1
|
Sourouni M, Haisch L, Oelmeier K, Möllers M, Willy D, Sondern K, Köster H, Steinhard J, Sandkötter J, Klockenbusch W, Schmitz R, Potratz J. Observed to expected lung area to head circumference ratio (O/E LHR) in fetuses with congenital anomalies of the kidney and urinary tract (CAKUT): assessment and evaluation as predictive factor for acute postnatal outcome-a single center study. Front Pediatr 2023; 11:1145907. [PMID: 37404558 PMCID: PMC10317208 DOI: 10.3389/fped.2023.1145907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/06/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction To assess the observed to expected lung area to head circumference ratio (O/E LHR) in fetuses with congenital anomalies of the kidney and urinary tract (CAKUT) and to explore its value as a potential predictive factor for postnatal outcome. Methods A retrospective single-center study was conducted on pregnancies complicated by CAKUT between 2007 and 2018. The lung-to-head ratio (LHR) was calculated for each fetus by two independent observers. Correlations between O/E LHR and various perinatal outcome factors were assessed with Spearman's rank correlation. Furthermore, nominal logistic regression was performed to assess O/E LHR as predictive factor for respiratory distress in newborn. Results Of 64 pregnancies complicated by CAKUT, 23 were terminated. In the 41 cases of continuation of pregnancy, newborn presenting respiratory distress with need for respiratory support in the delivery room showed earlier gestational age at onset of amniotic fluid abnormalities and at birth. Although median O/E LHR and median single deepest pocket (SDP) of amniotic fluid were significantly smaller in newborn that did develop respiratory distress with need of respiratory support in the delivery room, neither O/E LHR nor SDP were accurate predictors for the development of respiratory distress. Conclusions Our data show that O/E LHR alone cannot serve as a predictive marker for fetal outcome in pregnancies complicated by CAKUT, though it might still be a helpful parameter together with detailed renal ultrasound evaluation, onset of amniotic fluid abnormality and SDP, particularly in its extreme values.
Collapse
Affiliation(s)
- M. Sourouni
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
- Department of Gynecological Endocrinology and Fertility Disorders, University Hospital Heidelberg, Heidelberg, Germany
| | - L. Haisch
- Department of Pediatrics, University Hospital Muenster, Muenster, Germany
| | - K. Oelmeier
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - M. Möllers
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - D. Willy
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - K. Sondern
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - H. Köster
- Gynaecologist’s Office of Dr. Natalia Ulrich, Berlin, Germany
| | - J. Steinhard
- Department of Fetal Cardiology, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany
| | - J. Sandkötter
- Department of Pediatrics, University Hospital Muenster, Muenster, Germany
| | - W. Klockenbusch
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - R. Schmitz
- Department of Obstetrics and Gynecology, University Hospital Muenster, Muenster, Germany
| | - J. Potratz
- Department of Pediatrics, University Hospital Muenster, Muenster, Germany
| |
Collapse
|
2
|
Vikraman SK, Chandra V, Balakrishnan B, Batra M, Sethumadhavan S, Patil SN, Nair S, Kannoly G. Impact of antepartum diagnostic amnioinfusion on targeted ultrasound imaging of pregnancies presenting with severe oligo- and anhydramnios: An analysis of 61 cases. Eur J Obstet Gynecol Reprod Biol 2017; 212:96-100. [PMID: 28349892 DOI: 10.1016/j.ejogrb.2017.03.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/09/2017] [Accepted: 03/15/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The primary objective our study was to assess the role of diagnostic antepartum amnioinfusion on the yield from targeted ultrasounds performed in pregnancies with severe oligo- and anhydramnios. STUDY DESIGN This was a retrospective and descriptive study, conducted in the fetal medicine units of two private tertiary care referral centers in south India. The details of all the cases of diagnostic amnioinfusion performed at these two centers from January 2009 to June 2016 were collected and analyzed. Inclusion criteria were pregnancies between 17 and 26 weeks of gestational age with severe oligo- or anhydramnios. Pregnancies with obvious preterm premature rupture of membranes (PPROM) were excluded. The primary outcome measure was the improvement in diagnostic information pertaining to cause of severe oligo- and anhydramnios, and the nature of such anomalies. RESULTS A total of 61 cases of were identified. The median gestational age at performance of the procedure was 22 weeks [IQR, 19.5-23]. The mean volume of normal saline infused was 314±54ml. A significant increase in the single vertical pocket (SVP) was observed following the procedure (pre-procedure SVP=0.6±0.9cm, post procedure SVP=3.4±1.7; paired t test, p<0.001). In 37 cases (37/61, 60.7%), there were no pre-procedure ultrasound findings. There was significant overall detection of abnormalities post procedure (mean pre-procedure findings=0.39±0.49, mean post procedure findings=1.59±1.24; paired t test, p<0.001). The most frequent group of anomalies/abnormalities were renal (36/61, 59%), followed by PPROM (13/61, 21.3%) and finally fetal growth restriction (11/61, 18%). CONCLUSION(S) Antepartum amnioinfusion is a valuable ancillary technique in prenatal diagnosis as it increases the diagnostic yield from pregnancies presenting with severe oligo- and anhydramnios.
Collapse
Affiliation(s)
- Seneesh Kumar Vikraman
- Department of Fetomaternal Medicine, Centre for Infertility and Assisted Reproduction (CIMAR), Edappal Hospitals Private Limited, Edappal, Malappuram, Kerala 679576, India.
| | - Vipin Chandra
- Department of Fetomaternal Medicine, Centre for Infertility and Assisted Reproduction (CIMAR), Edappal Hospitals Private Limited, Edappal, Malappuram, Kerala 679576, India
| | - Bijoy Balakrishnan
- Department of Fetomaternal Medicine, Centre for Infertility and Assisted Reproduction (CIMAR), Edappal Hospitals Private Limited, Edappal, Malappuram, Kerala 679576, India
| | - Meenu Batra
- Department of Fetomaternal Medicine, Centre for Infertility and Assisted Reproduction (CIMAR), Edappal Hospitals Private Limited, Edappal, Malappuram, Kerala 679576, India
| | - Sreeja Sethumadhavan
- Department of Fetomaternal Medicine, Centre for Infertility and Assisted Reproduction (CIMAR), Edappal Hospitals Private Limited, Edappal, Malappuram, Kerala 679576, India
| | - Swapneel Neelkanth Patil
- Department of Fetomaternal Medicine, Centre for Infertility and Assisted Reproduction (CIMAR), Edappal Hospitals Private Limited, Edappal, Malappuram, Kerala 679576, India
| | - Sabila Nair
- Department of Fetomaternal Medicine, Centre for Infertility and Assisted Reproduction (CIMAR), Edappal Hospitals Private Limited, Edappal, Malappuram, Kerala 679576, India
| | - Gopinathan Kannoly
- Department of Fetomaternal Medicine, Centre for Infertility and Assisted Reproduction (CIMAR), Edappal Hospitals Private Limited, Edappal, Malappuram, Kerala 679576, India
| |
Collapse
|
3
|
Bhatt S, Tandon A, Kumar Singh A, Manchanda S, Jain S, Meena N. Caudal Regression Syndrome. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2017. [DOI: 10.1177/8756479316677012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Caudal regression syndrome (CRS), also known as caudal dysplasia syndrome, is a rare malformation that ranges from mild coccygeal to severe forms of lumbosacral and lower thoracic agenesis. Anomalies of other organ systems may also be found simultaneously. Recognition of CRS is important as the extent of abnormality and gestational age could determine the pregnancy’s outcome. Antenatal diagnosis is possible by recognizing the characteristic features on sonography. In this particular case study, a diagnosis of CRS was made during the second trimester with sonography and resulted in an adequate medical management decision. The sonographic features of CRS and its differential diagnoses are discussed in the context of this case study.
Collapse
Affiliation(s)
- Shuchi Bhatt
- Department of Radiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Anupama Tandon
- Department of Radiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Avneesh Kumar Singh
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Smita Manchanda
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandhya Jain
- Department of Obstetrics & Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Neha Meena
- Department of Radiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| |
Collapse
|
4
|
Gramellini D, Fieni S, Kaihura C, Piantelli G, Verrotti C. Antepartum amnioinfusion: a review. J Matern Fetal Neonatal Med 2009; 14:291-6. [PMID: 14986801 DOI: 10.1080/jmf.14.5.291.296] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Antepartum amnioinfusion is a relatively recent procedure introduced with fetal medicine techniques. It is usually indicated for severe oligohydramnios in order to avoid the related complications such as pulmonary hypoplasia, the deforming effects of oligohydramnios, variable fetal heart rate decelerations and intraventricular hemorrhage. Antepartum amnioinfusion is also employed to improve ultrasound visualization in cases with oligohydramnios. Our objective was to evaluate the benefits and complications related to this procedure which is still less commonly used compared to intrapartum amnioinfusion, and whose risks are therefore not well established. STUDY DESIGN Reports of study designs identified from searches of MEDLINE, PUBMED, the Cochrane Collaboration, specialized databases and bibliographies of review articles were identified. Studies in women who underwent amnioinfusion between 1987 and 2002 were included. RESULTS AND CONCLUSIONS Amnioinfusion seems to offer several benefits, in terms of both prenatal diagnosis and favorable perinatal outcome. Most clinical experiences report that amnioinfusion is safe, both for the mother and for the fetus. However, randomized control-group studies subdivided on the basis of the cause of oligohydramnios (e.g. premature rupture of membranes, fetal growth restriction, obstructive uropathy and renal agenesis) could help to determine the advantages and risks linked to this procedure. Prospective randomized studies should therefore be encouraged, to clarify any possible doubts regarding the procedure, before it can be introduced into routine practice in the management of oligohydramnios.
Collapse
Affiliation(s)
- D Gramellini
- Dipartimento di Scienze Ostetriche, Ginecologiche e di Neonatologia, Università degli Studi di Parma, Parma, Italy
| | | | | | | | | |
Collapse
|
5
|
Aslan H, Yanik H, Celikaslan N, Yildirim G, Ceylan Y. Prenatal diagnosis of Caudal Regression Syndrome : a case report. BMC Pregnancy Childbirth 2002; 1:8. [PMID: 11782287 PMCID: PMC64494 DOI: 10.1186/1471-2393-1-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2001] [Accepted: 12/11/2001] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND: Caudal regression is a rare syndrome which has a spectrum of congenital malformations ranging from simple anal atresia to absence of sacral, lumbar and possibly lower thoracic vertebrae, to the most severe form which is known as sirenomelia. Maternal diabetes, genetic predisposition and vascular hypoperfusion have been suggested as possible causative factors. CASE PRESENTATION: We report a case of caudal regression syndrome diagnosed in utero at 22 weeks' of gestation. Prenatal ultrasound examination revealed a sudden interruption of the spine and "frog-like" position of lower limbs. Termination of pregnancy and autopsy findings confirmed the diagnosis. CONCLUSION: Prenatal ultrasonographic diagnosis of caudal regression syndrome is possible at 22 weeks' of gestation by ultrasound examination.
Collapse
Affiliation(s)
- Halil Aslan
- Department of Perinatology, SSK Bakirkoy Maternity and Children Hospital, Istanbul, Turkey
- Defne 02 B-10 Daire 17, Bahcesehir Istanbul, Turkey
| | - Halil Yanik
- Department of Perinatology, SSK Bakirkoy Maternity and Children Hospital, Istanbul, Turkey
- SSK Bakirkoy Dogumevi, Yenimahalle Bakirkoy, Turkey
| | - Nurgul Celikaslan
- Department of Perinatology, SSK Bakirkoy Maternity and Children Hospital, Istanbul, Turkey
- SSK Bakirkoy Dogumevi, Yenimahalle Bakirkoy, Turkey
| | - Gokhan Yildirim
- Department of Perinatology, SSK Bakirkoy Maternity and Children Hospital, Istanbul, Turkey
- SSK Bakirkoy Dogumevi, Yenimahalle Bakirkoy, Turkey
| | - Yavuz Ceylan
- Department of Perinatology, SSK Bakirkoy Maternity and Children Hospital, Istanbul, Turkey
- SSK Bakirkoy Dogumevi, Yenimahalle Bakirkoy, Turkey
| |
Collapse
|
6
|
Kilpatrick SJ. Therapeutic interventions for oligohydramnios: amnioinfusion and maternal hydration. Clin Obstet Gynecol 1997; 40:328-36. [PMID: 9199844 DOI: 10.1097/00003081-199706000-00009] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- S J Kilpatrick
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco 94143, USA
| |
Collapse
|
7
|
Ouzounian JG, Paul RH. Clinical role of amnio-infusion. BAILLIERE'S CLINICAL OBSTETRICS AND GYNAECOLOGY 1996; 10:259-72. [PMID: 8836484 DOI: 10.1016/s0950-3552(96)80037-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Amnio-infusion is a simple, yet beneficial, technique for improving pregnancy outcome. Antepartum amnio-infusion has been shown to be beneficial as an aid to enhancing ultrasonographic fetal imaging and may have a role in the administration of antibiotic therapy or the prevention of pulmonary hypoplasia. There are considerable data to support the intrapartum use of amnio-infusion in the presence of oligohydramnios, variable decelerations or meconium. Numerous prospective clinical trials have shown a significant benefit of amnio-infusion in reducing the rate of emergency caesarean section for fetal distress and complications related to meconium when used for these indications. Additional research is needed to clarify further its intrapartum role in patients with premature rupture of membranes or chorio-amnionitis.
Collapse
Affiliation(s)
- J G Ouzounian
- Department of Obstetrics & Gynaecology, University of Southern California School of Medicine, Los Angeles 90033, USA
| | | |
Collapse
|
8
|
Sepulveda W, Stagiannis KD, Flack NJ, Fisk NM. Accuracy of prenatal diagnosis of renal agenesis with color flow imaging in severe second-trimester oligohydramnios. Am J Obstet Gynecol 1995; 173:1788-92. [PMID: 8610763 DOI: 10.1016/0002-9378(95)90428-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Our purpose was to examine the potential of color flow imaging to assess the presence of renal arteries in second-trimester pregnancies complicated by severe oligohydramnios. STUDY DESIGN Thirty-three consecutive second-trimester pregnancies referred with severe oligohydramnios were prospectively studied with high-resolution color Doppler ultrasonography to establish the presence or absence of renal arteries. Prenatal findings were correlated with the presence or absence of fetal kidneys at postmortem or postnatal examination. RESULTS Neither renal artery was visualized in eight fetuses; postmortem examination confirmed bilateral renal agenesis in seven and unilateral renal agenesis with a contralateral atrophic multicystic kidney in the other. Only one renal artery was seen in three; postmortem examination demonstrated unilateral renal agenesis in two fetuses and bilateral multicystic dysplastic kidneys in the other. Postmortem or postnatal evaluation confirmed the presence of both kidneys in all 22 fetuses in which both renal arteries were identified prenatally. CONCLUSIONS Color Doppler ultrasonography is useful in the prenatal evaluation of fetuses with severe second-trimester oligohydramnios to demonstrate the presence or absence of renal arteries. This technique should be added to the armamentarium of prenatal tests to evaluate second-trimester fetuses with severe oligohydramnios.
Collapse
Affiliation(s)
- W Sepulveda
- Centre for Fetal Care, Royal Postgraduate Medical School, London, United Kingdom
| | | | | | | |
Collapse
|