Re: Ob: Suspected nephrolithiasis
From: rmodugno@aol.com
Tue Dec 26 07:55:26 2006
As a CNM she should know that pain meds are fine in pregnancy. Ofcourse
her renal pelvis will enlarge as the pregnancy progresses - so
ultrasound is basically useless. One shot IVP if pain progresses,
worsens.
She may want to strain her urine.
On what basis would cystoscopy cause abortion?
Masterly inactivity sir.
Robert Modugno MD MBA FACOG
Sylva, NC
-----Original Message-----
From: forcep@intercom.net
To: ob-gyn-l@dns.obgyn.net
Sent: Tue, 26 Dec 2006 9:31 AM
Subject: Re: Ob: Suspected nephrolithiasis
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
