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Re: Ob: Suspected nephrolithiasisFrom: Joe (forcep@intercom.net)Tue Dec 26 07:29:34 2006
Garry E. Siegel, M.D. wrote: > 31 YO P0000 at 8 weeks. She is a CNM. > > She has a history of hematuria (dipstick and micro, not gross) predating > pregnancy, and saw a urologist who suspected a small, asymptomatic > stone, but no imaging done. > > Now, she is having daily unilateral flank pain radiating to her groin, > and was in enough pain/nausea last night to be admitted for IVF. She is > fearful of any meds for pain, and didn't require an anti-emetic. Her > hope is that IVF over time will help with passage of the suspected > stone. > > Her exam is benign, CBC and metabolic panels normal, and normal u/a with > a culture pending. > > Today's renal ultrasound is totally negative, and she has a viable 7w5d > gestation. The radiologist says that any stone big enough to warrant > consideration for extraction would result in hydronephrosis, and there > is none. > > In speaking with the urologist, we kicked around a limited IVP (scout, > and one or two post injection shots) versus simply using pain > meds/anti-emetics; the patient is torn and really wants to do nothing. I > have advised taking meds as needed and delaying imaging until later (12 > weeks, and only if symptomatic) for her peace of mind. > > I'm really not too worried about a limited IVP here--and I believe > Ashley had a nice paper from around 1995 regarding radiation in > pregnancy. Both the urologist and radiologist are hesitant, and the > urologist was worried about a cystoscopy (if needed for extraction) > causing an abortion. > > I've really not ever seen problems with indicated imaging studies such > as a limited IVP, or cystoscopy--realizing that the numbers of bad > outcomes would be exceedingly small, and the number of cases I've seen > isn't huge. > > My gut says take meds prn and image at some point--as per above. > > Any thoughs? > > Garry > > -- > Garry E. Siegel, M.D. > Private Practice > Roswell, GA > Leave her alone. Watch renal pelvis for dilation with untrasound. Ureteral dilation will solve problem with progression of pregnancy. Joe C
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