Evaluation Of The Single Center Results Of Antenatal Renal Pelvic Dilatations

Yıl 2017, Cilt: 2 Sayı: 3, 84 - 88, 28.12.2018

Yusuf Baltrak , Cihan Çetin

Öz

Objective

Renal pelvic dilatation is the most common form of the fetal anomalies detected with antenatal ultrasonography. Its reported incidence is 1-5 % of all pregnancies. Different classification systems are used for the determination of the renal pelvic dilatation with imaging systems during the fetal period.The most commonly used parameter for the diagnosis of the renal pelvic dilatation is the measurement of the anteroposterior diameter (APD) of the renal pelvis on the transverse plane.In this study, our objective was to measure the renal pelvic dilatation in the infants of the pregnant women followed up in our hospital and to compare the results with the results in the literature.

Materials and Methods

This study was to evaluate all pregnant women, who applied to the perinatology department between July 2017 and February 2018 and underwent detailed fetal anomaly screening with ultrasound and diagnosed with fetal renal pelvic dilatation following the measurement of the anteroposterior diameter (APD) of the renal pelvis and referred to the consultation with the pediatric surgery.

Results

In 82.7 % (n=57) of the cases, the renal pelvic dilatation was regressed or completely disappeared in the postnatal ultrasonographic examination performed during the follow-up period. However, in 17.3 % (n=12) of the cases, renal pelvic dilatation was still present in the postnatal examinations. Regarding the cases, who were screened for fetal anomalies in the 2nd trimester and diagnosed with renal pelvic dilatation (n=47); 41 cases were in the mild (87.2), 5 in the moderate (10.6%) and 1 case in the high-risk group (2.2%).

Conclusion

A cut-off value of 5 mm is an acceptable measurement value for the diagnosis of renal pelvic dilatation during the 2nd and 3rd trimesters. The parents should be consulted if further investigations become necessary due to the postnatal insistence of the pelvic renal dilatation.

Anahtar Kelimeler

Renal pelvik dilatation, cut off, obstetrik ultrasound

Antenatal Renal Pelvik Dilatasyon ve Fetal sonuçların Gözden Geçirilmesi

Öz

Giriş

Renal pelvis dilatasyonu antenatal ultrasonografi ile en sık tespit edilen fetal anomalilerden biridir. Tüm gebeliklerin yaklaşık %1-5'inde görüldüğü belirtilmektedir. Renal pelvis dilatasyonunun fetal dönemde görüntüleme ile tespit edilmesinde farklı sınıflama sistemleri kullanılmaktadır. Renal pelvis dilatasyonu tanısında genelde renal pelvisin transvers plandaki ön arka çap (ÖAÇ) ölçümüdür. Bu çalışma ile hastanemizde takip edilen gebelerin bebeklerindeki renal pelvis dilatasyonu olgularının ölçüm değerleri ve renal pelvis dilatasyonu tespit edilen olguların kısa dönem takip sonuçlarının literatür ile karşılaştırılması planlanmıştır.

Gereç ve Yöntem

Bu çalışmaya Temmuz 2017 ile Şubat 2018 tarihleri arasında perinatoloji kliniğinde ultrasonografi ile fetal anomali taraması yapılan gebelerin bebeklerinin renal pelvisin transvers plandaki ÖAÇ ölçümü (>5mm) sonucunda renal pelvis dilatasyonu tespit edilerek çocuk cerrahisi kliniğine konsulte edilen olgular çalışmaya dahil edilmiştir.

Bulgular

Renal pelvis dilatasyonu tespit edilen olguların% 82.7'sinin (n=57) doğum sonrası yapılan kontrol ultrasonografi görüntülemesinde renal pelvis dilatasyonun gerilediği veya kaybolduğu, takip edilen olguların %17.3'ünde (n=12) renal pelvis dilatasyonunun doğum sonrasında dadevam ettiği tespit edilmiştir. Fetal anomali taraması sırasında 2.t rimesterde renal pelvis dilatasyonu tespit edilen 47 olgu ölçüm sonuçlarına göre; 41 tanesinin (%87.2) hafif, 5 tanesinin (%10,6) orta, 1 tanesinin (%2,2) ciddi grupta olduğu sınıflandırılmıştır. Üçüncü trimesterde renal pelvis dilatasyonu tespit edilen ve bu dönemde hafif risk grubundaki olguların doğum sonrası yapılan ultrasonografi kontrollerinde dilatasyonun gerilediği görülmüştür.

Tartışma

5 mm'lik kesim noktası değeri 2. ve 3. trimester döneminde renal pelvis dilatasyonu tanısı için geçerli bir ölçüm değeridir. Doğum sonrası renal pelvis dilatasyonunun devam etmesi durumunda ileri tetkiklerin yapılması konusunda ebeveynlere danışmalık verilmesi önemlidir.

Anahtar Kelimeler

Renal pelvis dilatasyonu, kesim noktası, obstetrik ultrason

Kaynakça

• 1.Ek S, Lidefeldt KJ, Varricio L. Fetal hydronephrosis; prevalence,natural history and postnatal consequences in an unselected population. Acta Obstet Gynecol Scand. 2007; 86:1463-6.2. Garne E, Loane M, Wellesley D, Barisic I. Congenital hydronephrosis: prenatal diagnosis and epidemiology in Europe. J Pediatr Urol. 2009; 5:47-52.3. Mallik M, Watson AR. Antenatally detected urinary tract abnormalities: more detection but less action. Pediatr Nephrol. 2008; 23:897-904.4. Asl AS, Maleknejad S. Clinical outcome and follow-up of prenatal hydronephrosis. Saudi J Kidney Dis Transpl. 2012; 23:526-31.5. Plevani C, Locatelli A, Paterlini G, Ghidini A, Tagliabue P, Pezzullo JC, et al. Fetal hydronephrosis: natural history and risk factors for postnatal surgery. J Perinat Med. 2014; 42:385-91.6. Tombesi MM, Alconcher LF. Short-term outcome of mild isolated antenatal hydronephrosis conservatively managed. J Pediatr Urol. 2012; 8:129-33.7. Coco C, Jeanty P. Isolated fetal pyelectasis and chromosomal abnormalities. Am J Obstet Gynecol. 2005; 193:732-8.8. Estrada CR, Jr. Prenatal hydronephrosis: early evaluation. Curr Opin Urol. 2008; 18:401-3.9. Signorelli M, Cerri V, Taddei F, Groli C, Bianchi UA. Prenatal diagnosis and management of mild fetal pyelectasis: implications for neonatal outcome and follow-up. Eur J Obstet Gynecol Reprod Biol. 2005; 118:154-9.10. Nguyen HT, Benson CB, Bromley B, Campbell JB, Chow J, Coleman B, et al. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol. 2014; 10:982-98.11. Pilu G, Nicolaides KH. Diagnosis of fetal abnormalities: The 18-23-week scan. Taylor & Francis; 1999.12. Cockell AP, Chitty LS. Mild renal pelvis dilatation: implications and management. Fetal and Maternal Medicine Review. 1998; 10:153-61.13. Sinha A, Bagga A, Krishna A, Bajpai M, Srinivas M, Uppal R, et al. Revised guidelines on management of antenatal hydronephrosis. Indian J Nephrol. 2013; 23:83-97.14. Corteville JE, Gray DL, Crane JP. Congenital hydronephrosis: correlation of fetal ultrasonographic findings with infant outcome. Am J Obstet Gynecol. 1991; 165:384-8.15. Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P,et al. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol. 2010; 6:212-31.16. Zanetta VC, Rosman BM, Bromley B, Shipp TD, Chow JS, Campbell JB, et al. Variations in management of mild prenatal hydronephrosis among maternal-fetal medicine obstetricians,and pediatric urologists and radiologists. J Urol. 2012; 188:1935-9.17. Al-Shibli AI, Chedid F, Mirghani H, Al Safi W, Al-Bassam MK. The significance of fetal renal pelvic dilatation as a predictor of postnatal outcome. J Matern Fetal Neonatal Med. 2009; 22:797-800.18. Lee RS, Cendron M, Kinnamon DD, Nguyen HT. Antenatal hydronephrosis as a predictor of postnatal outcome: a metaanalysis. Pediatrics. 2006; 118:586-93.19. Ali S, Ali L. Etiology and Postnatal Management of Prenatal Hydronephrosis: A Study of Two Teaching Hospitals of Khyber Pakhtunkhwa. Pak J Med Res. 2014; 53:39.20. Chudleigh PM, Chitty LS, Pembrey M, Campbell S. The association of aneuploidy and mild fetal pyelectasis in an unselected population: the results of a multicenter study. Ultrasound Obstet Gynecol. 2001; 17:197-202.21. Hoddick WK, Filly RA, Mahony BS, Callen PW. Minimal fetal renal pyelectasis. J Ultrasound Med. 1985; 4:85-9.22. Benacerraf BR, Mandell J, Estroff JA, Harlow BL, Frigoletto FD, Jr. Fetal pyelectasis: a possible association with Down syndrome. Obstet Gynecol. 1990; 76:58-60.23. Corteville JE, Dicke JM, Crane JP. Fetal pyelectasis and Down syndrome: is genetic amniocentesis warranted? Obstet Gynecol.1992; 79:770-2.24. Morin L, Cendron M, Crombleholme TM, Garmel SH, Klauber GT, D'Alton ME. Minimal hydronephrosis in the fetus: clinical significance and implications for management. J Urol. 1996; 155:2047-9.25. Sairam S, Al-Habib A, Sasson S, Thilaganathan B. Natural history of fetal hydronephrosis diagnosed on mid-trimester ultrasound. Ultrasound Obstet Gynecol. 2001; 17:191-6.26. Ahmad G, Green P. Outcome of fetal pyelectasis diagnosed antenatally. J Obstet Gynaecol. 2005; 25:119-22.27. Kumar S, Walia S, Ikpeme O, Zhang E, Paramasivam G, Agarwal S, et al. Postnatal outcome of prenatally diagnosed severe fetal renal pelvic dilatation. Prenat Diagn. 2012; 32:519-22.28. Jaswon MS, Dibble L, Puri S, Davis J, Young J, Dave R, et al. Prospective study of outcome in antenatally diagnosed renal pelvis dilatation. Arch Dis Child Fetal Neonatal Ed. 1999; 80:F135-8.29. Mandell J, Blyth BR, Peters CA, Retik AB, Estroff JA, Benacerraf BR. Structural genitourinary defects detected in utero. Radiology.1991; 178:193-6.30. Srinivasan HB, Srinivasan N, Dhungel P, London R, Lampley C, Srinivasan G. Natural history of fetal renal pyelectasis. J Matern Fetal Neonatal Med. 2013; 26:166-8.31. Kirwan D. The NHS Fetal Anomaly Screening Programme (NHS FASP). 2010. 18+ 0 to 20+ 6 Weeks Fetal Anomaly Scan National Standards and Guidance for England. 2010.32. Longpre M, Nguan A, Macneily AE, Afshar K. Prediction of the outcome of antenatally diagnosed hydronephrosis: a multivariable analysis. J Pediatr Urol. 2012; 8:135-9.33. Coplen DE, Austin PF, Yan Y, Blanco VM, Dicke JM. The magnitude off