Although renal colic is the most common cause of non -obstetric pain for pregnant women in hospitalization, the diagnosis of urine in pregnant women is still a challenge; many symptoms and signs may be covered by the pregnancy uterus.With the progress of pregnancy, the feeling and positioning of pain will also change.About 25%of patients who were diagnosed with unobstructed ureteral stones were first misdiagnosed as appendicitis, diverticulum, or placenta.In addition to low back pain, most patients are accompanied by the naked eye hematuria or mirroring hematuria, and sometimes accompanied by urinary infections.Occasionally hematuria occurs during normal pregnancy, but painless hematuria patients with stones are rare.For patients with ureteral stones during pregnancy, the particularly important thing is to leave urine for urine culture and examination. The reason is that pregnant women are not uncommon and can reduce the sensitivity of urine culture testing.If pregnant women have continuous urology infections or break down urea microbial infections, the diagnosis of urinary stones should be considered.Other symptoms that may indicate the symptoms of urine stones are irritating symptoms, chills, nausea and vomiting.However, other acute abdomen may also cause similar symptoms. Urology doctors should pay great attention when checking patients.An important problem when pregnant women with urinary stones perform X -ray assessments are the effects of radiation on the fetus.The main impact of radiation on the fetus has deformities, carcinogenic effects, and mutagne.These risks of radiation examination are related to the pregnancy time of the pregnancy during the radiation examination and the amount of radio radiation received.The first three months of pregnancy were organ formation and rapid division of cells, and embryos were extremely sensitive to radiation.Although the sensitivity of the teratogenic effect of radiation in the second 3 months and the third 3 months of pregnancy is significantly reduced, the exposure of the X -ray is still increasing the risk of a child with malignant tumors after birth.
At present, it is not determined that the low radiation dose will not have a negative impact on the fetus, but the X -ray exposure at any degree of the X -ray will cause a certain risk.Ultrasonic is still the most basic way to diagnose pregnancy urinary stones.Ultrasonic will not have harmful effects on the development of fetal development due to the increase in tissue temperature. The Doppler ultrasound (US) can theoretically increase the tissue temperature. However, it has not yet found reports that it has adverse effects on the fetus.Real -time ultrasonic examination of renal cortex, renal pyelonephrodes, dilated ureter, and stones that accidental discovered will not cause harmful effects on the fetus. Therefore, ultrasonic examination can be used as the first choice for pregnancy tests.However, there are certain defects such as ultrasonic diagnosis of pregnancy urinary stones such as low sensitivity. The accuracy rate of stones is between 34%and 86%, and the specificity is not high.The accuracy of diagnosis of ureteral stones in the pelvic section is low.The vaginal ultrasound can improve the accuracy of the diagnosis of ureteral stones in the pelvic segment. This technology is more likely to be promoted and applied in clinical practice. The disadvantage is that it cannot make corresponding examination and diagnosis of the upper stones of the ureter.Doppler ultrasonic evaluation of kidney blood flow resistance index (RI) is conducive to improving the accuracy of diagnosis of ureteral stones. The RI is not interfered by the accumulation of hydronephrosis of the physiological kidney water in non -obstructive pregnancy, and does not affect the diagnosisThe accuracy of the result.
Lee (1992) used venous angiography to show ureteral stones of 16 patients in 17 patients with ureteralized ureter during pregnancy, which took three tablets, namely abdominal flat tablets, 30 seconds and 20 minutes.Nuclein scan is also a functional test that patients who can evaluate patients during pregnancy are suspected of side ureteral obstruction, and they are also limited by radiation.However, after the accumulation of isotopes of the bladder, the fetus can have a great impact on the fetus. Therefore, patients who have been examined during the examination need to drink a lot of water and frequent urination to reduce this impact.Unfortunately, the radiation imaging technology cannot display stones and anatomy changes well.MRI (MRI) does not rely on ionic radiation or contrast agents to make it a very attractive tool for evaluating patients during pregnancy.Because MRI cannot display stones, stones are only manifested as a filling defect in high signal density urine in the MRI image.MRI is extremely difficult to display smaller stones.Spencer and his colleagues (2004) reported the results of using MRI to evaluate the accumulated water and back pain during pregnancy.The author believes that the technology can accurately distinguish the accumulated water caused by the physiological renal water and ureteral obstruction of patients during pregnancy.
The primary problem of urethia during pregnancy is the impact of radioactive examination on the fetus.According to the basic rules of radiation biology, the perception of the cells of the cells is inversely proportional to the degree of differentiation of the cells. Therefore, the damage to embryonic cells of the same dose of radiation is significantly higher than that of mature body cells.Studies have shown that the degree of harm is closely related to the dose of pregnancy and radiation.In the embryo period, radiation is likely to cause the embryo to grow slowly, teratogenic or death.In the early days of the fetus, other organs and systems were less sensitive except for the nervous system.In the late fetus, the fetus is basically not affected by radiation, but if the radiation dose is too large, many organs and tissues will be damaged by permanent cells.Fetal damage caused by radiation includes congenital malformations, slow intraurus development (IUGR) and dead tires.X -ray irrades from the fetus should be strictly prohibited, so ultrasonic examinations have become the first choice for diagnosis of kidney stones in pregnant women.Although it can provide a complete appearance of the kidney, it cannot fully display the ureter and its contents.Moreover, the renal water during pregnancy is easily confused with the kidney hydrocephalus caused by stones obstruction.You can perform restricted varicose pelvis film, including a perspective and a flat tablet after 30 minutes in the injection of the developer.The exposure of the fetus to the fetus is 0.1rad or 0.2rad, which is far below the threshold of 1.2rad, which increases the risk of the threshold.Three months in the first three months of organic occurrence and a huge danger of fetal fetuses, X -ray irradiation is particularly avoided.
Radiation examinations (dose <50 mgy), which are generally considered to be used for diagnostic purposes, will not cause congenital malformations and IUGR.Although various data indicate that the safe dose of radiation is 50mgy, theoretically this dose will still have a physiological function and biochemical indicator on the fetus.In animal experiments, the amount of radiation of 10mgy will not affect the development of brain tissue in development, and the radiation volume below 200 mgy will not affect the active behavior of animals.But the radiation of 100 to 250 MGY can induce certain changes in brain cells.Observation results confirmed that the fetus that was radiated in the palace.After birth, its intelligence is generally lower than that of normal peers, and the seizures have increased significantly.The brain is the most sensitive to radiation at the 8-15 weeks of pregnancy.The earlier the radiation time during pregnancy, the greater the influence of the fetus.
The effect of radiation on fetal development is related to the age of the fetus and the radiation dose. Within 3 weeks of pregnancy, the embryo is highly sensitive to the radiation. In this period, contact with radiation can cause the fetus to die.During this period, contact with radiation can lead to the occurrence of congenital malformations of the fetus; 8 to 15 weeks of pregnancy, radiation exposure affects the development of the brain, which can lead to the slow development of the fetus;It occurred, and its incidence rate was about 1 /5000.The dosage of the fetus absorbing radiation is related to the technical operation accuracy and mother form of the radiologist. The fetal acceptance of the radioactive dose of less than 50 mgy has not seen reports of fetal growth and development. At present, most radioactive doses of radioactive examination are lower than thatEssenceThe American Society of Obstetrics and Gynecology recommends that "(childbearing age) women should understand that a single X -ray examination will not have harmful effects." Especially, radioactive examinations below 50mgy have nothing to do with fetal malformations or increased pregnancy defects.X -ray examinations in the middle and late pregnancy will not cause obvious harm to fetal growth and development.In the middle of pregnancy, the application of IVU diagnosis of pregnancy stones is high, and it can effectively improve the accuracy of diagnosis of pregnancy urinary stones. It is believed that if women during pregnancy encounters the following situations, IVUs can be considered for 48 hours of antibiotic treatment.Extraction of vegetarian muscle drunk, ultrasonic diagnosis of renal water, continuous vomiting lead to dehydration symptoms, etc., can be considered to be considered restricted IVU.It should be noted that there is a thyroid dysfunctional period in the first week of the birth of the newborn. Because the placenta can absorb a small amount of iodine -made agents, it has a certain impact on the fetal thyroid function. Therefore, IVU is not recommended to perform in the late pregnancy.If the film (including or excluding 2 hours of delayed camera) after the injection of the contracted agent, the radioactive dose received by the fetus will be greatly reduced, about 0.5mgy each time, which is greatly lower than 50 mgy.To shorten the examination time, accurate positioning, reduce voltage (60 ~ 70kV), realize the largest fetal shielding, and the patient’s tilt position, it can further reduce the radiation dose of radiation to the fetus.
Nuclein scanning diagnosis of pregnancy urinary stones is better than IVU. The reason is that the radiation dose received by the fetus during nuclear examination is only 1/10 of IVU, while the monthly nucleo scan can clearly display the kidney excretion function, which is more accurate more accuratePositioning the area of ureteral obstruction. Drinking water and urination can reduce the effects of nuclein radiation on the fetus by reducing the residence time of isotopes in the body in the body.The disadvantage is that the anatomical data of ureteral obstruction cannot be collected, which affects the accuracy of the diagnosis of urinary stones.The detection rate of spiral CT can reach 100%of the urinary tract stones, but the CT radiation dose is large, and the dose of fetal radiation is much higher than the safety dose (Somgy) that the fetus can accept.method.Individual authors have reported that precise positioning and fast camera can reduce the amount of radiation of CT examination and reduce the harmful effect on the fetus, but most experts believe that in order to ensure the safety of fetal development, CT should be avoided during pregnancy.
MRI (MRI) is considered to be harmless to the development of pregnant women and fetuses. The T2 weighted continuous pulse MRI combined contrasting agent imaging technology for pathological ureteral obstruction This technology can reach 93%to 100%.The main examination method of stones; its disadvantage is that MRI cannot directly display ureteral stones, and can only indicate the possibility of the existence of stones through some unique image signs, such as expanding the filling and defect in the ureter, the pelvic segment ureterStandingColumn of Urine) combined with neighboring ureteral expansion (Double KINK SIGN double twisting), etc., and cannot identify other MRI pathological characteristics including: ureteral anatomical obstruction, narrowing at the junction of pelvic ureter, narrow ureteral interruption (pelvic cavity cavity cavity cavity cavity cavity cavity cavityThe ureter is gradually thinner),} kidney peripheral or ureter edema.Moreover, due to the limited experience in the use of crickets, the US Radiation Protection Administration does not recommend the MRI examination of the cricket containing agent in the early pregnancy.However, MRI has its unique advantages in identifying other causes of pregnancy: it can identify non -urinary circuit lesions (such as appendicitis, ovarian reversal, etc.), and high -quality urinary system images when there are renal dysfunction.Due to the low use of MRI, being disturbed by metal objects, long time, high cost, high costs, and may cause dwelling phobia, MRI can be used as a second line inspection method for patients with suspicious pregnancy urinary stones.