Wunder-women: Systematic review of causes, treatment and outcomes of Wunderlich syndrome during pregnancy

摘要

Objective: The objective of this article is to conduct a contemporary literature review on Wunderlich syndrome, or spontaneous renal haemorrhage (SRH), among pregnant women to describe contemporary aetiology, investigations and management patterns. Methods: A systematic review of MEDLINE and CENTRAL in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. All articles, including case reports and case series on SRH published from 2000 to 2016, were included. Full-text manuscripts describing SRH among pregnant women were reviewed for clinical parameters, which were collated and analysed. Results: Twenty cases of SRH in pregnant women were identified. The median age and gestation were 32.1?years and 26.5 weeks, respectively, with SRH most commonly occurring in the third trimester (nine?patients; 45) and due to renal neoplasm, specifically angiomyolipoma (AML; 12?patients; 60), followed by renal artery aneurysm (RAA; five patients; 25). Surgical intervention (55) was most commonly used for acute SRH. Foetal demise was not uncommon (15). Conclusions: SRH in pregnant women is an uncommon but complex urological and obstetric emergency with potentially catastrophic consequences. A multidisciplinary approach is key to timely diagnosis and appropriate management considering the well-being both of mother and foetus. Pre-emptive diagnosis and intervention may reduce complications. Level of evidence: 4.