Clinical Analysis Of 55 Cases Of Ureteral Calculi In Pregnancy

Objective: To discuss the clinical features and diagnosis and treatment of ureteral calculi in pregnancy.Methods: Through consulting the electronic medical records of pregnant women admitted to Zunyi Medical College from December 2015 to January 2010,a total of 17780 cases of pregnant women were analyzed retrospectively,including 15280 cases of natural pregnancy with 53 cases of ureteral calculi,whose average age was(25±4)years,and 2500 cases assisted reproductive with 2 cases of ureteral calculi,whose average age was(32±5)years.The observation of the age,education,pregnancy,urinary tract infection,clinical symptoms,treatment methods,pre abdominal or urinary ultrasound examination of the pregnant women with ureteral calculi were recorded.We evaluated the use rate of pre pregnancy urinary ultrasound and the incidence of ureteral calculi in pregnancy,and compared the difference by chi square test between the women in the natural pregnancy group and assisted reproductive group.The relationship between ureteral calculi in pregnancy and age,culture and gestational weeks was analyzed.The clinical characteristics of the disease and value of ultrasound examination were analyzed.The effect of different treatment modalities on the clinical symptoms of ureteral calculi during pregnancy was compared.Effective treatment for ureteral calculi in pregnancy is summarized.Results:17780 cases of pregnant women,except for 2500 cases of assisted reproduction,received more than once abdominal or urinary ultrasound examination in the pre pregnancy examination,the remaining pregnant women were not examined by ultrasonography.The incidence of ureteral calculi in pregnancy was 0.08%(2/2500)and 0.35%(53/15280)in the group of assisted reproduction and spontaneous pregnancy.Two groups of pre pregnancy urinary ultrasound application rate and the incidence of ureteral calculi in pregnancy were significantly different(P<0.05).In natural pregnancy group,the incidence of ureteral calculi increases with incubation age decreasing during the age of <26 years old,and the incidence of the disease increases with incubation age increaseing during >35 years old.There were differences in the incidence of ureteral calculi in different gestation periods,with the highest incidence at 18~28 weeks,accounting for 76%(40/53).The proportion of ureteral calculi in pregnant women with different educational levels is different,and the educational level of senior high school students is relatively high,accounting for 67%(36/53).Calculi complicated with urinary tract infection were 89.09%(49/55),including acute pyelonephritis,high fever 34.54%(19/55),and a few developed septic shock(3.63%)(2/55).55 cases of pregnant women with ureteral calculi were treated by non-surgical treatment,of which 36 cases continued to control and gave birth smoothly.19 cases of non operation invalid pregnant women underwent surgical treatment,mainly under local anesthesia of ureteral stent implantation,accounting for about 68.42%(13/19),postoperative symptoms continued to ease to postpartum.There was a significant difference between the non operation group and the operation group in the clinical symptom control and recurrence rate(P<0.05).The curative effect of the non-surgical group is lower than that of the operation group.Conclusion:The overall incidence of ureteral calculi during pregnancy was low,but it has great influence on the mother and fetus.Pre pregnancy urinary tract ultra sound screening is helpful to reduce the incidence.The incidence of ureteral calculi in pregnancy is relatively high in pregnant women under 26 and over 35 years of age.The onset time is more concentrated in the second trimester of pregnancy.Most merge with urinary tract infection.Most ureteral calculi in pregnancy can be contr olled by nonoperative management.For patients withpoor nonoperative outcomes,ur eteral stent implantation under local anesthesia can be considered as the preferred s cheme,which can effectively control symptoms.