Isolated oligohydramnios and long-term neurological morbidity of the offspring

Analysis of Renal Pathology Predictors in Tender-Age Infants: Cohort Study

Background. The early onset of nephropathies creates certain risk of early chronic kidney disease development with loss of function (especially in children with unfavorable intrauterine period), renal tissue dysplasia, congenital malformations and/or urodynamic disorders.

Objective. The aim of the study is to evaluate the role of ontogenesis factors in nephropathies development in tender-age infants with specification of the course features and kidneys morphometric parameters.

Methods. Cohort study was conducted. The study group included 69 children aged from 0 to 36 months with changes in the kidneys (compared to age-specific ones) according to ultrasound and/or urinary syndrome (leukocyturia, bacteriuria, proteinuria, etc.). The control group included 35 relatively healthy children of the same age. Comparative analysis of antenatal and postnatal medical history was carried out in both groups, as well as comparison of morphometric indicators of the urinary system organs at neonatal ultrasound screening. Pathological process onset was also considered in the group of children with nephropathies. The study was conducted during 2018–2021.

Results. Possible predictors of pathology process in children with early onset of nephropathies are: 1) maternal diseases: urinary system disorders (OR = 4.99), blood pathology, mainly anemia of the 2nd–3rd grade (OR = 6.94), cardiovascular system diseases (OR = 10.26), inflammatory diseases of genital tract (OR = 10.61); 2) pregnancy failures: gestational diabetes mellitus (OR = 7.24), preeclampsia and eclampsia (OR = 4.40); placental pathology (OR = 17.0), and fetoplacental insufficiency (OR = 7.61); 3) feeding features: early conversion to breast-milk substitutes (OR = 2.81). 50.7% of children of this group has shown persistent urodynamic disorders already at first months of life according to ultrasound data, as well as signs of bloated kidneys. It was shown that the inflammatory process manifestation associated with aggravated perinatal history and congenital defects occurs significantly earlier — 2 months, and without any defects — 4 months (p = 0.004).

Conclusion. Burdened antenatal and neonatal medical history has negative effect on the morphogenesis of the urinary system organs and creates conditions for early nephropathies development during the first months of life.

Serum levels of kynurenine in pregnancies with fetal growth restriction and oligohydramnios

OBJECTIVES

Kynurinine (KYN) and its metabolites, which are released during the metabolism of tryptophan, an essential amino acid, have many important functions, such as cellular energy production, regulation of vascular tone, and regulation of the immune system. In this study, we aimed to detect serum KYN levels, which may be an indicator of KYN pathway activity, in idiopathic fetal growth restriction (FGR) and oligohydramnios cases whose pathophysiology is known to be affected by multiple factors, such as placental hypoperfusion, immune dysregulation, and maternal nutrition disorder, and to investigate their relationship with these common obstetric complications.

METHODS

This cross-sectional case-control study was carried out in the antenatal outpatient clinics of Ankara City Hospital between July and December 2021. While the study group consisted of pregnant women with idiopathic isolated FGR and oligohydramnios, the control group consisted of low-risk patients who did not have any problems. The clinical features of the patients, such as age, body mass indexes, and gestational week, were recorded by measuring basic laboratory parameters and serum KYN levels.

RESULTS

A total of 110 patients were included in this study. The patients were divided into three groups: FGR, oligohydramnios, and the control group. There was no significant difference between the patients' ages, weeks of gestation, or body mass indexes. Serum KYN level was calculated as 57.8 ± 13.4 pg/mL in IUGR, 75.3 ± 10.8 pg/mL in oligohydramnios and 95.1 ± 13.3 pg/mL in the control group (p<0.001).

CONCLUSIONS

Serum KYN levels were lower in pregnant women complicated with FGR and oligohydramnios more prominently in pregnant women diagnosed with FGR than in normal pregnancies. The results suggest that KYN plays an important role in either the etiopathogenesis or the response to these two obstetric pathologies.

Vaginal fluid index - The fifth amniotic pocket

OBJECTIVE

The forebag is a pocket of amniotic fluid preceding the fetal presenting part. Herein we describe the feasibility of transvaginal measurements of the forebag and assess its correlation with the standard amniotic fluid index (AFI).

METHODS

A prospective study was carried out between January 2019 and July 2020. Eligible cases were women with singletons, vertex presentation, and normal AFI at term. We assessed the implementation and acceptance of a novel process in the clinical practice setting. Feasibility was assessed by using transvaginal ultrasound to measure the three orthogonal planes of the forebag. The vaginal fluid index (VFI) was defined as the volume composite of the three orthogonal planes. Correlations of the forebag measurements with both AFI and maximal vertical pocket were then calculated.

RESULTS

In total, 292 out of 305 (95.7%) women were enrolled. All participants completed both transabdominal and transvaginal ultrasound, of which the vaginal pocket was demonstrated in 266 (91.1%) cases. We found significant correlations, in both nulliparas and multiparas, between the vaginal pocket measurements and the VFI to both the AFI and maximal vertical pocket measurements (R = 0.38, P < 0.001; R = 0.3, P < 0.001, respectively).

CONCLUSION

We introduced a new ultrasound variable, the VFI, with a high feasibility rate. This may provide invaluable information for future decision making around the time of delivery.