Pregnancy, caesarean delivery complication rates high in women with NB, LUTR
Women with neuropathic bladder (NB) and paediatric lower urinary tract reconstruction (LUTR) are at increased risk of developing complications during pregnancy and caesarean delivery (CD), with those having prolonged labour, prior CD or a history of noncompliance having the worst complications, according to a study.
Researchers looked at 11 consecutive female patients with spinal dysphraphism-related NB who underwent LUTR, became pregnant and gave birth via CD. They obtained data on demographics, hydronephrosis, symptomatic urinary tract infection (UTI), continence and catheterization during pregnancy. Pertinent CD data included gestational age, abdominal/uterine incisions and complications.
A total of 18 pregnancies were recorded, and there were 15 live neonates born via CD (53.3 percent term births). Of these neonates, 13 (86.7 percent) developed new (n=10) or worsening (n=3) hydronephrosis, with six (46.2 percent) undergoing nephrostomy tube placement.
Other events that occurred were difficulty catheterizing (eight of 15; 66.7 percent via native urethra; 44.4 percent via catheterizable channel; 50.0 percent required an indwelling catheter), urinary incontinence during pregnancy (five of 15) and UTI (10 of 15; 30.0 percent febrile).
A urologist was present in all CD cases, which occurred emergently (n=10) or were scheduled (n=5). Complications occurred in 40.0 percent of the cases, including five cystotomies (all occurred during emergent CD), one bowel deserosalization and one vaginal laceration. There were three cases (20.0 percent) of urinary fistulae recorded following emergent CD.
The present data show that rates of complications during pregnancy and CD delivery are high among women with NB and LUTR despite routine involvement of urologists, researchers said.
“Based on our experience, a urologist should always be present and participate in the CD,” they added.