Maternal and Neonatal Outcomes for Mothers with Symptomatic Hydronephrosis of Pregnancy Managed with Percutaneous Nephrostomy with Comparison High-Risk Pregnancy Group

Symptomatic hydronephrosis of pregnancy (SHOP) presents with flank pain but may include fever, bacteremia, or sepsis that is harmful to the mother and fetus. Current literature focuses on double-J stents (DJS) in SHOP patients with sparse reporting on percutaneous nephrostomy (PCN) outcomes. We assess the safety of PCN for SHOP.

We used CPT codes to identify women with SHOP who underwent PCN at our institution. Gravid women with maternal kidney infection were identified by ICD10 code and selected as a comparative high-risk (HR) group. Retrospective analysis was used to gather data on initial clinical presentation and demographics. Outcomes included fetal data, APGAR scores, and neonatal intensive care unit (NICU) admission. The number of procedures a mother underwent involving all PCN placements and subsequent changes, along with total procedural radiation dose measured in milligray (mGy), was collected. Multivariable regression analysis was performed to assess significance.

HR (n = 43) and SHOP (n = 44) groups included a similar number of patients. No statistical differences were noted between groups regarding BMI, body temperature, creatinine, and CBC. No differences were noted in maternal or fetal outcomes between groups. The average patient had 4.6 procedures with mean and median radiation exposure of 108 mGy and 58.2 mGy, respectively.

Maternal and fetal outcomes are acceptable with PCN placement and demonstrate non-inferiority to comparative HR pregnancy groups. PCN is a reasonable option for patients requiring intervention for SHOP. Further studies should consider randomization between treatment modalities to better identify the optimal treatment for women with SHOP.