Did you know that the most common cause of abdominal pain during the pregnancy is urinary stones which are also known as urolithiasis? Though stones present during pregnancy are a rare occurrence, proper diagnosis is necessary to ease the pain. Most of the stones are small enough to pass via the urinary tract but larger stones will require medical intervention.
Urinary stones are an aggregation of the chemical substances which are dissolved in urine. When the concentration level of these substances reaches a point and form stones. Kidney stones can be of small size or bigger in size depending on the complexity.
Physiological changes which lead to kidney stones in pregnant women
Given below are physiological changes, a pregnant woman will face. These changes usually occur in the second trimester and fall after delivery:
- There are some changes which occur in the woman’s physiology during pregnancy which may affect the urinary tract leading to increased chances of problems with already present urinary stones or these changes can even increase the chance of formation of new kidney stones.
- Later in pregnancy, the size of the uterus can restrict the flow of urine. The ureters get dilated in pregnancy and may not eliminate urine completely which can lead to hydronephrosis. The ureters can increase in size due to increased renal vascular during pregnancy. The collecting system and ureters also decrease their ability to contract which results in dilation and sometimes pain.
- During pregnancy, a variety of changes happening with vitamins and minerals can cause the formation of kidney stones. During this state, the body tends to handle calcium less effectively, leading to the onset of kidney stones.
- Urinary tract infection is also seen during pregnancy which can contribute to the formation of kidney stones.
Clinical presentation of kidney stones
This is commonly misdiagnosed as appendicitis, placental abruption. The stones occur in the ureter twice as often as in the kidney and it can affect both ureters in equal frequency. Here are some symptoms:
- Radiating pain to the groin
- Renal colic or flank pain
- Dysuria or painful urination
- Blood in urine
- Occurrence of vomiting
If the stones do not pass, it might initiate premature labor, produce intractable pain, cause urinary tract infection or it can interfere with the progress of normal labor.
Diagnosis of kidney stones during pregnancy
Urolithiasis in pregnancy is often a diagnostic challenge. Approximately 80-90% of urinary stones are diagnosed after the first trimester gets completed. Here are various ways to diagnose the disease:
- Laboratory assessment: A urine culture will confirm the infection, blood work can check the kidney function and increased serum calcium requires investigation.
- Radiological diagnosis: It includes magnetic resonance imaging, the risks from radiation are dependent on fetus age. Obtaining the imaging with the lower dose to treat the stone is done in some cases. X-rays are absolutely contraindicated as they are more risk to the fetus.
- Ultrasonography: This is the first option for diagnosing kidney stones present in pregnant women. Only specialists can perform the procedure. However, ultrasound does not always show the presence of stones.
- CT scanning: If the symptoms persist and they are causing other complex problems, then this is the option used in a pregnant woman.
- Nuclear renography: A radioisotope is injected into a vein which allows the radiologist to look at the kidneys. This is to check for functional studies.
Treatment for kidney stones
Let’s check out the kidney stone treatment during pregnancy.
- Conservative management: Patient is advised bed rest, should take proper fluid intake and medications which will help to manage the disease. Most of the stones pass normally with conservative treatment.
- Invasive treatment: Any type of manipulation in the pelvis, bladder or ureter could result in premature labor. However, treatments include:
- Stenting: A stent is placed in the ureter. The tube passes the urine which lessens the burden on the contraction of the urinary tract. The tube won’t be removed till the end of pregnancy.
- ESWL: ESWL uses ultrasonic pulses to break the stones. It’s contradicted during pregnancy as it can cause fetal damage and death, though it’s highly recommended for non-pregnant women.
- URS: URS is the recommended method for pregnant women where the removal of the stone is necessary. Holmium is used to fragment the stones and is used as an alternative to ESWL.
- PCNL: An access tract is created in the renal collecting system. Though its safety makes it good for non-pregnant women, this is not recommended during pregnancy, reasons include anesthesia and prone position.
Prevention of urinary stones during pregnancy
Prevention of urinary stones during pregnancy is key and is the best remedy. Here are some tips:
- Drink plenty of fluids which include water and keep your body hydrated
- Don’t hold your urine, even if it means frequent trips to the washroom
- Reduce your intake of high oxalate foods like nuts, dark green leafy vegetables, and berries
- Do exercise according to doctor
- Quickly consult a doctor in case of severe pain in the abdominal pain