Editing Stones During Pregnancy (section)

== Diagnosis and evaluation ==

=== History and Physical Exam ===

* '''<span style="color:#ff0000">History'''
**'''<span style="color:#ff0000">Signs and Symptoms'''
***'''<span style="color:#ff0000">Most common presenting symptoms: flank pain''' 
***'''<span style="color:#ff0000">Usually accompanied by either macroscopic or microscopic hematuria'''
*** '''Many of the usual manifesting signs and symptoms may be masked by the patient’s gravid status'''

=== Imaging ===

==== Ultrasound ====
* '''<span style="color:#ff0000">Preferred modality in pregnant women'''
* '''<span style="color:#ff0000">If an obstructing calculus cannot be visualized by conventional renal US, transvaginal US can provide imaging of the distal ureter'''

==== MRI ====
* '''<span style="color:#ff0000">Recommended as a second-line imaging test when ultrasonography is nondiagnostic''' (CW12 p2039)
* Does not rely on ionizing radiation or contrast medium, making it a potentially attractive tool to evaluate pregnant patients.
* '''Because MRI does not visualize calcium, stones are seen as filling defects overlying the high signal intensity of urine.'''
* '''Visualization of smaller stones with this technique is difficult'''

==== Limited Intravenous Pyelography (IVP) ====
* '''Consists of one scout image followed by one plate taken ≈30 minutes after the injection of contrast.'''
** '''Each plain film exposes the fetus to 0.1-0.2 rads''', much below the threshold of 1.2 rads, at which the risk begins to increase.
*** '''Low-dose CT <0.19 rads''' (1.9 mSV; 1 rad = 10 mSV) (online source)
*** '''The total pregnancy exposure should not exceed the American College of Obstetrics and Gynecology (ACOG) recommended maximum of 5 rads''' (2016 AUA Stone Surgery Guidelines)

==== CT ====

*'''Low-dose CT'''
* '''Conventional CT'''
** '''Should be avoided''' during pregnancy due radiation particularly high dose
**