Managing severe loin pain in pregnancy

Irving, S

doi:10.1016/s1470-0328(02)01340-x

Cited by 5 publications

(6 citation statements)

References 5 publications

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“…Limited IVU has been proposed as one option. Several different protocols of limited IVU have been suggested, 19,20,22,46,47 with sensitivities ranging from 60 to 94%. Stothers and Lee reported that IVU demonstrated calculi in 16 of 17 patients with a three film study (using a scout film, a film at 30 seconds and one at 20 minutes).…”

Section: Intravenous Urographymentioning

confidence: 99%

“…Stothers and Lee reported that IVU demonstrated calculi in 16 of 17 patients with a three film study (using a scout film, a film at 30 seconds and one at 20 minutes). 20 Irving and Burgess used a two film series (one plain film and one at 20 minutes) and reported improved detection of stones in three of 15 patients 47 and Butler et al. have reported better detection rates than renal ultrasound with a ‘single-shot’ IVP film, taken 30 min after contrast (60% versus 93%).…”

Section: Intravenous Urographymentioning

confidence: 99%

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Renal stones in pregnancy

2014

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Diagnosis and treatment of renal stones during pregnancy is a complex problem. Risks to the fetus from ionising radiation and interventional procedures need to be balanced with optimising clinical care for the mother. Management of such patients requires a clear understanding of available options, with a multidisciplinary team approach. In this review, we discuss the role of different diagnostic tests including ultrasound, magnetic resonance urography, and computerized tomography. We also provide an update on recent developments in the treatment of renal stones during pregnancy. Expectant management remains first-line treatment. Where definitive treatment of the stone is required, new evidence suggests that ureteroscopic stone removal may be equally safe, and possibly better than traditional temporising procedures.

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Section: Intravenous Urographymentioning

confidence: 99%

Section: Intravenous Urographymentioning

confidence: 99%

Renal stones in pregnancy

2014

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“…However, the lower doses of radiation used in intravenous urography pose a risk of less than 0.05 per cent 12. This urological investigation is safe and acceptable in pregnancy, with minimal risks in the right setting 13,14. The risk to the fetus is categorised as minor and not an indication for termination of pregnancy 15.…”

Section: Discussionmentioning

confidence: 95%

A rare cause of abdominal pain in early pregnancy

Matiluko

Smith

2010

Trends Urology, Gynecol. Sexual Health

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twisted, necrotic left tube and ovary were found ( Figure 1). A laparoscopic left salpingo-oophorectomy was performed. The histology report showed extensive haemorrhage and necrosis of the left ovary and fallopian tube, but no evi dence of trophoblastic tissue to suggest ectopic pregnancy.Subsequently, a pelvic ultrasound scan showed a viable intrauterine pregnancy equivalent to eight weeks' gestation. She had vaginal progesterone support for the rest of the fi rst trimester. Her 20-week anomaly scan was normal and she gave birth to a healthy baby girl, at 39 weeks of gestation, by caesarean section for breech presentation. DiscussionTorsion of an ovary and fallopian tube is rare in pregnancy and poses a considerable diagnostic challenge. 1,2 The prevalence of this condition has been estimated at 1 in 1800, 3 but we believe this to be an overestimation.In the case reported here, the pregnancy was initially unrecognised because of a false-negative pregnancy test kit. False-negative qualitative urine pregnancy tests are well documented. 4-8 Qualitative point-of-care and home pregnancy tests both have limitations and are not 100 per cent sensitive in detecting pregnancy. In one study, 5 only 44 per cent of 18 brands gave a clearly positive result at serum beta-human chorionic gonadotrophin (β-hCG) levels of 100mIU/ml. In other words, 56 per cent were falsely negative. In a woman of childbearing age with abdominal pain, we therefore suggest that a negative qualitative urine pregnancy test should be confi rmed by quantitative serum β-hCG measurement.Laparoscopic salpingo-oophorectomy was performed because the tissues appeared necrotic and persistent fever suggested early sepsis. The necrosis was subsequently confi rmed histologically. However, successful detorsion of twisted adnexa has been described regardless of delay in diagnosis and the appearance of the adnexum. 1 A 33-year-old woman was referred to the urology team with a four-day history of left loin pain, syncope and vomiting. She had tachycardia (108 beats per minute), a mildly raised temperature (37.3°C) and tenderness in the left lumbar region and iliac fossa. Urine pregnancy test was negative, but a trace of haemolysed blood was found on ward urinalysis. An intravenous urogram showed no ureteric obstruction. A diagnosis of pyelonephritis was made.However, her pain failed to settle on antibiotics, and a gynaecological opinion was sought two days after admission. On questioning, her last menstrual period transpired to be three months before presentation. She was cardiovascularly stable, but examination revealed abdominal peritonism, a bulky uterus and cervical excitation. A repeat pregnancy test was positive. A clinical diagnosis of ectopic pregnancy was made.The authors present a case history of a pregnant woman with abdominal pain who was found to have torsion of an ovary and fallopian tube. This condition is rare in pregnancy and the case highlights the diagnostic challenges involved. Twisted adnexum Necrotic left tube Necrotic left ovary a b Figure 1. La...

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“…With lead shielding of the pelvis, a control film is taken followed by 15‐ and 30‐ or 60‐min images postintravenous contrast administration. This limits radiation exposure and can diagnose obstruction or ureterolithiasis 15–19 . Magnetic resonance imaging (MRI) is safe in pregnancy and can diagnose obstruction but provides limited information about calculi.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic urinary stone disease in pregnancy

Cheriachan

Arianayagam

Rashid

2008

Aust NZ J Obst Gynaeco

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Background: Symptomatic urinary calculi are rare in pregnancy with an incidence of one per 1500 pregnant women. Calculi may cause ureteric obstruction that can be further complicated by sepsis. This may have a significant morbidity for mother and fetus. Objective: To provide an update on the current investigations and management options for pregnant patients with symptomatic urinary calculi. Discussion: We discuss the different imaging modalities available to investigate the renal tract in pregnant women and propose a management pathway. This topic is particularly pertinent to obstetricians in their roles as coordinators of prenatal care.

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Managing severe loin pain in pregnancy

Cited by 5 publications

References 5 publications

Renal stones in pregnancy

Renal stones in pregnancy

A rare cause of abdominal pain in early pregnancy

Symptomatic urinary stone disease in pregnancy

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