The incidence of calculi is the same in pregnancy as the general population. When it does occur, it is seen more commonly in the 2nd and 3rd trimester. Stones typically pass spontaneously but cystoscopy with stent placement may be necessary if the patient is septic or has a urinary tract obstruction. The complication rate of ureteroscopic stone removal is no different in pregnant patients than in nonpregnant patients (1) [A]. |
A neuraxial or general technique can be utilized. Spinal and epidural blocks can decrease the amount of medication administered and should be considered in patients who are early in pregnancy or have a potentially difficult airway. |
Goals should be to avoid teratogenic drugs, maintain oxygenation and baseline hemodynamics, and provide left uterine displacement if possible. |
Consult an obstetrician for guidance on preoperative, intraoperative, and postoperative fetal monitoring. |
Urinary obstruction may lead to irreversible kidney injury. Reversibility is dependent on duration and severity of obstruction.