Emergency management of intractable renal colic in pregnancy Pregnancy combined with intractable renal colic is a special type of renal colic, the onset of which is not only painful for the pregnant woman herself, but also can induce contractions and even lead to miscarriage and preterm delivery, endangering the safety of the pregnant woman and the fetus; with the development of treatment technology and the increasing concern for health, the clinical incidence is on the rise. Srirangam et al. reported that the incidence of urinary stones in pregnant women was 0.05% to 0.40%. The incidence of urinary stones in pregnancy is not clear because most of the patients were seen only when they had symptoms of colic, and some of the patients who did not have symptoms were not detected in time. The susceptibility to stone formation during pregnancy is generally believed to be due to changes in the normal anatomy of the urinary system during pregnancy and changes in calcium and phosphorus metabolism in pregnant women; together with the increased level of progesterone during pregnancy and the influence of autonomic function; causing a decrease in smooth muscle tone in the urinary system, dilatation of the ureter and a significant decrease in peristalsis, and slow urinary flow, resulting in stone formation. If the treatment is not timely, combined. In case of pyelonephritis and other infections or premature rupture of fetal membranes, the rate of preterm delivery of pregnant women is higher, so timely and effective analgesic, antispasmodic and anti-infective treatment is very necessary. Although surgical interventions such as the placement of double J-tubes can be used to treat pregnancy-associated intractable renal colic, and the efficacy of the treatment is exact, most pregnant women and their families still have concerns about surgical treatment and refuse it; at the same time, some studies have shown that about 70% to 80% of urinary stones in pregnant patients can be expelled naturally, so the first goal should be to relieve symptoms and not deliberately pursue stone cure, that is, to take Conservative treatment. Although the clinical use of drugs is limited in consideration of the safety of the pregnant woman and the fetus, appropriate conservative management of drugs can both relieve the patient’s pain and protect the fetus from miscarriage and preterm delivery. Among them, scopolamine (654-2) and progesterone have been used clinically for many years, and neither has been reported to be significantly harmful to pregnant women and fetuses, indicating that they are safe for pregnant women and fetuses. Scopolamine is the antispasmodic of choice in the clinical treatment of renal colic. It has peripheral anti-M choline receptor effects and can release smooth muscle spasm caused by acetylcholine. It can relax the smooth muscle of ureter and relieve renal colic, but the effect is limited when used alone; and when used in excessive doses, it is easy to have side effects such as rapid heartbeat, blurred vision, dizziness, blurred eyes, dry mouth, and even induce intestinal paralysis and intestinal obstruction, which affects the therapeutic effect; while progesterone can relax the spastic smooth muscle of ureter, and at the same time has the effect of diastolic smooth muscle of uterus, which has both antispasmodic and antifetal functions, as well as antagonizing aldosterone sodium excretion It is suitable for the treatment of stone colic attacks during pregnancy; moreover, the combination of progesterone and scopolamine can significantly reduce the dosage of scopolamine, thus reducing the occurrence of scopolamine side effects. All of our data had first intramuscular injection of scopolamine 10mg and progesterone 20mg, but the pain relief effect was limited and renal colic was persistent. The reasons for this are related to the increase in progesterone in pregnancy, which reduces the tone of the smooth muscle of the urinary tract, which weakens the peristalsis of the renal pelvis and slows down the urine flow; at the same time, the enlarged uterus compresses the ureter, which increases the pressure of the renal pelvis; and the difficulty of passing the stones through the three physiological stenoses of the ureter (pelvic-ureteral junction, crossing the iliac artery and the bladder wall), which causes obstruction; together with the anxiety and tension of the pregnant women caused by pain, the body The body is also less reactive and tolerant. This weakens or counteracts the smooth muscle antispasmodic and analgesic effects of scopolamine and progesterone, as well as the natriuretic effects. If the use of scopolamine and progesterone does not provide relief of renal colic in such pregnant women, mebendazole (Phloroglucinol) should be added promptly. Phloroglucinol has been used in Europe for more than 40 years and in China for nearly 10 years. Its rapid antispasmodic effect, significant effect and low adverse effects have been widely recognized, and the clinical application results over the years have shown that it has no adverse effects on the mother and fetus, which proves that it is safe to be used in pregnancy and renal colic. The present data also show that the effect of combining mebendazole to control acute renal colic is more significant than that of scopolamine and progesterone alone, because mebendazole is a pro-muscular antispasmodic, which only acts on the spastic smooth muscle and has only a minimal effect on normal smooth muscle. In acute renal colic, the smooth muscles of the genitourinary tract are in pathological spasm, and ask benzotriophen acts on the spastic smooth muscles, and relieves the colic by relaxing the spastic smooth muscles. If the pain is still not relieved, pethidine 75-100mg of opioid can be injected intramuscularly, but caution should be exercised when using pethidine near the due date to avoid causing fetal respiratory depression. Non-steroidal anti-inflammatory analgesics can block prostaglandin synthesis in the fetus, which can easily lead to premature closure of the fetal ductus arteriosus and the risk of fetal pulmonary hypertension, so their use should be prohibited. For patients with intractable renal colic in pregnancy complicated by irregular contractions of the uterus and vaginal bleeding, it is appropriate to apply magnesium sulfate treatment in time, because: (1) intractable renal colic in pregnancy complicated by irregular contractions of the uterus and vaginal bleeding, mainly related to the uterine meconium and endometrial local production of prostaglandins, and magnesium sulfate can block the synthesis and release of prostaglandins, while magnesium ions can reduce the release of neurotransmitters (2) magnesium ions into the blood circulation also acts on the renal pelvic ureter, relaxing the smooth muscle of the renal pelvis ureter; at the same time block the synthesis and release of prostaglandins in the kidney, affecting the glomerular filtration rate, reducing. Renal pelvic pressure, relieve renal colic; (3) magnesium ion can also affect the solubility of calcium oxalate, reduce crystal precipitation, promote stone dissolution; (4) magnesium ion into the extracellular fluid, can inhibit the central nervous system, can also reduce the release of motor nerve endings acetylcholine, block the peripheral neuromuscular junction, produce sedation, antispasmodic, relaxation of muscle action, thus relieving patients irritable tension, facilitate pregnant women The effect of magnesium sulfate can be improved by cooperating with the treatment. To sum up, magnesium sulfate has good effect of relaxing smooth muscle, relieving renal colic, promoting lithotripsy, preventing contraction and calming fetus, which is suitable for the treatment of intractable renal colic during pregnancy. But in the use of magnesium sulfate should pay attention to the speed of intravenous infusion, to 1-2g/h is appropriate, the first intravenous drip can double the dose of 4g/h. At the same time, closely observe the patient’s heart rate, m pressure, respiration, urine volume and knee reflex, to prevent overdose poisoning. Any heart rate <60 times/min, urine volume less than 25-30 ml/h, hypotension, hypocalcemia and renal insufficiency should be prohibited. If the dose is too high or the drip rate is too fast which may cause a drop in blood pressure, respiratory depression, weakening or disappearance of knee reflex, the drug should be stopped immediately and the calcium should be slowly injected for relief. Patients with pregnancy and renal colic have more or less urinary tract obstruction, which is more likely to cause infection, and inflammation will aggravate the condition of renal colic. A vicious circle is formed, and sepsis can occur in severe cases, seriously affecting the safety of the pregnant woman's fetus. Therefore, if clinical symptoms (urinary tract irritation signs, etc.) and test results (routine blood and urine) suggest the presence of infection, or combined with appendicitis, antibiotics should be applied promptly. It is best to apply antibiotics based on the results of drug sensitivity tests, but this is generally not possible in emergency medicine and is often used empirically in clinical practice. Urinary tract infections are mostly caused by Gram-negative bacilli such as Escherichia coli, and penicillins or third-generation cephalosporin antibiotics are both sensitive to Gram-negative bacilli and safe for the fetus, so they are commonly used for urinary tract infections during pregnancy. With these treatments, almost all patients with pregnancy and intractable renal colic can have their pain relieved, and with close observation, most patients can safely survive the pregnancy and wait for delivery before further treatment of stones. For those who have failed conservative treatment or have acute renal failure due to stone obstruction or serious infection, surgical treatment is required.