ABSTRACT
A 12-month prospective population study of antenatal patients was undertaken in a large district general hospital to assess ultrasound scanning in late pregnancy for the detection of non-lethal fetal renal abnormalities. The rate of false-negative antenatal scans during the study period was also assessed. Both 18-20 and 28-32 weeks' gestational scans were performed on 6497 pregnant women. Forty fetuses with a suspected abnormality were referred for postnatal examination and 29 neonates were found to have renal abnormalities. Of these, 21 were significant and eight were likely to be extrarenal pelves. In six, there was evidence of an abnormality at the early scan. Nine children, seven with reflux, presented within the study period, all with preceding normal antenatal scans. The incidence (0.46 per cent) of structural renal abnormalities is similar to that reported previously. A late scan is necessary for the antenatal detection of non-lethal renal abnormalities.
Subject(s)
Kidney/abnormalities , Kidney/diagnostic imaging , Ultrasonography, Prenatal , Congenital Abnormalities/epidemiology , Female , Follow-Up Studies , Humans , Incidence , Predictive Value of Tests , Pregnancy , Pregnancy Trimester, Second , Pregnancy Trimester, Third , Prospective StudiesABSTRACT
OBJECTIVE: To evaluate screening for abnormalities of the fetal renal tract by ultrasonography and to determine the incidence of such abnormalities in a population. DESIGN: A 12 month prospective population study. Follow up of infants to between 9 and 18 months. SETTING: A district general hospital. PARTICIPANTS: 6292 Pregnant women reaching 28 weeks' gestation within the study period. INTERVENTIONS: Antenatal ultrasound scanning was offered to all of the women. Babies in whom an abnormality of the renal tract had been detected antenatally underwent ultrasound scanning at the end of the first week. If the abnormality was confirmed contrast radiography was performed. END POINT: Confirmation of suspected renal abnormality by postnatal investigations. Detection of abnormality in children thought to be normal antenatally. MEASUREMENTS AND MAIN RESULTS: Of the 92 babies who had abnormal antenatal scans, 42 had abnormalities confirmed postnatally. Four of them died and 21 had had or were awaiting an operation at 18 months' follow up. Seven children had renal abnormalities that were missed antenatally. The incidence of abnormalities detected by screening antenatally was 0.65%, and the overall incidence at 18 months' follow up was 0.76%. CONCLUSIONS: The incidence of structural renal abnormalities in babies is higher than reported previously. Antenatal ultrasonography is an effective way of detecting such abnormalities.
Subject(s)
Fetal Diseases/diagnosis , Kidney/abnormalities , Mass Screening , Prenatal Diagnosis , Ultrasonography , Urologic Diseases/diagnosis , England , False Negative Reactions , False Positive Reactions , Female , Follow-Up Studies , Humans , Infant, Newborn , Pregnancy , Prospective Studies , Sensitivity and Specificity , Urologic Diseases/prevention & controlABSTRACT
Over three years all infants in this hospital found to have an abnormality of the urinary tract on antenatal scanning were followed up after delivery with contrast radiography. Disease of the renal tract was confirmed in 17 of 20 infants. Of the 15 survivors, 12 underwent surgery in the first year of life. Abnormality of the fetal urinary tract detected by ultrasound scanning seems to be an important indicator of disease of the renal tract. Before its use is extended, however, further assessment of the benefit of antenatal diagnosis and of the best time to scan is required.
