Changes in the urinary system during pregnancy

The article is professionally consulted by Master, Doctor Ly Thi Thanh Nha - Department of Obstetrics and Gynecology - Vinmec International General Hospital Da Nang.

During pregnancy, the organs and physiological functions in the mother's body change. The normal physiological changes in the urinary system during pregnancy can be a risk factor for many dangerous diseases.

1.1 Anatomical changes of the urinary system during pregnancy Kidney size increases during pregnancy: On ultrasound, the length of the kidney increases by about 1cm compared to before pregnancy. The size of the kidneys will return to normal after birth. Dilatation of the renal pelvis and ureters: Because of fluid retention due to urinary obstruction. This fluid retention is usually mild and is referred to as “physiological” pyelonephritis during pregnancy. Urine stasis favors UTIs and can progress to severe pyelonephritis. In rare cases, this pooling of urine can cause renal colic. Changes in kidney morphology may persist for up to 12 weeks postpartum. Therefore, if you want to investigate the morphology of the urinary system, it should be done at least 12 weeks postpartum.

1.2 Changes in renal function Renal blood flow and glomerular filtration rate in pregnant women are increased by about 40% of normal. These flows increase quite early, as early as the first months of pregnancy. This increase in glomerular filtration rate increases the excretion of waste products. Proteinuria excreted will be doubled. Serum creatinine concentration decreased by 35 to 44% of the normal value. Therefore, the biochemical indicators in pregnant women will be different from those of normal people. In pregnant women, serum creatinine levels above 80 μmol/l (0.8 mg/dl) and blood urea levels above 5 mmol/l (13 mg/dl) may be indicative of functional impairment. Renal in pregnancy Increased blood flow will dilute the blood, thereby reducing blood albumin concentration, blood urea and plasma osmotic pressure. Urate clearance is increased, causing the normal value of blood Urate to decrease. Blood tends to be slightly alkaline (pH = 7.42 - 7.44) 1.3 Changes in fluids During pregnancy, a mother usually gains about 12-15 kg. The amount of water increases about 6-9 liters, in which mainly water is in the extracellular compartment, about 4-6 liters. During pregnancy the plasma volume almost doubles and edema is normal.

Urinary tract infections: Usually due to decreased tone and dilation of the urinary tract, accounting for 5-10%. Common bacteria in urinary tract infections are E.Coli, Proteus, Klebsiella, Enterococus... The doctor will prescribe initial treatment with empiric antibiotics, then conduct a urine culture as antibiotics. and treat according to the antibiotic chart.

Acute renal failure: May be caused by microvascular hemolytic disease plus thrombocytopenia, or by acute renal failure associated with acute fatty liver in pregnancy (HELLP syndrome). Placental ischemia: Due to the release of vasoconstrictor substances and possibly a lack of vasodilators leading to increased blood pressure. This condition can cause complications in the mother such as eclampsia, placental abruption, in the fetus such as fetal malnutrition, stillbirth, premature birth. This is an obstetric emergency that requires immediate treatment to ensure the safety of the mother and fetus. Renal disease that causes hypertension with proteinuria and edema occurs from 20 weeks onwards is called preeclampsia. It is caused by decreased cardiac output and placental ischemia leading to thromboblastin release and intravascular coagulation. Vinmec International General Hospital offers a Package Maternity Care Program for pregnant women right from the first months of pregnancy with a full range of antenatal check-ups, periodical 3D and 4D ultrasounds and other routine tests to ensure that the mother is healthy and the fetus is developing comprehensively.
Pregnant women will be consulted and checked for health under the close supervision of experienced and specialized Obstetricians, helping mothers have more knowledge to protect their health during pregnancy as well as reduce reduce complications for mother and child.
Master. Doctor. Ly Thi Thanh Nha has worked at Hue University of Medicine and Pharmacy Hospital and Quang Tri Provincial General Hospital before working at Vinmec Danang International General Hospital as it is today. Dr. Nha has strengths and experience in diagnosing, monitoring and treating pregnancy, pregnancy pathology. Pregnancy screening. Perform caesarean section techniques. Laparoscopic surgery to treat ovarian cysts, ectopic pregnancy.