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Ultrasound in Obstetrics & Gynecology :... Jul 2000
Topics: Congenital Abnormalities; Female; Humans; Kidney Pelvis; Pregnancy; Ultrasonography, Prenatal; Urinary Tract
PubMed: 11084957
DOI: 10.1046/j.1469-0705.2000.00161.x -
Ultrasound in Obstetrics & Gynecology :... Dec 2013We performed a meta-analysis to examine the performance of second-trimester (14-24 weeks' gestation) isolated fetal pyelectasis as a marker for trisomy 21 and to... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
We performed a meta-analysis to examine the performance of second-trimester (14-24 weeks' gestation) isolated fetal pyelectasis as a marker for trisomy 21 and to calculate its associated weighted pooled likelihood ratios.
METHODS
PubMed, Ovid MEDLINE and Cochrane databases were searched using the terms 'pyelectasis' and 'pelviectasis'. Studies were included if fetuses with isolated pyelectasis were reported separately from fetuses with other soft markers of aneuploidy and/or structural anomalies and if knowledge of the fetal karyotype was unknown at the time of ultrasound examination.
RESULTS
Individual study statistics were pooled as weighted positive and negative likelihood ratios with 95% CIs, using a random-effects model. Ten observational studies were included (2148 cases of isolated pyelectasis). Isolated fetal pyelectasis was defined in seven out of 10 studies as a renal pelvis anteroposterior diameter of ≥ 4 mm. Isolated fetal pyelectasis was associated with pooled positive and negative likelihood ratios of 2.78 (95% CI, 1.75-4.43) and 0.99 (95% CI, 0.98-1.00), respectively.
CONCLUSIONS
The detection of isolated fetal pyelectasis on mid-trimester ultrasound is associated with an increased likelihood of trisomy 21. If the finding of isolated fetal pyelectasis is used to adjust the trisomy 21 risk from maternal serum screening tests, a positive likelihood ratio of 2.78 should be used in the calculation.
Topics: Down Syndrome; Female; Humans; Kidney Pelvis; Likelihood Functions; Pregnancy; Pregnancy Trimester, Second; Pyelectasis; Risk; Ultrasonography, Prenatal
PubMed: 23712390
DOI: 10.1002/uog.12516 -
Cureus Jul 2023Hyperthyroidism is more common in women and the sensitivity of thyroid function changes during pregnancy. Excess levels of thyroid hormones and thioamides have a major... (Review)
Review
Hyperthyroidism is more common in women and the sensitivity of thyroid function changes during pregnancy. Excess levels of thyroid hormones and thioamides have a major impact on maternal and fetal outcomes. Our aim was to perform an extensive literature review and provide relevant details concerning the analytical and clinical aspects of the potential effects of the two main drugs used (methimazole and propylthiouracil) in newborns. A thorough literature review was conducted using PubMed and Google Scholar databases. In total, 10 relevant studies were identified and data from these studies were extracted and then extrapolated into results after analysis. Three out of four studies that used methimazole and carbimazole, one and two, respectively, showed adverse fetal outcomes requiring surgical management for congenital anomalies like aplasia cutis, patent vitellointestinal duct, and gastroschisis. Out of the three studies that used propylthiouracil, one baby underwent surgery for bilateral pyelectasis, vesicovaginal fistula, anal stenosis, and polydactyly. The findings of the aforementioned studies provide enough evidence to imply that the use of methimazole and carbimazole to treat antenatal hyperthyroidism has worse fetal outcomes than the use of propylthiouracil. Also, given the paucity of data in the existing literature regarding propylthiouracil's effects on newborns, further studies in this demographic are needed.
PubMed: 37551246
DOI: 10.7759/cureus.41505 -
Children (Basel, Switzerland) Feb 2023Pyelectasis, also known as renal pelvic dilatation or hydronephrosis, is frequently found on fetal ultrasound. This study correlated prenatally-detected, moderate...
Pyelectasis, also known as renal pelvic dilatation or hydronephrosis, is frequently found on fetal ultrasound. This study correlated prenatally-detected, moderate pyelectasis with postnatal outcomes. This retrospective, observational study was conducted at a tertiary medical center in Israel. The study group consisted of 54 fetuses with prenatal diagnosis of pyelectasis on ultrasound scan during the second trimester, defined as anteroposterior renal pelvic diameter (APRPD) 6-9.9 mm. Long-term postnatal outcomes and renal-related sequelae were obtained using medical records and telephone-based questionnaires. The control group included 98 cases with APRPD < 6 mm. Results indicate that fetal pyelectasis 6-9.9 mm was more frequent among males (68.5%) than females (51%, = 0.034). We did not find significant correlations between 6-9.9 mm pyelectasis and other anomalies or chromosomal/genetic disorders. Pyelectasis resolved during the pregnancy in 15/54 (27.8%) cases. There was no change in 17/54 (31.5%) and 22/54 (40.7%) progressed to hydronephrosis Among the study group, 25/54 (46.3%) were diagnosed with neonatal hydronephrosis. There were more cases of renal reflux or renal obstruction in the study group compared to the control group 8/54 (14.8%) vs. 1/98 (1.0%), respectively; = 0.002. In conclusion, most cases of 6-9.9 mm pyelectasis remained stable or resolved spontaneously during pregnancy. There was a higher rate of postnatal renal reflux and renal obstruction in this group; however, most did not require surgical intervention.
PubMed: 36832536
DOI: 10.3390/children10020407 -
Journal of Ultrasonography 2018Renal pelvicalyceal dilatation is caused by urine retention in the upper urinary tract. It is referred to as pyelectasis in medical literature. This term does not...
Renal pelvicalyceal dilatation is caused by urine retention in the upper urinary tract. It is referred to as pyelectasis in medical literature. This term does not indicate the cause that leads to the dilatation of and urine retention in the renal pelvicalyceal system. Mild pelvicalyceal dilatation during pregnancy is usually considered to be physiological in nature - it can occur in up to 90% of pregnant women. Retention is more common in the right kidney, in primigravidae, in the second half of pregnancy and in multiple pregnancies. Pyelectasis during pregnancy rarely causes clinical symptoms and often does not require treatment. Nevertheless, urine retention in the renal pelvicalyceal system is conducive to the development of asymptomatic bacteriuria and may be a risk factor for recurrent urinary tract infections, pyelonephritis and acute kidney failure; it may also cause renal colic. In consequence, this condition can lead to intrauterine infection and premature labor in the pregnant woman and to prematurity, anemia, congenital pneumonia or sepsis in the child. In a study conducted at the 3 rd Department of Gynecology of the Medical University of Lublin it was concluded that unilateral pyelectasis of more than 20 cm 3 is associated with a significant increase in the risk of asymptomatic bacteriuria. This volume corresponds to grade 3 and/or 4 pelvicalyceal dilatation according to the Society for Fetal Urology/European Federation of Societies for Ultrasound in Medicine and Biology classification. The pyelectasis volume measuring method using three-dimensional ultrasound scanning included in the criteria for the assessment of asymptomatic bacteriuria was assessed as sensitive and specific. The ultrasound-based evaluation of the kidneys for the presence of pyelectasis and its grade in pregnant women has some clinical implications. It allows for identifying cases with an increased risk of asymptomatic bacteriuria, which requires treatment in pregnant women. Screening during pregnancy for pyelectasis seems to be important in preventing asymptomatic bacteriuria from progressing to symptomatic urinary tract infection.
PubMed: 30451409
DOI: 10.15557/JoU.2018.0022 -
Ultrasound in Obstetrics & Gynecology :... Oct 2017To investigate the natural history of fetal megacystis from diagnosis in utero to postnatal outcome, and to identify prognostic indicators of spontaneous resolution and...
OBJECTIVES
To investigate the natural history of fetal megacystis from diagnosis in utero to postnatal outcome, and to identify prognostic indicators of spontaneous resolution and postnatal outcome after resolution.
METHODS
This was a national retrospective cohort study. Fetal megacystis was defined in the first trimester as a longitudinal bladder diameter (LBD) ≥ 7 mm, and in the second and third trimesters as an enlarged bladder failing to empty during the entire extended ultrasound examination. LBD and gestational age (GA) at resolution were investigated with respect to likelihood of resolution and postnatal outcome, respectively. Sensitivity, specificity and area under the receiver-operating characteristics curve (AUC) were calculated.
RESULTS
In total, 284 cases of fetal megacystis (93 early megacystis, identified before the 18 week, and 191 late megacystis, identified at or after the 18 week) were available for analysis. Spontaneous resolution occurred before birth in 58 (20%) cases. In cases with early megacystis, LBD was predictive of the likelihood of spontaneous resolution (sensitivity, 80%; specificity, 79%; AUC, 0.84), and, in the whole population, GA at regression was predictive of postnatal outcome, with an optimal cut-off at 23 weeks (sensitivity, 100%; specificity, 82%; AUC, 0.91). In the group with early megacystis, the outcome was invariably good when resolution occurred before the 23 week of gestation, whereas urological sequelae requiring postnatal surgery were diagnosed in 3/8 (38%) cases with resolution after 23 weeks. In the group with late megacystis, spontaneous resolution was associated with urological complications after birth, ranging from mild postnatal hydronephrosis in infants with resolution before 23 weeks, to more severe urological anomalies requiring postnatal surgery in those with resolution later in pregnancy. This supports the hypothesis that an early resolution of megacystis is often related to a paraphysiological bladder enlargement that resolves early in pregnancy without consequences, while antenatal resolution occurring later in pregnancy (after the 23 week of gestation) should suggest a pathological condition with urological sequelae.
CONCLUSIONS
In fetal megacystis, LBD and GA at regression can be used as predictors of resolution and outcome, respectively. These parameters could help in fine-tuning the prognosis and optimizing the frequency of follow-up scans. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Duodenum; Female; Fetal Diseases; Gestational Age; Humans; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, First; Prognosis; ROC Curve; Remission, Spontaneous; Retrospective Studies; Ultrasonography, Prenatal; Urinary Bladder
PubMed: 28133847
DOI: 10.1002/uog.17422 -
Clinics (Sao Paulo, Brazil) Sep 2016To 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.
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.
Topics: Dilatation, Pathologic; Disease Progression; Female; Fetus; Follow-Up Studies; Gestational Age; Humans; Kidney Pelvis; Longitudinal Studies; Male; Organ Size; Prospective Studies; Pyelectasis; Reference Values; Remission, Spontaneous; Statistics, Nonparametric; Time Factors; Ultrasonography, Prenatal
PubMed: 27652832
DOI: 10.6061/clinics/2016(09)05 -
Ultrasound in Obstetrics & Gynecology :... Jul 1997Isolated 'mild renal collecting system dilatation' (mild pyelectasis) is a common prenatal sonographic finding. An association between mild pyelectasis and fetal... (Comparative Study)
Comparative Study
Isolated 'mild renal collecting system dilatation' (mild pyelectasis) is a common prenatal sonographic finding. An association between mild pyelectasis and fetal aneuploidy has been established, but in the absence of a concomitant anomaly, mild pyelectasis is usually regarded as benign and of no clinical consequence, and follow-up is often not obtained after the initial ascertainment. To test this, we investigated the relationship between mild pyelectasis and (1) progression to hydronephrosis; (2) postnatal vesicoureteral reflux (VUR); and (3) postnatal surgery. Between 1 January 1992 and 1 January 1995, we performed 453 prenatal sonographic examinations of 306 patients with mild fetal pyelectasis and no other anomalies. During the course of a routine sonographic examination, we performed a detailed evaluation of the fetal genitourinary tract, Mild pyelectasis was defined as a pelvocalyceal fluid-filled space with the smallest of two transverse perpendicular sonographic measurements of > or = 4 mm and < 10 mm. Hydronephrosis was defined similarly, but with a measurement of > or = 10 mm. Postnatal urological assessment was obtained with routine renal ultrasonography, and voiding cystourethrography (VCUG), measurement of 99mTc-labelled diethylenetriamine pentaacetic acid (DPTA) mercaptacetyltriglycerine (MAG3), and intravenous pyelogram, as necessary. After exclusion criteria were applied, 294 (96%) patients with isolated fetal pyelectasis were considered. A total of 251 (82%) of these were followed with ultrasonography prenatally and during the postnatal period. Two or more prenatal examinations were carried out in 129 patients (51%) and in 35 (27%) of these cases the biometry progressed to frank hydronephrosis (> 10 mm). In only six (5%) of the cases followed prenatally did the measurement diminish to < 4 mm. We found a greater variability in prenatal renal biometry throughout gestation in infants found to have VUR, when compared with those who had no VUR. On postnatal follow-up, 84 patients had VCUG. Sixteen of these patients (6% of all patients [16/251] and 19% [16/84] of those who had the test) were found to have an abnormal finding. Whereas the prenatal appearance of mild pyelectasis improved in only a small number of cases, we found that it progressed to hydronephrosis in 27% of cases. Postnatal evaluation found VUR to be common in apparent uncomplicated mild prenatal pyelectasis. Although postnatal surgery was necessary in only a small number of cases, surgical intervention was necessary in 33% (four of 12) of those with VUR.
Topics: Adolescent; Adult; Dilatation, Pathologic; Female; Follow-Up Studies; Gestational Age; Humans; Hydronephrosis; Infant, Newborn; Kidney Diseases; Kidney Pelvis; Male; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Radiopharmaceuticals; Retrospective Studies; Technetium Tc 99m Pentetate; Ultrasonography, Prenatal; Urography; Vesico-Ureteral Reflux
PubMed: 9263417
DOI: 10.1046/j.1469-0705.1997.10010012.x -
Ultrasound in Obstetrics & Gynecology :... Mar 2001Mild pyelectasis is a common finding and there is some debate as to its association with aneuploidy. The results of a large, prospective, multicenter study of mild...
INTRODUCTION
Mild pyelectasis is a common finding and there is some debate as to its association with aneuploidy. The results of a large, prospective, multicenter study of mild pyelectasis designed to determine the incidence and association with aneuploidy in an unselected population are reported.
METHODS
A large multicenter, prospective observational study of unselected fetuses with mild pyelectasis identified between 16 and 26 weeks' gestation in routine ultrasound departments.
RESULTS
There were 737 fetuses with mild pyelectasis of which 12 had an abnormal karyotype. Pyelectasis was isolated in three fetuses with Down syndrome, but in one the mother was older (36 years).
CONCLUSION
These data confirm the fact that the presence of mild fetal pyelectasis increases the risk for aneuploidy, in particular trisomy 21. However, other risk factors should be considered before embarking on fetal karyotyping, as for most pregnancies complicated by isolated mild pyelectasis, risks of aneuploidy will remain small.
Topics: Adult; Aneuploidy; Dilatation, Pathologic; Female; Gestational Age; Humans; Karyotyping; Kidney Pelvis; Male; Maternal Age; Middle Aged; Prospective Studies; Risk Factors
PubMed: 11309167
DOI: 10.1046/j.1469-0705.2001.00360.x -
Turkish Journal of Obstetrics and... Mar 2021Persistent cloaca is a rare abnormality that occurs usually in females and is characterized by direct communication between the gastrointestinal, urinary, and genital...
Persistent cloaca is a rare abnormality that occurs usually in females and is characterized by direct communication between the gastrointestinal, urinary, and genital structures resulting in a single perineal opening. We report a case of persistent cloaca accompanying uterus didelphys that was diagnosed antenatally with fetal ultrasonography. A gravida 3, para 2, 35-year-old women at 22 weeks of gestation was referred to our hospital with a diagnosis of moderate pyelectasis of the fetal kidneys and fetal diffuse intestinal dilation. Detailed ultrasound scan findings were reported as a small thick-walled septated cystic pelvic mass of 5.2×5.5 cm size seen at the level of the fetal pelvic region. The target sign could not be visualized, it was considered as anal atresia. In the following weeks, the patient, who was evaluated together with meconium on the uterine septum, and monitoring of the neighboring bladder and anal atresia, was diagnosed as having persistent cloaca. Ultrasound findings showed that it could be persistent cloaca accompanying uterus didelphys. The fetus postnatally manifested persistent cloaca. On the first day after vaginal delivery, pelvic ultrasound in the neonatal intensive care unit showed bilateral 2-degree hydronephrosis, presacral enlarged bowel loops, uterus didelphis, vaginal septum, direct contact between urethra and vagina, proximal end in the rectum compatible with atresia. On the second day, colostomy was performed. Her renal condition continued to be stable. She is now waiting for definitive surgery for cloaca. Persistent cloaca should be considered in any female fetus presenting with hydronephrosis and a cystic pelvic mass lesion as diagnosed by ultrasound. Prenatal diagnosis allows time for parental counseling and delivery planning at a tertiary hospital for neonatal intensive care and pediatric surgery.
PubMed: 33715337
DOI: 10.4274/tjod.galenos.2020.44442