Management Protocol of Acute Hydronephrosis in Pregnancy

Acute hydronephrosis during pregnancy poses significant management challenges due to the physiological changes and risks associated with the intervention. Addressing this condition effectively requires a multidisciplinary approach and a deeper understanding of its clinical management. Objective: This study aims to evaluate a comprehensive care strategy for managing acute symptomatic hydronephrosis in pregnant women by analysing various treatment measures and their outcomes. Methods: A prospective cohort study was conducted at the tertiary care hospital from November 1, 2022, to October 31, 2023. The study enrolled 125 pregnant patients experiencing acute hydronephrosis at any stage of pregnancy. Patients with pre-existing renal disorders, incomplete medical records, or who were untraceable were excluded. Data were collected through extensive electronic and paper medical records searches, focusing on demographic features, clinical presentation, and therapeutic outcomes. The severity of hydronephrosis was classified as mild, moderate, or severe, and the impact of interventions like percutaneous nephrostomy was evaluated. Results: The average age of participants was 28.5 years, with the majority (36%) aged between 25 and 29 and 56% being multigravida. The average gestational age at presentation was 28.2 weeks, and 72% reported flank pain. Hydronephrosis was mild at 30.4%, moderate at 50.4%, and severe at 19.2%. The percutaneous nephrostomy caused complications in 10% of mothers and 5% of fetuses, while postoperative complications were more pronounced, affecting 25% of mothers and 20% of fetuses. Conclusion: The study provides valuable insights into the effective management of acute hydronephrosis during pregnancy, highlighting the demographic characteristics, clinical manifestations, and outcomes of different treatment modalities. The findings suggest that while percutaneous nephrostomy is a relatively safe procedure, it still poses significant risks, necessitating careful consideration and a tailored approach for each patient.