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Managing severe loin pain in pregnancy
Stuart O Irving1, Neil A Burgess
1Department of Urology, Norfolk and Norwich University Hospital, UK.
BJOG : an International Journal of Obstetrics and Gynaecology
|September 25, 2002
Summary
Intravenous urography is a safe and valuable diagnostic tool for managing severe loin pain in pregnancy when conservative treatment fails. This imaging technique aids in accurate diagnosis and guides multidisciplinary treatment decisions for improved maternal and fetal outcomes.
Area of Science:
- Obstetrics and Gynecology
- Radiology
- Urology
Background:
- Severe loin pain during pregnancy can be debilitating and may indicate underlying renal pathology.
- Conservative management is often the first line of treatment, but may not be effective for all cases.
Purpose of the Study:
- To evaluate the diagnostic value and safety of intravenous urography (IVU) in pregnant women with severe loin pain unresponsive to conservative treatment.
- To assess the role of IVU in guiding management decisions for renal complications during pregnancy.
Main Methods:
- A prospective observational study was conducted over 24 months at a university teaching hospital.
- Fifteen pregnant women with severe loin pain, suspected to be of renal origin and unresponsive to conservative measures, were included.
- Intravenous urography, including plain and postmicturition films, was performed on all participants.
Main Results:
- All 15 women had prior ultrasounds showing dilatation on the symptomatic side.
- IVU confirmed ipsilateral dilatation in 14/15 cases, identified the level of obstruction in these cases, and showed delayed contrast excretion in 14/15.
- IVU identified three cases of ureteric calculi and one non-obstructed system, aiding in diagnosis.
Conclusions:
- Intravenous urography is a safe investigation for pregnant women when indicated.
- IVU facilitates accurate diagnosis and enables appropriate, tailored treatment through multidisciplinary collaboration (urology, obstetrics, radiology).
- This approach enhances patient safety for both mother and baby.