were refractory to routine enteral or parenteral analgesia over 72 hrs.
They were managed in a semi-prone position while in bed, with the affected side up and non-dependant. Head end of their bed was kept raised by 10° throughout this period of conservative management; initiated in the hospital and continued at home until term.
Results
121 of the 130 women (93.1%) had symptomatic improvement. None required regular analgesia and went to term without further intervention i.e. insertion of nephrostomy / stenting. Follow-up USS at three months post-partum revealed complete resolution of hydronephrosis.
Conclusions
Postural drainage of the kidney is highly effective in the management of acute symptomatic hydronephrosis of pregnancy. In the majority of cases (93%), if used diligently, it will help prevent the need for invasive uro-radiological intervention.
