Obstetrics & Gynecology>>>>>Maternal-Fetal Physiology and Placentation
Question 10#

A 19-year-old P0 at 20 weeks’ gestation presents to the emergency department (ED) with complaints of right flank pain. The ED physician orders a renal sonogram as part of a workup for a possible kidney stone. The radiologist reports that no nephrolithiasis is present, but reports the presence of bilateral mild hydronephrosis and hydroureter, which is greater on the right side than on the left.

What is the most appropriate next step in management?

A. Order renal function tests, including BUN and creatinine, to evaluate the renal function
B. These findings are consistent with normal pregnancy and are not of concern. No further evaluation is required
C. Order an intravenous pyelogram to further evaluate the bilateral hydronephrosis
D. Request a urology consult to obtain recommendations for further workup and evaluation
E. The findings are concerning for bilateral ureteral obstruction, and the patient should be referred for stent placement

Correct Answer is B

Comment:

Bilateral mild hydronephrosis and hydroureter are normal findings during pregnancy and do not require any additional workup or concern. When the gravid uterus rises out of the pelvis after 12 weeks, it presses on the ureters at the pelvic brim, causing ureteral dilatation and hydronephrosis. It is also likely that hormonal effect from progesterone contributes to the development of hydroureter and hydronephrosis of pregnancy. In the vast majority of pregnant women, ureteral dilatation tends to be greater on the right side as a result of the dextrorotation of the uterus and/or cushioning of the left ureter provided by the sigmoid colon.