Maternal obstructive uropathy during labor is a risk factor for cesarean delivery

Obstructive uropathy is the impairment of urinary flow resulting from mechanical compression along the urinary tract between the ureter's origin in the renal pelvis and the urethral outlet. While uncommonly encountered during labor, maternal obstructive uropathy (thought to result from ureteral compression by the fetal head) can be associated with acute kidney injury, and its relationship with clinically meaningful endpoints including risk of cesarean delivery, arrest of labor (previously known as cephalopelvic disproportion (CPD)), and high birthweight remain unknown.

We conducted a retrospective case-control, propensity score-matched study using an institutional database of patients who delivered at one of two hospitals within our healthcare system between January 2017 and December 2023, querying the relationship between ICD-9 and ICD-10 diagnostic codes of maternal obstructive uropathy and labor outcomes.

The diagnosis of ureteral obstruction was significantly associated with incidence of cesarean delivery (93 % in cases, 16 % in controls, p<0.001) and clinical suspicion for CPD (80 % in cases, 13 % in controls, p<0.001) but was not significantly associated with birthweight (p=0.729).

These results suggest that intrapartum diagnosis of obstructive uropathy may portend labor dystocia and subsequent indication for intrapartum cesarean delivery.