The event of hydronephrosis and hydroureters during pregnancy has been described physiological, inasmuch as it is seen in more than 80-85%, a lot of regularly and most pronounced in primigravida.
The dilatation establishes during the second trimester, and ends up being more prominent on the right side, is just seen above the linea terminalis and vanishes within a few weeks after birth. The condition is not seen in women whose ureters do not cross the pelvic brim.
The extent of the dilatation can be decreased by positioning the woman on the side least affected or in the knee-elbow position. After a survey of the literature, the conclusion is reached that today there is every likelihood that hydronephrosis during pregnancy establishes as a result of compression of the ureters between the pregnant uterus and the linea terminalis.
It has not been demonstrated that the change in hormonal balance during pregnancy is of significance. The scientific significance of hydronephrosis depends on the association in between ureteral obstruction and the high frequency of rising urinary tract infection during pregnancy and in the understanding of the significance– in the treatment of infection– of improving drainage by ways of a change in position.
What is Hydronephrosis During Pregnancy?
Did you understand that around 90-95% of pregnant women experience hydronephrosis in one kind or the other? This may sound stunning to you, but that is the result of a number of reports from current times. If you are an anticipating mom, it is due time you established an awareness of Hydronephrosis to remain safe during your pregnancy.
Hydronephrosis is not a disease. It is a structural condition which typically takes place in one kidney or when chronic, impacts both the kidneys. The failure of typical drainage of urine from the kidney to the urinary bladder can lead to the swelling of either one of the kidneys or both. This condition frequently describes Hydronephrosis. It might take place due to a typical version or an underlying disease.
When the swelling impacts one of the kidneys, it is called Unilateral Hydronephrosis. While, when both the kidneys are concurrently impacted, the condition is called Bilateral Hydronephrosis.
A condition of establishing Hydronephrosis during pregnancy, due to the presence of the fetus within the womb, is Maternal Hydronephrosis. The asymptomatic dilation of the kidney calyces, the kidney pelvis and the upper two-thirds of uterus during pregnancy leads to this typical condition.
Likewise described as gestational hydronephrosis, it associates with the typical trouble of urinary tract infection in pregnant women. Therefore, it is approximated, around 90-95% of pregnant women suffer from some form of Hydronephrosis during pregnancy.
The dilation is typically more prominent on the right side of the body (80-85%) than the left side (15-20%). The ureteral dilation does not happen below the pelvic brim. An existence of Hydronephrosis due to some pathological condition prenatally worsens the disorder.
What Causes Hydronephrosis During Pregnancy?
The hormone changes during pregnancy involving estrogen, progesterone, and prostaglandin like agents cause conditions like Hydronephrosis and Ureter Ectasis.
Pregnancy leads to generalized relaxation of smooth muscles due to the result of progesterone. Along with dextro-rotation of the uterus, the occurrence of hydronephrosis in pregnant women becomes greater.
The growing weight of the uterus in a minimal pelvic space can cause dilation of the uterus and thus add to the occurrence of Hydronephrosis. Increasing gestational age and growth of the uterus outside the hips can decrease this pressure on the ureters.Increased hydration can result in an increased degree of Hydronephrosis.
Pregnancy increases the kidney blood flow to approximately 75% and approximate 50% increase in the Glomerular Filtration Rate (GFR). The GFR is a test used to check how well the kidneys are working. Therefore, the incidence of fetal Hydronephrosis in pregnancy increases.
The obstruction or the blockage in the urinary tract can happen congenitally in a fetus or may be one of the physiological actions to pregnancy. Kidney stones, blood clots or a stricture or scarring of the kidneys, bladder cancer, urethral stricture, etc. are few of the intrinsic causes of Hydronephrosis.
Likewise, external causes of Cervical Cancer, the Ovarian Vein Syndrome and functional causes like Diabetes and Vesicoureteral Reflux can also result in Hydronephrosis.
Hydronephrosis Symptoms During Pregnancy
Here are a few of hydronephrosis during pregnancy symptoms. Nevertheless, in many cases, there will be no symptoms at all. Symptoms depend upon whether the swelling occurs acutely, progressively or more gradually.
- Intense flank pain or pain in the back and abdominal area
- Nausea and vomiting, fever
- Consistent urinary tract infection with painful urination, increased frequency of urination.
- Colicky pain
- Spots of blood in the urine
- Chest pain
- Swelling of the legs.
- The gestational Hydronephrosis usually takes place in the 2nd trimester. It affects practically 90-95% of pregnancies by the 26th and 28th weeks.
- The incidence of dilation is greater in nulliparous patients. A woman who has actually not brought the pregnancy beyond 20 weeks is described nulliparous.
- Mainly Hydronephrosis disappears by itself, with no kind of treatment. The ideal period is 6 weeks after delivery, however in some cases, it might persist longer.
- Hydronephrosis explains swelling of the kidney resulting from the failure of urine to drain pipes from the kidney into the bladder.
- Hydroureter explains swelling of the ureter, the tube that links the kidney to the bladder.
- The obstruction may take place at any level in the urinary collecting system from the kidney to the ureter to the bladder to the urethra.
- Depending upon the level of the cause, hydronephrosis might be unilateral including one kidney or bilateral including both.
- The increased pressure caused by hydronephrosis potentially can compromise kidney function if it is not eased in a reasonable period of time.
- Symptoms of hydronephrosis rely on whether the swelling takes place acutely or advances more slowly. If it is an intense obstruction, symptoms might include twisting pain, queasiness, and vomiting.
- Treatment of hydronephrosis and hydroureter is targeted at restoring urine circulation from the impacted kidney.
Diagnosis for Hydronephrosis During Pregnancy
Isotope renographic research studies seem to show a possible relationship between bilateral ureteral obstruction and the development of pre-eclampsia.
Similarly, it appears that severe hydronephrosis or worsening of an existing hydronephrosis has actually been rather neglected as a possible cause of unsure abdominal pain during pregnancy.
These conditions must be examined by means of ultrasonography, and an effort at treatment by a change in position need to be made. In cases of ongoing pain or impacted kidney function, treatment ought to consist of the insertion of a ureteral catheter.
- Ultrasound scan can help in separating physiologic Hydronephrosis from obstruction secondary to calculus disease.
- Analysis of urine to identify an infection.
- Blood test to check for anemia.
- Electrolyte analysis and the GFR to identify the proper functioning of kidneys.
Risk of Hydronephrosis
An unusual however possibly dangerous issue connected with Gestational Hydronephrosis is a spontaneous kidney rupture.
It occurs due to increased hydrostatic pressure within the gathering structures that goes beyond the holding capacity of the calyceal-renal capsular junctions.
Kidneys with prior damage before pregnancy are more prone to suffer from a spontaneous kidney rupture.
If left without treatment beyond a reasonable period, the kidney will completely cannot work.
Call Your Doctor for Medical Advice
An occurrence of fever, acute pain in the abdominal area or traces of blood in the urine are all guidelines to immediately seek medical help.
Hydronephrosis can be fatal in pregnant women with simply one kidney. For that reason, even the development of light symptoms must be brought to the attention of your doctor!
Treatment of Hydronephrosis During Pregnancy
The treatment of Hydronephrosis during pregnancy is carefully performed through various stages. Have a look at them.
- 1. Draining the urine through a thin catheter placed into the bladder or straight to the kidney through the skin. It alleviates the pressure of the urine in the kidneys.
- Treating the underlying cause which primarily caused the clog is the next step in line. A surgery called Ureteral Stenting generally gets rid of the obstruction. Various causes will have various treatments. For example, if it is a kidney stone that triggered Hydronephrosis, acoustic waves or lasers are used to break it.
- But if it is purely pregnancy that caused the condition, absolutely nothing much can be done to treat the condition. You just need to wait till it finishes its natural course to heal. Nevertheless, the procedure of draining the excess urine through a catheter will be done to reduce the pressure on the kidneys and avoiding chances of more damage.
Preventing Hydronephrosis During Pregnancy
Kidney illness typically have no symptoms. Thus, it can go undetected if not evaluated at the right time.
Early detection and treatment can slow or avoid the development of kidney’s disease. A regular urine test and blood test can help in discovering the occurrence of any kidney conditions in pregnancy.
Routinely consult your practitioner throughout pregnancy and make sure you don’t show any warning signs of renal conditions.
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