The feasibility of ultrasound screening of the urinary system in order to detect urological diseases in pregnant women when registering in an antenatal clinic

Abstract

The frequency of urinary tract infection in pregnant women is 5–12%. Pregnant women with kidney abnormalities are at high risk for developing pregnancy complications. Moreover, the state of the kidneys and upper urinary tract in the vast majority of patients before pregnancy and in the first trimester of pregnancy remains unclear due to the existing observation algorithm. Due to the lack of previous information about the state of the organs of the urinary system, urologists often find themselves in a difficult diagnostic collision. Objective: to determine the role of ultrasound screening of the organs of the urinary system of pregnant women when registering in an antenatal clinic in the first trimester of pregnancy. Materials and methods. Ultrasound screening was performed for 370 pregnant women using Logiq-400 MD and HONDA HS-2000 ultrasound machines. A comprehensive ultrasound of the urinary system, including dopplerography and dopplerometry of the renal vessels and ureteric jets, was performed in 32 pregnant women. Results. Ultrasound screening revealed urolithiasis in 12 pregnant women, stage I hydronephrosis in 21, stage II hydronephrosis in 43 (20 with secondary pyelonephritis), pyelonephritis in 16, cystitis in 5, kidney doubling in 8, solitary cyst kidneys – in 3, a single kidney – in 1 pregnant. In the presence of hydronephrosis, positional therapy was recommended for all pregnant women, they were allocated to the risk group with impaired urodynamics and with the possible development of pyelonephritis. In two pregnant women, the data of complex ultrasound and lack of relief of pyelonephritis within 3–4 days, despite the positional and antibiotic therapy, served as the basis for the drainage of the upper urinary tract using the ureteric stent. Stenting made it possible to quickly stop gestational pyelonephritis, and the further course of pregnancy proceeded without complications. Conclusions. Ultrasound screening of the organs of the urinary system of pregnant women when registering in the antenatal clinic revealed urological pathology in 29.5% of pregnant women. Of these, in particular, hydronephrosis was detected in 11.9%, hydronephrosis complicated by pyelonephritis in 5.4%, pyelonephritis in 4.3%, urolithiasis in 3.2%, renal development abnormalities in 2.2%. When conducting ultrasound screening in the first trimester of pregnancy, in case of complications of pregnancy from the urinary organs in the second or third trimesters, repeated ultrasound is a dynamic study. This contributes to a more objective assessment of the clinical situation and facilitates the development of tactics of conducting a pregnant by urologist. Ultrasound screening makes it possible to judge the nature of the occurring urodynamic disorders during pregnancy, timely conduct adequate correction of urodynamic disorders, minimize negative consequences in the event of gestational pyelonephritis, and also prevent the transition of the serous form of pyelonephritis to purulent. These measures help maintain maternal and fetal pregnancy and health. In the future, we consider it appropriate to conduct a comprehensive examination of future parents before the planned pregnancy, including the mandatory ultrasound of the urinary system in women.