ĐÁNH GIÁ KẾT QUẢ ĐIỀU TRỊ VÀ BƯỚC ĐẦU XÂY DỰNG THANG ĐIỂM PHÂN TẦNG NGUY CƠ TRÊN NHÓM THAI PHỤ THẬN Ứ NƯỚC CÓ TRIỆU CHỨNG TẠI BỆNH VIỆN NHÂN DÂN GIA ĐỊNH

Abstract

Introduction: Symptomatic hydronephrosis in pregnancy (SHP) remains a significant clinical challenge due to the risk of severe complications, including septic shock, acute kidney injury, and adverse obstetric outcomes. The choice between conservative management and urological intervention lacks a universal consensus, necessitating a dedicated risk stratification tool to support clinical decision-making.

Methods: A retrospective cohort study was conducted on 118 pregnant women hospitalized for SHP at Gia Dinh People’s Hospital from January 2017 to June 2025. Patients were categorized into two groups: conservative management (n=106) and Double-J (DJ) stenting (n=12). Statistical analyses were performed using Chi-square, Fisher’s exact, and t-tests where appropriate. Univariate and multivariate Firth’s Logistic regression models were employed to identify independent predictors for intervention. The SHIP score was developed and validated using the Area Under the Curve (AUC), sensitivity, specificity, positive predictive value, negative predictive value.

Results: The mean maternal age was 30,3 ± 5,6 years, and the mean gestational age was 23,2 ± 6,9 weeks, predominantly occurring in the second and third trimesters (88.2%). Flank pain was the most prevalent clinical symptom (93.2%). The rate of urinary tract infection (UTI) was 45.8%, with Escherichia coli as the primary pathogen (80%), 25.0% of which were Extended-spectrum beta-lactamase (ESBL) producing strains. Urolithiasis was identified in 43.2% of cases, and pathological hydronephrosis accounted for 25.0%. Conservative management was successful in 89.8% of cases, while 10.2% required DJ stenting. Independent predictors for intervention included: fever ≥ 38^oC, ureteral stones, and hydronephrosis ≥ grade II. The SHIP score demonstrated high predictive performance with an AUC of 0.857 (95% CI: 0,751 – 0,964), facilitating the classification of patients into three risk groups for tailored management.

Conclusion: While the majority of hydronephrosis in pregnancy is physiological and responds well to conservative treatment, a significant proportion involves pathological conditions such as ureteral stones and UTIs that require early intervention. The SHIP score is a valuable clinical tool for risk stratification, enabling timely management to minimize hazardous complications for both mother and fetus.