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Accuracy and outcome of sonographically diagnosed fetal hydronephrosis
SPO Abstracts
Volume 176, N u m b e r 1, Part 2 A m J Obstet Gynecol
257
FACTORS AFFECTING TERMINATION OF A N O M A L O U S FETUSES. BD Raynm~ Departnrent of Gynecology & Obstetrics, Division of Maternal/ Fetal Medicine, EmmT University School of Medicine, Atlanta GA. OBJECTIVE: To determine factors atSecting the decision to terminate an anonlalous fetus. STUDY DESIGN: Medical records of 109 pregnancies affected by congenital abnormalities considered lethal or causing significant neonatal mortality or long-term morbidity were reviewed. Cases were diagnosed Dec 1992-Aug 1996 by ultrasound in our center which serves an indigent population. Factors considered were maternal age, race, religion, marital status, gravidity, number of living children, diagnosis, indication tor ultrasound, gestational age at diagnosis (dxega), amniocentesis (anmio), previous spontaneous abortions and terminations, anomalous births and handicapped children, and family histoly of birth defects. Statistical analysis used chi square, Pearson correlation, and nmlfiple regression. RESULTS: 66% of cases, diagnosed prior to 25 weeks gestation were included in the analysis. 68% of these telqminated. Those with CNS, GU, mulfiple abnornralities and NTD were more likely to elect abortion (p < 0.003), as were lethal abnormalifies (p < 0.002). Women who did not have amnio were also more likely to terminate (p < .005). Increasing maternal age and gravity correlated with abortion (p < 0.05). Stepwise multiple regression analysis using 7 variables as predictors of termination accounted for 34% of the variance (nmltiple R = 0.64). Significant predictors included amnio (R e = 0.12, p < 0.006), affected organ (R 2 = 0.10, p < 0.006), dxega (R z = 0.08, p < 0.015), and age (R2 = 0.07, p < 0.02). CONCLUSIONS: Age, earlier diagnosis, organ system affected and no anmiocentesis are factors independently associated with termination of anomalous fi~tuses. Nonperformance of anmio may reflect patient predisposition to termination because of other factors or lesions not associated with genetic abnormalities or the perception that genetic information will not affect the outcome. It is also noteworthy that in this patient population, 1/3 of the abnormalities were detected too late in the gestation to make abortion an option. This observation has an important impact on perinatal mortality and morbidity.
258
SIGNIFICANCE OF ISOLATED FETAL PYELECTASIS. N.IVL Sabir ~, .~P. Crino, f B . Silva~. Dept. Ob/Gyu, Univ. Of Texas-Houston Med. School, Houston, Texas. OBJECTIVE: Our objectives were (1) to describe the characteristics of a cohort of fetuses with isolated mild pyelectasis, and (2) to prospectively determine the significance of this finding on pregnancy outcome. STUDY DESIGN: All fetuses diagnosed with isolated mild pyelectasis ti-om April, 1993 through March, 1996 were prospectively identified. Pyelectasis was defined as an anteroposterior (A-P) renal pelvic diameter of -->4 mm prior to 33 weeks and -->7 mm after 33 weeks. Exclusion criteria were A-P renal pelvic diameter -->10 mm on the initial scan, any associated fetal anomaly, and abnormal amniofic fluid volume. All women in the case group undel~vent genetic counseling, were offered ti~tal kap/otype determination, and were scheduled for follow-up ultrasonography. Normal controls were recruited from the same patient population concurrently. Data collected included patient demographics, prenatal sonographic findings, amniocentesis results, delivery intormation, and neonatal physical findings. RESULTS: Eighty-seven cases and 104 controls were identified. Eleven cases were lost to fbllow-up and excluded. Male:tbmale ratio for the cases was 4.5:1, higher than previously reported. Progression of pyelectasis by at least 1 mm was demonstrated in 25% of cases and progression to >10 mm in 12%. Twenty of 76 cases (26%) and 14/104 controls (13%) delivered <37 weeks (O.R. 2.30 {1.01-5.26}, p < 0.05). Eleven of 76 cases (14%) and 4/104 controls (4%) delivered <34 weeks (O.R. 4.23 {1.18-16.55}, p < 0.05). These differences persisted after controlling for amniocentesis and medical complications. One fetus with trisomy 21 was detected in the case group. CONCLUSIONS: Isolated mild fetal pyelectasis is associated with an increased risk for preterm delivel-/and a significant risk for progression in utero.
259
260
S81
PRENATAL DIAGNOSIS AND MANAGEMENT OF FETAL RENAL PELVIC DILATION. D. MtOonald ~, j~Af. Mastrobattista, E.R~ Newton. Dept. O f Ob/Gyn, Univ. Of Texas Houston, Houston, TX OBJECTIVE: To predict the natural history of renal pelvic dilation and amniotic fluid volume in a group of fetuses with mildly dilated renal pelves (4-10 mm). STUDY DESIGN: Singleton gestations with renal pelvic dilation greater than or equal to 4 mm were eligible for the stud),'. Fetuses with karyotypic abnormalities, congenital anomalies, renal pelvic dilation greater than 10 mm at presentation, or parenchymal renal disease were excluded. Between 1993-1995, 42 fetuses were followed with serial sonography. The changes in the degree and dming of renal pelvic diIation were analyzed. The amniotic fluid volmnes were corrected with these changes. RESULTS: Six fetuses (14.3%) progressed to pathologic (-->10 min) dilation at 36 weeks (3), 32 weeks (1), and 28 weeks (2). Four of the six had progressive bilateral dilation. There was no correlation between amniotic fluid index and renal pelvic dilation (r = 0.14, ns). The average number of ultrasound evaluations was 2.5 (range 2-9) at a cost of $265 per exam. CONCLUSIONS: Most cases of fetal renal pelvic dilation are not pathologic and may represent physiologic dilation. We cannot predict when pathologic dilation will occur. With uncomplicated, mild renal pelvic dilation, a single follow up sonogram in 6 weeks and after 28 weeks is probably sutficient.
ACCURACY AND O U T C O M E OF SONOGRAPHICALLY DIAGNOSED FETAL HYDRONEPHROSIS. M ~ Henness'~,* R. Neiger, M. Patel, x M. Mal@;on. Dept. of OB/GYN, Univ. of Tenn., Knoxville, TN OBJECTIVES: The objective of this study was to correlate prenatal ultrasonographic findings of suspected congenital hydronephrosis with postnatal outcome. STUDY DESIGNS: The study population consisted of 160 fetuses with suspected hydronephrosis followed fi-om 6/92 to 8/95. Each patient received an average of 3.8 prenatal ultrasounds. Hydronephrosis was defined as mild, moderate or severe based on the relative renal AP pelvic diameter and calyx dilation related to gestadonal age. All infants had ultrasound and VCUG ~e~aluation of their kidneys between 3-7 days after delivery. If VCUG was negative, a diuretic renogyam was performed. All infants were followed fiom 1-5 years. RESULTS: Of the 160 cases of hydronephrosis followed prenatally, 109 cases were defined as mild, 30 as moderate, 15 as severe and 6 were classified as suspected dysplastic. O f the mild cases, 35 were diagnosed as normal on the first neonatal ultrasound. Of the 124 remaining intants studied, the initial ultrasound grading of hydronephrosis correlated with prenatal finding 94% of the time (117/124). Prenatal diagnosis of less common etiologies of hydronephrosis such as duplicated collecting system with obstruction, posterior urethral valves and ureterocele were accurate only 41% of the time (7/17). Of the 160 intants in the initial study population, 24 eventually undel~vent surgep/. Of those diagnosed prenatally, 19 were moderate or severe, and 5 were considered to have mild hydronephrosis. CONCLUSION: Sonographic detection of fetal hydronephrosis is very accurate although the etiology is usually elusive. Postnatal tonow-up is warranted even in nlild cases.
Volume 176, N u m b e r 1, Part 2 A m J Obstet Gynecol
257
FACTORS AFFECTING TERMINATION OF A N O M A L O U S FETUSES. BD Raynm~ Departnrent of Gynecology & Obstetrics, Division of Maternal/ Fetal Medicine, EmmT University School of Medicine, Atlanta GA. OBJECTIVE: To determine factors atSecting the decision to terminate an anonlalous fetus. STUDY DESIGN: Medical records of 109 pregnancies affected by congenital abnormalities considered lethal or causing significant neonatal mortality or long-term morbidity were reviewed. Cases were diagnosed Dec 1992-Aug 1996 by ultrasound in our center which serves an indigent population. Factors considered were maternal age, race, religion, marital status, gravidity, number of living children, diagnosis, indication tor ultrasound, gestational age at diagnosis (dxega), amniocentesis (anmio), previous spontaneous abortions and terminations, anomalous births and handicapped children, and family histoly of birth defects. Statistical analysis used chi square, Pearson correlation, and nmlfiple regression. RESULTS: 66% of cases, diagnosed prior to 25 weeks gestation were included in the analysis. 68% of these telqminated. Those with CNS, GU, mulfiple abnornralities and NTD were more likely to elect abortion (p < 0.003), as were lethal abnormalifies (p < 0.002). Women who did not have amnio were also more likely to terminate (p < .005). Increasing maternal age and gravity correlated with abortion (p < 0.05). Stepwise multiple regression analysis using 7 variables as predictors of termination accounted for 34% of the variance (nmltiple R = 0.64). Significant predictors included amnio (R e = 0.12, p < 0.006), affected organ (R 2 = 0.10, p < 0.006), dxega (R z = 0.08, p < 0.015), and age (R2 = 0.07, p < 0.02). CONCLUSIONS: Age, earlier diagnosis, organ system affected and no anmiocentesis are factors independently associated with termination of anomalous fi~tuses. Nonperformance of anmio may reflect patient predisposition to termination because of other factors or lesions not associated with genetic abnormalities or the perception that genetic information will not affect the outcome. It is also noteworthy that in this patient population, 1/3 of the abnormalities were detected too late in the gestation to make abortion an option. This observation has an important impact on perinatal mortality and morbidity.
258
SIGNIFICANCE OF ISOLATED FETAL PYELECTASIS. N.IVL Sabir ~, .~P. Crino, f B . Silva~. Dept. Ob/Gyu, Univ. Of Texas-Houston Med. School, Houston, Texas. OBJECTIVE: Our objectives were (1) to describe the characteristics of a cohort of fetuses with isolated mild pyelectasis, and (2) to prospectively determine the significance of this finding on pregnancy outcome. STUDY DESIGN: All fetuses diagnosed with isolated mild pyelectasis ti-om April, 1993 through March, 1996 were prospectively identified. Pyelectasis was defined as an anteroposterior (A-P) renal pelvic diameter of -->4 mm prior to 33 weeks and -->7 mm after 33 weeks. Exclusion criteria were A-P renal pelvic diameter -->10 mm on the initial scan, any associated fetal anomaly, and abnormal amniofic fluid volume. All women in the case group undel~vent genetic counseling, were offered ti~tal kap/otype determination, and were scheduled for follow-up ultrasonography. Normal controls were recruited from the same patient population concurrently. Data collected included patient demographics, prenatal sonographic findings, amniocentesis results, delivery intormation, and neonatal physical findings. RESULTS: Eighty-seven cases and 104 controls were identified. Eleven cases were lost to fbllow-up and excluded. Male:tbmale ratio for the cases was 4.5:1, higher than previously reported. Progression of pyelectasis by at least 1 mm was demonstrated in 25% of cases and progression to >10 mm in 12%. Twenty of 76 cases (26%) and 14/104 controls (13%) delivered <37 weeks (O.R. 2.30 {1.01-5.26}, p < 0.05). Eleven of 76 cases (14%) and 4/104 controls (4%) delivered <34 weeks (O.R. 4.23 {1.18-16.55}, p < 0.05). These differences persisted after controlling for amniocentesis and medical complications. One fetus with trisomy 21 was detected in the case group. CONCLUSIONS: Isolated mild fetal pyelectasis is associated with an increased risk for preterm delivel-/and a significant risk for progression in utero.
259
260
S81
PRENATAL DIAGNOSIS AND MANAGEMENT OF FETAL RENAL PELVIC DILATION. D. MtOonald ~, j~Af. Mastrobattista, E.R~ Newton. Dept. O f Ob/Gyn, Univ. Of Texas Houston, Houston, TX OBJECTIVE: To predict the natural history of renal pelvic dilation and amniotic fluid volume in a group of fetuses with mildly dilated renal pelves (4-10 mm). STUDY DESIGN: Singleton gestations with renal pelvic dilation greater than or equal to 4 mm were eligible for the stud),'. Fetuses with karyotypic abnormalities, congenital anomalies, renal pelvic dilation greater than 10 mm at presentation, or parenchymal renal disease were excluded. Between 1993-1995, 42 fetuses were followed with serial sonography. The changes in the degree and dming of renal pelvic diIation were analyzed. The amniotic fluid volmnes were corrected with these changes. RESULTS: Six fetuses (14.3%) progressed to pathologic (-->10 min) dilation at 36 weeks (3), 32 weeks (1), and 28 weeks (2). Four of the six had progressive bilateral dilation. There was no correlation between amniotic fluid index and renal pelvic dilation (r = 0.14, ns). The average number of ultrasound evaluations was 2.5 (range 2-9) at a cost of $265 per exam. CONCLUSIONS: Most cases of fetal renal pelvic dilation are not pathologic and may represent physiologic dilation. We cannot predict when pathologic dilation will occur. With uncomplicated, mild renal pelvic dilation, a single follow up sonogram in 6 weeks and after 28 weeks is probably sutficient.
ACCURACY AND O U T C O M E OF SONOGRAPHICALLY DIAGNOSED FETAL HYDRONEPHROSIS. M ~ Henness'~,* R. Neiger, M. Patel, x M. Mal@;on. Dept. of OB/GYN, Univ. of Tenn., Knoxville, TN OBJECTIVES: The objective of this study was to correlate prenatal ultrasonographic findings of suspected congenital hydronephrosis with postnatal outcome. STUDY DESIGNS: The study population consisted of 160 fetuses with suspected hydronephrosis followed fi-om 6/92 to 8/95. Each patient received an average of 3.8 prenatal ultrasounds. Hydronephrosis was defined as mild, moderate or severe based on the relative renal AP pelvic diameter and calyx dilation related to gestadonal age. All infants had ultrasound and VCUG ~e~aluation of their kidneys between 3-7 days after delivery. If VCUG was negative, a diuretic renogyam was performed. All infants were followed fiom 1-5 years. RESULTS: Of the 160 cases of hydronephrosis followed prenatally, 109 cases were defined as mild, 30 as moderate, 15 as severe and 6 were classified as suspected dysplastic. O f the mild cases, 35 were diagnosed as normal on the first neonatal ultrasound. Of the 124 remaining intants studied, the initial ultrasound grading of hydronephrosis correlated with prenatal finding 94% of the time (117/124). Prenatal diagnosis of less common etiologies of hydronephrosis such as duplicated collecting system with obstruction, posterior urethral valves and ureterocele were accurate only 41% of the time (7/17). Of the 160 intants in the initial study population, 24 eventually undel~vent surgep/. Of those diagnosed prenatally, 19 were moderate or severe, and 5 were considered to have mild hydronephrosis. CONCLUSION: Sonographic detection of fetal hydronephrosis is very accurate although the etiology is usually elusive. Postnatal tonow-up is warranted even in nlild cases.