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Ruptured renal artery aneurysm in pregnancy and puerperium: literature review of 53 cases

  • Goran AugustinEmail author
  • Tomislav Kulis
  • Nina Kello
  • Vanja Ivkovic
Review
  • 16 Downloads

Abstract

Purpose

To summarize and define the most appropriate diagnostic methods and therapeutic options for ruptured renal artery aneurysms in pregnancy based on rarely published data.

Methods

Literature searches of English-, German-, Spanish-, and Italian-language articles were performed in PubMed (1946–2018), PubMed Central (1900–2018) and Google Scholar. The search terms included renal artery aneurysm, renal artery rupture, pregnancy, puerperium, nierenarterienaneurysma, schwangerschaft, wochenbett, aneurisma de la arteria renal, el embarazo, puerperio, aneurisma dell'arteria renale and gravidanza. Additional studies were identified by reviewing reference lists of retrieved studies.

Results

Fifty-three cases were collected. The average maternal age was 31 ± 6 years; 71.4% were multiparous and significantly older than primiparas. The majority presented in the third trimester (62.3%), followed by second (20.7%) and the first (5.7%), while 11.3% presented postpartum. All postpartum patients presented during the first week postpartum and 50% during the first 24 h postpartum. Parity was not associated with the trimester of presentation. The left renal artery was affected slightly more frequently (58.5% vs. 41.5%). There were no differences in the affected side according to trimester of presentation, including postpartum. 25 out of 53 cases underwent ipsilateral nephrectomy (47.1%) and 18 underwent aneurysm repair or coil embolization (34.0%). There was no difference in maternal (25.8%) vs. 4 (18.1%) and fetal mortality according to the side of rupture. There were no differences in the distribution of maternal or fetal mortality frequency according to the trimester of presentation.

Conclusions

The clinical presentation is easily confused with more common conditions and time to diagnosis is often delayed. Diagnostic delay is associated with high maternal and fetal mortality. Ruptured renal artery aneurysm should be included in the differential diagnosis for pregnant or peripartum patients presenting with acute and severe flank pain, especially if followed by a drop in blood pressure. Early diagnosis and immediate intervention are important for achieving better maternal and fetal outcomes. There are several methods of managing asymptomatic or ruptured renal artery aneurysm during pregnancy although no established guidelines exist.

Keywords

Renal artery aneurysm Pregnancy Differential diagnosis Maternal mortality Fetal mortality 

Notes

Author contributions

GA: data collection, data analysis, manuscript writing. TK and VI: data collection and data analysis. NK: manuscript writing, supervision.

Funding

No funding.

Compliance with ethical standards

Conflict of interest

We declare that we have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

404_2019_5087_MOESM1_ESM.docx (25 kb)
Supplementary file1 (DOCX 24 kb)

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryUniversity Hospital Centre Zagreb and School of Medicine University of ZagrebZagrebCroatia
  2. 2.Department of UrologyUniversity Hospital Centre Zagreb and School of Medicine University of ZagrebZagrebCroatia
  3. 3.Division of RheumatologyNorthwell HealthGreat NeckUSA
  4. 4.Department of Internal MedicineUniversity Hospital Centre Zagreb and School of Medicine University of ZagrebZagrebCroatia

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