Prenatal natural history of isolated fetal mild bilateral pyelectasis

OBJECTIVE: To analyze the prenatal outcomes in a cohort of fetuses with mild bilateral pyelectasis and determine whether performing serial ultrasounds is a good follow-up strategy. METHODS: A prospective longitudinal study was conducted on 62 fetuses with mild bilateral pyelectasis. Fetal mild bilateral pyelectasis was considered when the renal pelvis measured (in millimeters) ≥5.0 to 10.0, ≥7.0 to 10.0, and ≥10.0 to 15 at ≤23 weeks 6 days, 24 to 31 weeks 6 days, and ≥32 weeks, respectively, with no uretero-calyceal dilatation. Ultrasounds were performed every 3 weeks to assess whether the mild bilateral pyelectasis regressed, remained unchanged (Group 1) or progressed (Group 2). RESULTS: Group 1 consisted of 53 fetuses (85.4%), and progression was observed in 9 cases (Group 2, 14.6%). The initial renal pelvis diameter was significantly larger in fetuses with progression (p=0.028). Statistically significant differences in the renal pelvis diameter were also found at weeks 31 and 35 for both kidneys (p<0.05). The cases requiring intrauterine procedures or early delivery were not observed. CONCLUSION: Fetal mild bilateral pyelectasis with no calyceal dilatation is a benign condition that can be managed in the postnatal period. The initial renal pelvis diameter and the diameter in week 31 or 35 were valuable parameters for identifying cases that would eventually need specific postnatal procedures.

Second-trimester fetal genetic ultrasonography to detect chromosomal abnormalities

Genetic ultrasonography refers to the evaluation of risk of chromosomal abnormalities via various soft sonographic markers. Although the maternal serum test is the primary screening method for chromosomal abnormalities, genetic ultrasonography is also widely used and can help increase detection rates. To date, many soft markers, including choroid plexus cysts, echogenic intracardiac foci, mild ventriculomegaly, nuchal fold thickening, echogenic bowel, mild pyelectasis, short femur and humerus length, and absent or hypoplastic nasal bone, have been reported. An aberrant right subclavian artery was the most novel soft marker introduced. Because these soft markers involve diverse relative risks of chromosomal abnormalities, it is difficult to apply them to clinical practice. To optimize the efficacy of genetic ultrasonography, it is important to understand the precise relative risks of chromosomal abnormalities innumerous soft markers and integrate these risks with each other and the results of maternal serum screening.

Recent advances in obstetrical ultrasound / 대한산부인과학회지

An obstetrical ultrasound examination provides invaluable information regarding the fetus. Many publications from the last years have advanced the use of ultrasound in obstetrics. With the advent of high-resolution ultrasound and transvaginal scanning, a significant amount of information about the fetus have been gained, and provided to the patient. It must be emphasized to evaluate the fetus for structural malformations, and searches for the sonographic markers of fetal aneuploidy in first trimester because it allows the early diagnosis of many conditions. The presence of sonographic markers including the nuchal fold, short femur and humerus, pyelectasis, hyperechoic bowel, echogenic intracardiac focus, and any major abnormality, either singly or in combination, will raise the baseline risk of aneuploidy using likelihood ratios calculated for each individual marker. Fetuses with abnormal Doppler velocimetry in the uteroplacental, umbilical, and fetal circulations but normal chromosomes are at higher risk for adverse pregnancy outcome, including preeclampsia and growth restriction. Improved technology has lowered the gestational age at which fetal cardiac anatomy scanning can be reliably performed by properly trained and experienced examiners. Early fetal echocardiography can be offered as a screening examination to at-risk and low-risk patients, with the condition that it be repeated following screen-negative scans at mid-gestation to exclude later developing lesions. This review describes the recent advances in the role of first trimester ultrasound in screening and diagnosis of fetal anomalies, a number of new ultrasound markers for fetal aneuploidy, Doppler ultrasonography, and fetal echocardiography.

A study in fetuses with prenatally diagnosed single umbilical artery by ultrasonund / 대한산부인과학회지

OBJECTIVE: To evaluate the incidence, combined anomaly, and prognosis of prenatally diagnosed Single Umbilical Artery (SUA) by ultrasound. METHODS: From January 2001 to December 2005, a single umbilical artery (SUA) was observed in 41 cases out of 22,868 deliveries. Among 41 cases, 39 cases were examined by targeted imaging to rule out fetal anomalies in the mid trimester (intrauterine pregnancy 16-27 weeks). The remaining two cases were detected in the third trimester, which were transferred from a local clinic, and were examined by routine sonogram. Pregnancy and perinatal outcome data were retrieved by review of the medical records. RESULTS: The incidence of SUA in our population was 0.18%. Of 41 fetuses with SUA, 8 cases presented congenital malformations (19.5%) such as acrania (n=1), Tetralogy of Fallot (n=1), renal anomalies (unilateral renal agenesis n=2, pyelectasis n=1), esophageal atresia (EA) with tracheoesophageal fistula (TEF)(n=1), omphalocele with choroid plexus cyst (CPC)(n=1), and congenital diaphragmatic hernia with hypoplastic left heart syndrome (n=1). Of 33 fetuses with isolated SUA, 3 (9.1%) demonstrated growth restriction. Karyotype analysis was performed in three cases. Two were normal and omphalocele with CPC was Trisomy 18. CONCLUSION: During the prenatal period, the fetus with SUA by ultrasound examination must be carefully monitored with targeted prenatal ultrasound because of its frequent association with fetal congenital anomalies (19.5%). Isolated SUA without associated anomaly dose not affect the outcome of the pregnancy.

Ultrasound Screening for Fetal Down Syndrome in the Second Trimester of Pregnancy / 대한산부인과학회잡지

OBJECTIVE: To determine the risk of Down syndrome in fetuses with sonographic markers using the likelihood ratios and individual risk assessment. METHODS: We retrospectively evaluated the midtrimester genetic sonographic features of fetuses with Down syndrome and compared them with euploid fetuses. Patients were referred for an increased risk of aneuploidy and evaluated for the presence of structural defects, a nuchal fold, short long bones, pyelectasis, brachycephaly, small stomach, and hyperechoic bowel. Outcome information included the results of genetic amniocentesis (if performed), the results of pediatric assessment, and follow-up after birth. The sensitivity, specificity, and likelihood ratios for markers ware calculated isolated findings. RESULTS: There were 59 fetuses with Down syndrome and 600 euploid fetuses. The presence of any marker resulted in sensitivity for the detection of Down syndrome of 86.4% with a false-positive rate of 13.6%. Structural defect had a likelihood ratio of 77.8. As an isolated marker, the nuchal fold, short humerus, short femur, echogenic bowel and renal pyelectasia has a likelihood ratio of 20.2, 12.7, 3.9, 2.5, 1.1 respectively. Other isolated markers had low likelihood ratios because of the higher prevalence in the unaffected population. CONCLUSION: Combining second-trimester serum testing and fetal sonography is a feasible approach to Down syndrome screening, compatible with current obstetric practice. Although an isolated marker with a low likelihood ratio may not increase a patient's risk of Down syndrome, the presence of such a marker precludes reducing the risk of aneuploidy. This information will be useful in counseling pregnant women who are at high risk for fetal Down syndrome and who prefer to undergo genetic sonography before deciding about genetic amniocentesis.

Ultrasound Screening for Fetal Down Syndrome in the Second Trimester of Pregnancy / 대한산부인과학회잡지

OBJECTIVE: To determine the risk of Down syndrome in fetuses with sonographic markers using the likelihood ratios and individual risk assessment. METHODS: We retrospectively evaluated the midtrimester genetic sonographic features of fetuses with Down syndrome and compared them with euploid fetuses. Patients were referred for an increased risk of aneuploidy and evaluated for the presence of structural defects, a nuchal fold, short long bones, pyelectasis, brachycephaly, small stomach, and hyperechoic bowel. Outcome information included the results of genetic amniocentesis (if performed), the results of pediatric assessment, and follow-up after birth. The sensitivity, specificity, and likelihood ratios for markers ware calculated isolated findings. RESULTS: There were 59 fetuses with Down syndrome and 600 euploid fetuses. The presence of any marker resulted in sensitivity for the detection of Down syndrome of 86.4% with a false-positive rate of 13.6%. Structural defect had a likelihood ratio of 77.8. As an isolated marker, the nuchal fold, short humerus, short femur, echogenic bowel and renal pyelectasia has a likelihood ratio of 20.2, 12.7, 3.9, 2.5, 1.1 respectively. Other isolated markers had low likelihood ratios because of the higher prevalence in the unaffected population. CONCLUSION: Combining second-trimester serum testing and fetal sonography is a feasible approach to Down syndrome screening, compatible with current obstetric practice. Although an isolated marker with a low likelihood ratio may not increase a patient's risk of Down syndrome, the presence of such a marker precludes reducing the risk of aneuploidy. This information will be useful in counseling pregnant women who are at high risk for fetal Down syndrome and who prefer to undergo genetic sonography before deciding about genetic amniocentesis.

5 Cases of Dismembered Spatulated Ureteropyeloplasty in Marked Hydronephrosis / 대한비뇨기과학회지

The effect of dismembered spatulated ureteropyeloplasty on irreparable severe hydronephrosis in 5 cases during the period from November 1970 to May 1972 was investigated. 5 cases which were performed ureteropyeloplasty were observed for 1 to 5 months. The results were summarized as follows: 1. Hydronephrosis particularly pyelectasis secondary to obstruction or stricture at the ureteropelvic junction was caused by aberrant vessel in 3 kidneys, fibrous band in 2 kidneys and congenital stricture in 1 kidney. 2. 2 aberrant vessels of 3 cases were cut and the other was not because of ischemia of corresponding lower pole. 3. 2 cases with nephrostomy showed no complication of urinary leakage. 4. Follow up study in 1 case of 2 cases with nephrostomy was performed, which improved renal function, hydronephrosis and disappeared infection signs. 5. 4 kidneys without nephrostomy and splinting showed improved renal function and disappeared infection signs, but improvement of hydronephrosis was not obtained.

A Case of Postcaval Ureter / 대한비뇨기과학회지

Post-caval or retrocaval ureter is a congenital anomaly of the vascular system. This anomaly almost. always involve the rt. ureter and occurs more frequently in male We have reported a 36 years male of rt. postcaval ureter that was resulted marked hydronephrosis due to compression of rt. ureter by vena cava. Three months after the operation, excretory urogram showed previous caliectasis and pyelectasis were moderately reduced and previous dislocated ureteral course was corrected.

Pyelographic Observation on Renal Tuberculosis / 대한비뇨기과학회지

Pyelographic examination is very essential in diagnosis of renal tuberculosis along with detection of tubercle bacilli in the urine and cystoscopic procedure. Furthermore, it is that the pyelography gives the very important and influencing information on therapeutic indication, surgical intervention how to and when to operate, and on forecasting prognosis. It therefore, is requested that grade of tuberculous invasion, its correct localization and its itemized classification be established most carefully. In the present study, 120 pyelograms made out of 197 cases of renal tuberculosis at the Department of Urology. Seoul National University Hospital, during the period January 1957 through June 1963, were collected and detailed pyelographic interpretation on plain films, intravenous pyelograms (I.V.P.) of individual tuberculous kidneys (from 120 patients) and on 50 retrograde pyelograms was attempted and the following results were obtained: Thereafter, an individual kidney will be counted as one case. 1) Of 152 cases of plain film, calcification in the kidney area was found in 6 cases or 3.9%, and renal calculus in 4 cases or 2.6%, kidney outline was observed in 24.3%. Plain film should be all made prior to perform pyelography. 2) Functional classification of intravenous pyelogram was made into 5 groups according to grade of visualization of contrast media as the following Group 1: Pelvio-calyceal system is well visualized, revealing the neighborhood of uretero-pelvic juncture precisely. Group 2: Most calyces are essentially visualized but no pelvis is outlined. The entire picture can not be drawn. Group 3: Only one to two calyces or cavities are filled with contrast media. They appear at most times round, oval or hazy figures. This group may stand for advanced group 2. Group 4: Contrast media seem to be visualized in traces but no outline of calyx nor pelvis observable. Group 5: Absence of visualization. 3) Most commonly observable urographic changes in intravenous pyelogram can be listed as: (1) absence of visualization, 43.1% ;(2) delayed visualization, 37%; (3) caliectasis, 36% ; (4) feathery, irregular or "moth-eaten" outline of calyces, 33.5%; (5) deformity, narrowing or dilation of the ureter, 26%; (6) obliteration of one or more calyces, 8.6% ; (7) cicatrical deformity of the calyces and "pinching off" of the tips of minor calyces, 7.2% ; (8) poor visualization with only one or two "globs" of contrast medium, 5.9% and (9) pyelectasis, 2.6%. 4) After injecting contrast media in intraveuous pyelography, the more the kidney involved, the lower the appearance and the intensity of nephrogram observed. 5) Retrograde pyelograms were classified into four grades after Lattimer and they were studied along with appearance of contrast media in intravenous pyelogram. The more invasion by retrograde pyelogram indicated, the later the appearance of contrast media and the poorer visualization observed. 6) Retrograde anatomical grading and intravenous functional classification were compared and it was almost likely that they paralleled pretty well. Nintythree per cent of I.V.P. below group 2. inclusive, showed more marked anatomical involvement than grade III of retrograde pyelogram.