Haematuria in pregnancy

Haematuria in pregnancy

• 1.
  Prof. M.C.Bansal MBBS., MS. FICOG. MICOG. Ex Principal & Controller Jhalawar Medical college and Hospital Jhalawar . MGMC & Hospital Sitapura., Jaipur
• 2.
   Definition— It is defined as the presence of red blood cells in urine and should not be confused with haemoglobinurea, in which the pigment only is filtered through kidneys. Varieties— 1. Microscopic—where blood test is positive on dipstick testing only. 2. Macroscopic or frank haematuria—An unusual symptom encountered in ob& gy practice.
• 3.
   1.Physological—menstruation  2. Infection—Pyelonephriitis , cystitis , urethritis , Tuberculosis of kidney and bladder  3. Trauma– Renal injury, Foreign body in bladder and urethra including catheter.  Inflammatory / autoimmune—Glomerulonephritis , Polyarteritis nodosa , Ch. Interstitial nephritis, radiatinal inflammation of renal tract.  Stones– renal , ureteric , bladder and urethra.  Tumors– benign /malignant of renal tract.  General—drugs including anticoagulants Bleeding disorders , caruncle and prolapse of urethral mucosa.
• 4.
   Accidental haemorrhage Rupture uterus  Obstructed labour  Septicaemia(post abortal /puerperal)  DIC  Traumatic PPH  Heparine therapy for DVT  Eclampsia  HellP syndrome  Mismatched blood transfusion  Pregnancy associated with hematological diseases  Drug induced  Instrumental delivery  Traumatic VVF
• 6.
   The causes will very with age and also in the presence or absence of pregnancy.  In pregnancy urine is checked with dipstick at each ANC visit. It is unusual to find frank haematuria without other obvious symptoms.  In most of cases , the cause of the haematuria is infection . Any UTI may be associated with frequency , dysurea , fever, renal pain and or offensive urine.
• 7.
   When haematuria(micro / Macro ) is noted Nephrologist’s consultation should be shout.  Clinical Assessment Check the catheter, clinical examination of renal tract , genital tract any other bleeding sites.  Investigations Complete urine examination, CBC, platelet count , bleeding – clotting factor profile, liver enzyme study should be immediately ordered.  Management --. It will depend upon the cause of the haematuria.  Useful website— www.nice.uk/CG027