Re: Ob: Suspected nephrolithiasis
From: Joe Cutchin (forcep@intercom.net)
Tue Dec 26 09:22:51 2006
Large dilated renal pelvis now? I think that might have some
significance. Joe C
rmodugno@aol.com wrote:
> 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
>
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