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  • Title: Sonographic screening for urinary tract abnormalities in patients with Schistosoma haematobium infection: pitfalls in examining pregnant women.
    Author: Richter J, Wagatsuma Y, Aryeetey M, Feldmeier H.
    Journal: Bull World Health Organ; 1996; 74(2):217-21. PubMed ID: 8706238.
    Abstract:
    In areas where Schistosoma haematobium is endemic, urinary schistosomiasis and pregnancy are frequently concomitant; however, both these conditions may produce similar urinary tract changes in ultrasound scans and hence their differential diagnosis may be difficult. In patients with urinary schistosomiasis, focal and/or diffuse urinary bladder wall changes are frequently detected ultrasonically. Dilatation of one or both ureters and progressive hydronephrosis may be observed in more severe cases. Satisfactory ultrasound examination of the urinary bladders of pregnant women is generally not feasible because mechanical compression by the fetus or transitory lower urinary tract infection hampers adequate filling of the bladder. Pregnancy itself is frequently associated with dilatation of one or both ureters and/or hydronephrosis; this is due to hormonal factors, infection, or compression of one or both ureters by the enlarged uterus and growing fetus. Hence, when sonography of the urinary bladder is not feasible such pregnancy-associated changes are virtually indistinguishable from those caused by S. haematobium, and may be incorrectly attributed to the latter. Pregnant women, therefore, should be excluded from ultrasonic surveys of urinary schistosomiasis. In contrast, ultrasound scans of adolescents and of women with positive parasitological findings and/or pathological alterations in the urinary tract should include examination of the uterus in order to assess whether the woman is pregnant; thereby, misinterpretation of sonographic findings can be avoided. Pregnant women with significant hydronephrosis must be closely followed up by an obstetrician since this condition may indicate a complication of the pregnancy; in some cases only a postpartum examination will permit definitive diagnosis. During July-August 1993, in the Accra region of Ghana, physicians collected urine samples from 73 female patients aged 6-61 and 101 male patients and conducted ultrasound examinations of all patients with confirmed urinary schistosomiasis. They were concerned with the effect of pregnancy on the urinary tract so they compared the parasitological and ultrasound findings of the 5 pregnant women with those of the 68 nonpregnant women. The pregnant women had a lower egg count than the nonpregnant women (47.94 vs. 64.72 ova/10 ml). Ultrasound screening revealed upper urinary tract dilatation in some of the pregnant women with urinary schistosomiasis, but this alteration is common in pregnant women without schistosomiasis. One pregnant woman had moderate hydronephrosis. The three pregnant women in the second and third trimesters could not retain enough urine in their bladders for a reliable ultrasound examination. Mechanical compression by the fetus or transitory lower urinary tract infection hinders satisfactory filling of the bladder and therefore prevents adequate ultrasound examination of the urinary bladders of pregnant women. These findings suggest that researchers should not include pregnant women in ultrasonic surveys of urinary schistosomiasis. They should also conduct ultrasound scans of female adolescents and women with positive parasitological findings and/or pathological alterations in the urinary tract to determine whether or not they are pregnant in order to avoid misinterpretation of sonographic findings. Obstetricians should follow closely pregnant women with significant hydronephrosis since it may indicate a pregnancy complication. A postpartum examination will allow obstetricians to make a definitive diagnosis.
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