Managing severe loin pain in pregnancy

Objective To investigate whether the intravenous urogram used in an appropriate setting is a valuable investigation for managing severe loin pain in pregnancy.

Design Prospective obsevational study.

Setting University teaching hospital.

Population Fifteen pregnant women referred with severe loin pain.

Methods A prospective study collecting data over a 24-month period was performed. Women with severe loin pain believed to be of renal origin that had failed to respond to conservative treatment were referred by their obstetricians. The intravenous urogram was performed that consisted of a two-film series (plain film and a 20-minute postmicturition film).

Main outcome measures Management of severe loin pain in pregnancy based on the findings of the intravenous urogram.

Results Over the two-year period, 15 women had an intravenous urogram performed at a median gestation of 32 weeks (24–36 weeks). All women had undergone a prior urinary tract ultrasound examination within 24 hours of referral, which showed dilatation on the symptomatic side in 15/15 cases. The intravenous urogram confirmed dilatation on the ipsilateral side in 14/15 cases and revealed the level of dilatation in all of these cases. Delayed excretion of contrast was seen in all 14/15 cases. Three patients had obstructing ureteric calculi revealed by the intravenous urogram and one patient had a non-dilated and non-obstructed system.

Conclusions An intravenous urogram is a safe investigation in the appropriate setting. It allows for an accurate diagnosis to be made and for appropriate treatment to be instigated with joint decisions from urologic, obstetric and radiologic teams. This multidisciplinary approach care can be specifically tailored to the individual patient, which we feel is safer for both mother and baby.