Advertisement

Hydronephrosis during pregnancy: a literature survey

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      The occurrence of hydronephrosis and hydroureters during pregnancy has been termed physiological, inasmuch as it is seen in more than 80%, most frequently and most pronounced in primigravida. The dilatation develops during the second trimester, and becomes more prominent on the right side, is only seen above the linea terminalis and disappears 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 reduced by placing 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 probability that hydronephrosis during pregnancy develops 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 importance. The clinical significance of hydronephrosis lies in the association between ureteral obstruction and the high frequency of ascending urinary tract infection during pregnancy and in the understanding of the importance —in the treatment of infection—of improving drainage by means of a change in position. Isotope renographic studies seem to show a possible relationship between bilateral ureteral obstruction and the development of pre-eclampsia. Similarly, it appears that acute hydronephrosis or worsening of an existing hydronephrosis has been somewhat overlooked as a possible cause of uncertain abdominal pain during pregnancy. These conditions should be examined by means of ultrasonography, and an attempt at treatment by a change in position should be made. In cases of continued pain or affected renal function, treatment should consist of the insertion of a ureteral catheter.

      Keywords

      References

        • Morgagni JB
        3rd edn. The seats and causes of diseases. 2. A Millar; T Cadell & Johnson & Payne, London1769: 428-429
        • Rayer PFO
        3rd edn. Traite des maladies des reins. 1. JB Bailliere, Paris1839: 47 + 506
        • Opitz E
        Die pyelonephritis gravidarum et puerperarum.
        Z Geburtshilfe Gynaekol. 1905; 55: 209-294
        • Shulman A
        • Herlinger H
        Urinary tract dilatation in pregnancy.
        Br J Radiol. 1975; 48: 638-645
        • Kretschmer HL
        • Heaney NS
        Dilatation of the ureter and kidney pelvis during pregnancy.
        J Am Med Assoc. 1925; 85: 406-409
        • Schumacher P
        Die schwangerschaftsveranderungen der ableitenden harnwege im rontgenbild.
        Arch Gynecol. 1930; 143: 28
        • Hundley JM
        • Siegel IA
        • Hachtel FW
        • Dumler JC
        Some physiological and pathological observations on the urinary tract during pregnancy.
        Surg Gynecol Obstet. 1938; 66: 360-379
        • Badr M
        Renography in normal pregnant patients.
        Acta Obstet Gynecol Scand. 1973; 52: 69
        • Bergstrom H
        Renographic evaluation of renal excretion in hydronephrosis of pregnancy.
        Acta Obstet Gynecol Scand. 1975; 54: 203
        • Fried AM
        Hydronephrosis of pregnancy: ultrasonographic study and classification of asymptomatic women.
        Am J Obstet Gynecol. 1979; 135: 1066-1070
        • Sanger M
        Discussion.
        Zentralbl Gynaecol. 1892; 16: 719
        • Hofbauer J
        Structure and function of the ureter during pregnancy.
        J Urol. 1928; 20: 413-426
        • Küstner H
        Progressive wachstumveranderungen am ureter während der schwangerschaft.
        Z Mikrosk Anat Forsch. 1925; 3: 295
        • Pugh WS
        Pyelitis of pregnancy: its treatment with an indwelling catheter.
        J Urol. 1927; 18: 553
        • Traut HF
        • Kuder A
        Inflammation of the upper urinary tract complicating the reproductive period of women.
        Int Abst Surg. 1938; 67: 568
        • Mengert WF
        The effect of pregnancy upon the ureters of common animals.
        Am J Obstet Gynecol. 1934; 27: 544
        • Schmidt S
        • Schmith HR
        Der nierenbecken und harnleitertonus in schwangerschaft und wochenbett.
        Z Urol Chir. 1929; 28: 489
        • Baird D
        The upper urinary tract in pregnancy.
        Lancet. 1932; ii: 983-990
        • Traut HF
        • McLane CM
        Physiological changes in the ureter associated with pregnancy.
        Surg Gynecol Obstet. 1936; 62: 65-71
        • Hundley JM
        • Diehl WK
        • Diggs ES
        Hormonal influences on the ureter.
        Am J Obstet Gynecol. 1942; 44: 858
        • Roberts JA
        Hydronephrosis of pregnancy.
        Urology. 1976; 8: 1-4
        • Baird D
        A study of ureteral tone during pregnancy.
        J Obstet Gynaecol Br Emp. 1933; 40: 472
        • Wüllenweber G
        Untersuchungen über die druckverhältnisse in blase, ureter und nierenbecken (besonders während der schwangershaft). Zugleich mitteillung einer neues apparatur.
        Deutch Arch Klin Med. 1929; 165: 296
        • Lapides J
        A report regarding the physiology of the intact human ureter.
        J Urol. 1948; 59: 501
        • Kiil F
        The function of the ureter and renal pelvis.
        WB Saunders, Philadelphia1957
        • Sala NL
        • Rubi RA
        Ureteral function in pregnant women. II: ureteral contractility during normal pregnancy.
        Am J Obstet Gynecol. 1967; 99: 228
        • Kidd FS
        Common infections of the kidneys with the colon bacillus and allied bacteria.
        Frowde, London1920
        • Saitz O
        Über veranderungen an den harnleitern während der menstruation und gravidität.
        Zentralbl Gynaekol. 1931; 55: 347
        • Philipp E
        Pyelitis und pyelonephritis in der schwangerschaft.
        Zentralbl Gynaekol. 1937; 61: 1820
        • Hundley JM
        • Diehl WK
        The influence of gynecologic disorders on the urinary system.
        J Am Med Assoc. 1945; 127: 572
        • Lubin S
        • Drexler LS
        • Bilotta WA
        Postpartum pyeloureteral changes following hormone administration.
        Surg Gynecol Obstet. 1941; 73: 391
        • Draper WB
        • Darley W
        • Harvey JL
        The effect of pituitary extract upon the tonus of the human pelvis and ureter and its possible application in the therapeutics of pyelitis and related conditions.
        J Urol. 1931; 26: 1
        • Hundley JM
        • Walton HJ
        • Hibbitts JT
        • Siegel IA
        • Brack CB
        Physiological changes occurring in the urinary tract during pregnancy.
        Am J Obstet Gynecol. 1935; 30: 625
        • Mattingly RF
        The physiology of the urinary tract in pregnancy.
        in: Marcus CC Advances in obstetrics and gynecology. Williams & Wilkins, Baltimore1967: 124
        • Marchant DJ
        Alterations in anatomy and function of the urinary tract during pregnancy.
        Clin Obstet Gynecol. 1978; 21: 855-861
        • Schneider DH
        • Eichner E
        • Gordon MB
        An attempt at production of hydronephrosis of pregnancy, artificially induced.
        Am J Obstet Gynecol. 1953; 65: 660
        • Stadfeldt A
        Bidrag til hydronephroses aetiologi.
        Hosp Tid Kjobenh. 1861; 4: 101-105
        • Chamberlain WM
        The relations of the urinary organs to puerpural diseases.
        Am J Obstet. 1877; 10: 177-205
        • Crabtree EG
        • Prather GC
        Clinical aspects of pyelonephritis in pregnancy.
        N Engl J Med. 1930; 202: 357
        • Lee HP
        • Mengert WG
        The effect of pregnancy on the urinary tract.
        J Am Med Assoc. 1934; 102: 102-107
        • Harrow BR
        • Sloane JA
        • Salhanick L
        Etiology of the hydronephrosis of pregnancy.
        Surg Gynecol Obstet. 1964; 119: 1042-1048
        • Clark JC
        The right ovarian vein syndrome.
        in: Emmett JL Witten DM Clinical urography. 3rd edn. WB Saunders, Philadelphia1971: 1997-2006
        • Dykhuizen RF
        • Roberts JA
        The ovarian vein syndrome.
        Surg Gynecol Obstet. 1970; 130: 443
        • Roberts JA
        The ovarian vein and hydronephrosis of pregnancy. Experimental studies in the rhesus monkey (Macaca mulatta).
        Invest Urol. 1971; 8: 610
        • Rubi RA
        • Sala NL
        Ureteral function in pregnant women. III: Effect of different positions and of fetal delivery upon ureteral tonus.
        Am J Obstet Gynecol. 1968; 101: 230-237
        • Schloss WA
        • Solomkin M
        Acute hydronephrosis of pregnancy.
        J Urol. 1952; 68: 885-892
        • Rhode Nielsen F
        • Rasmussen PE
        Hydronephrosis during pregnancy: four cases of hydronephrosis causing symptoms during pregnancy.
        Eur J Obstet Gynecol Reprod Biol. 1988; 27: 245-248
        • TeLinde RW
        Urological aspects of gynecology.
        Am J Obstet Gynecol. 1950; 60: 273
        • Bergstrom H
        The diagnostic value of renography in suspected obstruction of the urinary tract during pregnancy.
        Acta Obstet Gynecol Scand. 1975; 54: 65
        • Kumar D
        In vitro inhibitory effect of progesterone on extrauterine smooth muscle.
        Am J Obstet Gynecol. 1962; 84: 1300
        • Raz S
        • Zeigler M
        • Caine M
        Hormone influence on the adrenergic receptors of the ureter.
        Br J Urol. 1972; 44: 405
        • Rossi V
        La dilatazione delle vie urinary nella gravidanza normale (studio sperimentale).
        Arch Ital Urol. 1936; 13: 232
        • Payne FL
        • Hodes PJ
        The effect of the female hormones and of pregnancy upon the ureters of lower animals, as demonstrated by intravenous urography.
        Am J Obstet Gynecol. 1939; 37: 1024
        • Padovani E
        Ricerche urografiche ed istologiche sulle modifica zioni pieloureterali, indotte dagli ormoni sessuali femminili.
        Quad Clin Ostet Ginecol. 1954; 9: 67
        • McNellis D
        • Sherline DM
        The rabbit ureter in pregnancy and after norethynodrol-mestranol administration. A radiographic and histologic study.
        Obstet Gynecol. 1967; 30: 336
        • Roberts JA
        • Auger M
        the effect of a progestational agent on ureteral physiology.
        Invest Urol. 1971; 9: 206
        • Fainstat T
        Physiological hydroureter of pregnancy in a four-legged animal.
        Am J Obstet Gynecol. 1963; 87: 486-490
        • Corriere JN
        • Murphy JJ
        The effect of oestrogen upon ascending urinary tract infection in rats.
        Br J Urol. 1959; 40: 306
        • Van Wagenen G
        • Jenkins RH
        An experimental examination of factors causing ureteral dilatation of pregnancy.
        J Urol. 1939; 42: 1010-1020
        • Roberts JA
        • Wolf RH
        Hydronephrosis of pregnancy: a naturally occurring disorder in non-human primates closely resembling that in man.
        Folia Primatol. 1971; 15: 143-147
        • Klein EA
        Urologic problems of pregnancy.
        Obstet Gynecol Surv. 1984; 39: 605-615
        • Mattingly RF
        • Borkowf HI
        Clinical implications of ureteral reflux in pregnancy.
        Clin Obstet Gynecol. 1978; 21: 863-873
        • Cunningham FG
        • Morris GB
        • Mickal A
        Acute pyelonephritis of pregnancy. A clinical review.
        Obstet Gynecol. 1973; 42: 112
        • D'elia FL
        • Brennan RE
        • Brownstein PK
        Acute renal failure secondary to ureteral obstruction by a gravid uterus.
        J Urol. 1982; 128: 803-804
        • O'Shaughnessy R
        • Weprin SA
        • Zuspan FP
        Obstructive renal failure by an overdistended pregnant uterus.
        Obstet Gynecol. 1980; 55: 247-249
        • Lapata RE
        • McElin TW
        • Adelson BH
        Ureteral obstruction due to compression by the gravid uterus.
        Am J Obstet Gynecol. 1970; 106: 941-942
        • Laverson PL
        • Hankins GDV
        • Quirk JG
        Ureteral obstruction during pregnancy.
        J Urol. 1984; 131: 327-329
        • Kolbusz WE
        • Carter MF
        Renal insufficiency in a solitary kidney secondary to hydronephrosis of pregnancy.
        J Urol. 1979; 122: 823-824
        • Quigley MM
        • Cruickshank DP
        Polyhydramnios and acute renal failure.
        R Reprod Med. 1977; 19: 92-94
        • Fox JJ
        • Katz M
        • Klein SA
        • Young BK
        Sudden anuria in a pregnant women with a solitary kidney.
        Am J Obstet Gynecol. 1978; 132: 583-585
        • Fisher HAG
        • Bennet AH
        • Rivard DJ
        • Caputo T
        • Goldman M
        Nonoperative supravesical urinary diversion in obstetrics and gynecology.
        Gynecol Oncol. 1982; 14: 365-372
        • Meares EM
        Urologic surgery during pregnancy.
        Clin Obstet Gynecol. 1978; 21: 907-920
        • Enhorning G
        Pre-eclampsia: a hypothesis for its pathogenesis.
        Acta Obstet Gynecol Scand Suppl. 1984; 118: 7-11
        • Morrison AR
        • Nishikawa K
        • Needleman P
        Thromboxane A2 biosynthesis in the ureter obstructed isolated perfused kidney of the rabbit.
        J Pharmacol Exp. 1978; 205: 1-8c
        • Laakso L
        Isotoprenography on parturients.
        Acta Obstet Gynecol Scand Suppl V. 1967; 46