Prenatal sonographic evaluation and postnatal outcome of renal anomalies.

OBJECTIVE: To determine the prognosis of antenatally detected renal anomalies by sonographic evaluation. MATERIALS AND METHODS: This was a follow-up study of all antenatally detected renal anomalies from January 2008 to Dec 2009 referred to fetal medicine clinic. Prenatal evaluation was done and cases were divided into four groups depending upon their prenatal sonographic findings. Post natal follow-up was done up to one year in cases of live babies. Autopsy was carried out in still born fetus after consent. RESULTS: The renal anomaly was detected in 55 cases, which were fully followed. The prognosis was said to be poor for group I cases with gross extra renal anomaly along with the renal anomaly, and for group II in which there was organic renal pathology with loss of renal function suggested by non-visualization of bladder and almost absent liquor. Prognosis was guarded and depended upon the gestational age of presentation in group III, which had obstructive uropathy; prognosis was good in group IV cases, which were mild, unilateral or which presented late. CONCLUSION: Prenatal sonographic evaluation gives reasonably accurate picture of the prognosis and can be very helpful in counseling the parents regarding prognosis and help in deciding the timing and route of delivery.

Outcomes of antenatally detected renal pelvic dilatation: A retrospective study.

Background Renal pelvic dilatation is one of the abnormalities detected antenatally by ultrasound scan (USS), incidence being around 0.5-1% of live births. In most children it is benign. Objectives To determine the local occurrence and outcomes of antenatally detected renal pelvic dilatation and to determine whether there is a sex difference in the incidence and outcomes Method The 18-20 weeks morphology scans of all live newborn babies delivered in the maternity ward of Hervey Bay hospital from 01/02/2008 to 30/09/2008 were retrospectively analysed. Infants with antenatally detected renal pelvic dilatation were followed up with 2 weeks postnatal USS. Infants with increasing pelvic dilatation or persistent moderate to severe dilatation were followed up with MCUG / MAG 3 scan. Results Total number of live births during the 8 month period was 695. There were 362 males and 333 females. There were 15 (2.2%) neonates (7 male, 8 female) with antenatally detected renal pelvic dilatation. Occurrence in males was 1.9% and females 2.4% (p =0.671). Five cases were bilateral and 10 unilateral. In unilateral cases, left side involvement was more common (60%). In bilateral cases left side involvement was more severe in 60%. There were 9 (60%) cases with mild dilatation, 4 (27%) with moderate dilatation and 2 (13%) with severe dilatation. Oligohydramnios, thickened bladder or dilated ureters were not detected in any of the cases. Caliectasis was detected in 2 infants (13.3%) who had severe dilatation in antenatal scan. Subsequent postnatal scan was completely normal in 6 (40%), improved in six (40%) and worse in three (20%). There were 4 cases with mild, 2 with moderate and 3 with severe dilatation. All infants with severe dilatation had caliectasis. MCUG was done in 3 infants but did not detect any abnormality or reflux. Antibiotic prophylaxis was stopped after normal MCUG. MAG 3 scan was done in 3 infants including one with normal MCUG and all three detected PUJ obstructions but none required surgery. All 3 infants with PUJ obstruction had either severe (2) or moderate (1) dilatation on antenatal scan and all 3 had severe dilatation on postnatal scan. Of these 3 infants with PUJ obstruction, 2 had caliectasis in antenatal scan and all 3 had caliectasis in the subsequent postnatal scan. Follow up period varied from 1 to 9 months. None developed symptomatic UTI during this period. Conclusions There were 2.2% neonates with antenatally detected renal pelvic dilatation. Outcome was satisfactory in 80% of cases. There was no significant sex difference in occurrence or outcome.

Clinical outcome of prenatally diagnosed isolated fetal ventriculomegaly: retrospective analysis of 175 cases / 대한산부인과학회지

OBJECTIVE: The objective of this study is to evaluate the natural course, postnatal outcome, and association between the degree of ventriculomegaly and neurodevelopmental delay in isolated fetal ventriculomegaly. METHODS: We reviewed the medical records of pregnant women diagnosed with isolated fetal ventriculomegaly from October 1996 to June 2004. We defined mild ventriculomegaly as atrial width of 10-14.9 mm and overt ventriculomegaly as 15 mm or more. Neonatal brain ultrasonography was performed in all cases and brain MRI was performed as necessary. Neurodevelopmental outcome was evaluated by medical records and telephone interviews. We analyzed the final outcome of isolated fetal ventriculomegaly according to the ventricular width. RESULTS: There were 175 cases of isolated fetal ventriculomegaly, with a large proportion of male fetuses (68.6%), and one case of trisomy 21. While the group with prenatally resolved ventriculomegaly (n=119) had a smaller ventricular width and more unilaterality, there was no resolution in cases with a ventricular width of 15 mm or more. One hundred and thirty one fetuses with an initial ventricular width of 10 to 11.9 mm had no developmental delay, however, there were 2 cases of cerebral palsy and 2 cases of genetic disorder. Seventeen fetuses had ventricular dilatation of 15 mm or more, with 6 corresponding cases of developmental delay and one case of cerebral palsy. CONCLUSION: Among isolated fetal ventriculomegaly, mild, unilateral or stable ventriculomegaly seems to have a favorable neurological outcome, especially those cases with ventricular width of less than 12 mm. However, management of the condition and counseling of parents are still crucial, because it can be a marker of genetic disorder or brain developmental delay.

Clinical Characteristics and Outcome of Isolated Fetal Hydronephrosis / 대한산부인과학회지

OBJECTIVE: Routine maternal ultrasonography has revealed a very high incidence of fetal hydronephrosis. However, there is little data available, in Korea, on the natural progress of prenatal hydronephrosis. Therefore, to help in the management of patients, the antenatal course and neonatal follow-up data of isolated fetal hydronephrosis were analyzed. METHODS: Prenatal diagnosis, etiologies, clinical characteristics, and outcome were studied retrospectively in 77 cases of unilateral and bilateral prenatal hydronephrosis from January 2000 to March 2004. Cases were classified as mild (7 mm > or =, , ) prenatal hydronephrosis as depending on the renal pelvis anteroposterior diameter. Fisher's exact test and Chi-square test were used for statistical analysis. RESULTS: The etiologies of prenatal hydronephrosis were ureteropelvic junction obstruction 45 (58.4%), vesicoureteral reflux 2 (2.6%), ureterocele 1 (1.3%), and urethra obstruction 1 (1.3%). At delivery, 18 cases were normal kidneys, and during the follow-up periods, 10 cases resolved spontaneously. Mild, moderate, and severe hydronephrosis were present in 30 (38.9%), 38 (49.4%), and 9 (11.7%) respectively. Operations were performed in 2/38 (5.3%) of moderate cases, and 7/9 (77.8%) of severe cases. CONCLUSION: Most of prenatal hydronephrosis diagnosed by ultrasonography disappeared postnatally and the needs for postnatal operations were rare. It is suggested that hydronephrosis in the fetus or neonate dose not necessarily imply the presence of an obstructive uropathy or a significant functional abnormality and the reassurance of parents and follow up evaluation of the neonate during perinatal period may be needed.

Postnatal outcome of Prenatally detected Fetal Hydronephrosis / 대한주산의학회잡지

OBJECTIVE: To help prenatal counselling in fetal hydronephrosis by demonstrating the postnatal investigation, treatment and outcome of infants with hydronephrosis prenatally diagnosed. METHODS: Between January 2000 and December 2001, we studied 20 infants who presented with fetal hydronephrosis confirmed by postnatal ultrasonography. In the postnatal follow-up period, the infants were followed with sequential ultrasonography and urinalysis. (99m)Tc-DTPA scan, intravenous pyelography and voiding cystourethrography were performed in selected cases. An anteroposterior renal pelvic diameter >7 mm after 30 weeks of pregnancy was defined as fetal hydronephrosis. Follow-up ranged from 6 to 18 months (mean, 12). RESULTS: Unilateral hydronephrosis was diagnosed in 13 infants and bilateral in 7. A male predilection was found (4:1) and the left kidney was more commonly involved. If there was no resolution, ultrasonographic follow-up was done until 18 months. As a results, hydronephrosis resolved in 11, who were all in the unilateral hydronephrosis group. The range of the fetal renal pelvis on prenatal ultrasonography was 7~13 mm in the resolution group. Pyeloplasty was performed in two unilateral hydronephrosis infants. CONCLUSION: When the fetal renal pelvis was below 14 mm at least on prenatal ultrasonography, it didn't progress. Fetal hydronephrosis below 14 mm may be safely observed, and surgical correction was performed only a few infants. So, we suppose that this outcome must be considered enough in prenatal counsellings and that the work-up for more many people is needed, because of the small number of the patients whose renal pelvic diameter is above 14 mm in this study.

The postnatal outcome and prognostic cut-off value of fetal pyelectasia / 대한산부인과학회잡지

OBJECTIVE: The purpose of our study was to evaluate the postnatal outcome of fetal pyelectasia and to assess the cut-off value for prediction of renal pathologic processes and surgical intervention. MATERIALS AND METHODS: Seventy-seven cases of pyelectasia were identified during the study period (1996 through 2000). Fetuses with antero-posterior pelvic diameter (APPD) >or=7 mm after 28 weeks were included. Postnatal evaluation included renal sonogram, voiding cystourethrogram, and renal flow and function studies. RESULTS: Renal pathologic processes after birth were found in 38 of 77 cases (49%). Ureteropelvic junction obstruction (19 cases, 50%) was the most common, followed by 4 cases of duplicated kidney, 3 cases of ureterovesical junction obstruction, 2 cases of primary vesicoureteral reflux, dysplastic kidney, extrarenal pelvis respectively and 1 case of ureterocele. Surgical intervention was performed in 21 cases (55%); pyeloplasty (13), nephrectomy (including partial) (3), transurethral incision of ureterocele (2), uretero- ureterostomy (1), uretero-cystostomy (2). Using cut-off value derived from receiver operating characteristic (ROC) curve, renal APPD >or=10.5 mm, >or=13.6 mm after 28 weeks gestation could predict the fetuses who would have renal pathologic processes and need surgical intervention, with sensitivity and specificity of 77.5%, 79.4% and 90.5%, 89.3%, respectively. CONCLUSION: It is possible to predict the fetuses who would require appropriate urologic evaluation and surgical intervention after birth, with determining the renal pelvic diameter in the third trimester of pregnancy.

Correlation of prenatal renal parenchymal thickness with postnatal outcome of fetal hydronephrosis / 대한산부인과학회잡지

PURPOSE: The aims of this research are to correlate prenatal renal parenchymal thickness with postnatal outcome of fetal hydronephrosis, to establish the predictability of prenatal renal parenchymal thickness for surgical treatment and to apply this parameter to the evaluation and the follow-up of prenatal hydronephrosis. Material and METHOD: Between Jun 1991 and Jun 1998 we retrospectively identified 59 cases of fetal hydronephrosis in which renal pelvic anteroposterior diameter(PAPD) was greater than 10mm. Renal parenchymal thickness(RPT), renal pelvis anteroposterior diameter and renal anteroposterior diameter(RAPD) were measured on midtransverse from prenatal sonograms. The ability of these parameters to predict who would require surgical treatment was examined. The difference of these parameters in groups were compared using Wilcoxon rank sums analysis. RESULTS: 66.7% of fetuses with a renal parenchymal thickness lesser than 8mm and 71.4% of fetuses with a renal parenchymal thickness lesser than 6mm required surgical treatment. 33.3% of fetuses with an PAPD greater than 12mm and 45% of fetuses with an PAPD greater than 15mm required surgical treatment. 60% of fetuses with an ratio of PAPD/RAPD greater than 0.4 and 70% of fetuses with an ratio of PAPD/RAPD greater than 0.5 required surgical treatment. CONCLUSION: The research shows that RPT could be used as an useful parameter in the prediction of requirement of postnatal surgical treatment of fetal hydronephrosis ,in addition to the size of PAPD and the ratio of PAPD/RAPD which have been assumed as one of the most important parameters.