Abstract
Aim: To define a better cut-off value of the renal pelvis anteroposterior diameter (RPAPD) to predict persistent or progressive pyelectasis during pregnancy.
Methods: We retrospectively reviewed 8873 women whose fetal RPAPD was measured. Midtrimester pyelectasis was defined as a RPAPD of ≥4 mm. Persistent/progressive pyelectasis was defined as a RPAPD of ≥10 mm before delivery. A RPAPD cut-off value to predict a persistent/progressive pyelectasis was determined by receiver operating characteristic curve analysis.
Results: Among 249 isolated cases of pyelectasis, persistent/progressive pyelectasis was found in 6.9% before delivery. The midtrimester RPAPD cut-off value that best predicted persistent/progressive pyelectasis before delivery was ≥6 mm with sensitivity, specificity, positive and negative predictive values of 64.3%, 88.7%, 30.0%, and 97.1%, respectively.
Conclusions: Although most cases of midtrimester fetal pyelectasis regress to normal during pregnancy, those with a RPAPD of ≥6 mm in the midtrimester are at higher risk for persistent or progressive pyelectasis.
References
[1] Adra AM, Mejides AA, Dennaoui MS, Beydoun SN. Fetal pyelectasis: is it always “physiologic”? Am J Obstet Gynecol. 1995;173:1263–6.10.1016/0002-9378(95)91367-XSearch in Google Scholar
[2] Ahmad G, Green P. Outcome of fetal pyelectasis diagnosed antenatally. J Obstet Gynaecol. 2005;25:119–22.10.1080/01443610500041446Search in Google Scholar
[3] Babcook CJ, Silvera M, Drake C, Levine D. Effect of maternal hydration on mild fetal pyelectasis. J Ultrasound Med. 1998;17:539–44; quiz 45–6.10.7863/jum.1998.17.9.539Search in Google Scholar
[4] Belarmino JM, Kogan BA. Management of neonatal hydronephrosis. Early Hum Dev. 2006;82:9–14.10.1016/j.earlhumdev.2005.11.004Search in Google Scholar
[5] Blyth B, Snyder HM, Duckett JW. Antenatal diagnosis and subsequent management of hydronephrosis. J Urol. 1993;149:693–8.10.1016/S0022-5347(17)36185-2Search in Google Scholar
[6] Bobrowski RA, Levin RB, Lauria MR, Treadwell MC, Gonik B, Bottoms SF. In utero progression of isolated renal pelvis dilation. Am J Perinatol. 1997;14:423–6.10.1055/s-2007-994173Search in Google Scholar
[7] Chapman T. Fetal genitourinary imaging. Pediatr Radiol. 2012;42:S115–23.10.1007/s00247-011-2172-6Search in Google Scholar
[8] Cohen-Overbeek TE, Wijngaard-Boom P, Ursem NT, Hop WC, Wladimiroff JW, Wolffenbuttel KP. Mild renal pyelectasis in the second trimester: determination of cut-off levels for postnatal referral. Ultrasound Obstet Gynecol. 2005;25:378–83.10.1002/uog.1840Search in Google Scholar
[9] Corteville JE, Gray DL, Crane JP. Congenital hydronephrosis: correlation of fetal ultrasonographic findings with infant outcome. Am J Obstet Gynecol. 1991;165:384–8.10.1016/0002-9378(91)90099-DSearch in Google Scholar
[10] Dhillon HK. Prenatally diagnosed hydronephrosis: the great ormond street experience. Br J Urol. 1998;81:39–44.10.1046/j.1464-410X.1998.0810s2039.xSearch in Google Scholar
[11] Ek S, Lidefeldt KJ, Varricio L. Fetal hydronephrosis; prevalence, natural history and postnatal consequences in an unselected population. Acta Obstet Gynecol Scand. 2007;86:1463–6.10.1080/00016340701714802Search in Google Scholar
[12] Feldman DM, DeCambre M, Kong E, Borgida A, Jamil M, McKenna P, et al. Evaluation and follow-up of fetal hydronephrosis. J Ultrasound Med. 2001;20:1065–9.10.7863/jum.2001.20.10.1065Search in Google Scholar
[13] Gramellini D, Fieni S, Caforio E, Benassi G, Bedocchi L, Beseghi U, et al. Diagnostic accuracy of fetal renal pelvis anteroposterior diameter as a predictor of significant postnatal nephrouropathy: second versus third trimester of pregnancy. Am J Obstet Gynecol. 2006;194:167–73.10.1016/j.ajog.2005.06.071Search in Google Scholar
[14] Gunn TR, Mora JD, Pease P. Antenatal diagnosis of urinary tract abnormalities by ultrasonography after 28 weeks’ gestation: incidence and outcome. Am J Obstet Gynecol. 1995;172:479–86.10.1016/0002-9378(95)90560-XSearch in Google Scholar
[15] Homsy YL, Saad F, Laberge I, Williot P, Pison C. Transitional hydronephrosis of the newborn and infant. J Urol. 1990;144:579–83; discussion 93–4.10.1016/S0022-5347(17)39527-7Search in Google Scholar
[16] Ismaili K, Hall M, Donner C, Thomas D, Vermeylen D, Avni FE. Results of systematic screening for minor degrees of fetal renal pelvis dilatation in an unselected population. Am J Obstet Gynecol. 2003;188:242–6.10.1067/mob.2003.81Search in Google Scholar
[17] Kent A, Cox D, Downey P, James SL. A study of mild fetal pyelectasia — outcome and proposed strategy of management. Prenat Diagn. 2000;20:206–9.10.1002/(SICI)1097-0223(200003)20:3<206::AID-PD783>3.0.CO;2-4Search in Google Scholar
[18] Kim HJ, Jung HJ, Lee HY, Lee YS, Im YJ, Hong CH, et al. Diagnostic value of anteroposterior diameter of fetal renal pelvis during second and third trimesters in predicting postnatal surgery among Korean population: useful information for antenatal counseling. Urology. 2012;79:1132–7.10.1016/j.urology.2012.01.007Search in Google Scholar
[19] Livera LN, Brookfield DS, Egginton JA, Hawnaur JM. Antenatal ultrasonography to detect fetal renal abnormalities: a prospective screening programme. Br Med J. 1989;298:1421–3.10.1136/bmj.298.6685.1421Search in Google Scholar
[20] Mandell J, Blyth BR, Peters CA, Retik AB, Estroff JA, Benacerraf BR. Structural genitourinary defects detected in utero. Radiology. 1991;178:193–6.10.1148/radiology.178.1.1984303Search in Google Scholar
[21] Nam KH, Cho A, Kwon JY, Park YW, Kim YH. Feasibility of measuring 3-dimensional renal parenchymal volume to predict postnatal renal function in near-term fetuses with congenital hydronephrosis: a preliminary study. J Ultrasound Med. 2012;31:955–62.10.7863/jum.2012.31.6.955Search in Google Scholar
[22] Odibo AO, Marchiano D, Quinones JN, Riesch D, Egan JF, Macones GA. Mild pyelectasis: evaluating the relationship between gestational age and renal pelvic anterior-posterior diameter. Prenat Diagn. 2003;23:824–7.10.1002/pd.709Search in Google Scholar
[23] Odibo AO, Raab E, Elovitz M, Merrill JD, Macones GA. Prenatal mild pyelectasis: evaluating the thresholds of renal pelvic diameter associated with normal postnatal renal function. J Ultrasound Med. 2004;23:513–7.10.7863/jum.2004.23.4.513Search in Google Scholar
[24] Pates JA, Dashe JS. Prenatal diagnosis and management of hydronephrosis. Early Hum Dev. 2006;82:3–8.10.1016/j.earlhumdev.2005.11.003Search in Google Scholar
[25] Persutte WH, Koyle M, Lenke RR, Klas J, Ryan C, Hobbins JC. Mild pyelectasis ascertained with prenatal ultrasonography is pediatrically significant. Ultrasound Obstet Gynecol. 1997;10:12–8.10.1046/j.1469-0705.1997.10010012.xSearch in Google Scholar
[26] Robinson JN, Tice K, Kolm P, Abuhamad AZ. Effect of maternal hydration on fetal renal pyelectasis. Obstet Gynecol. 1998;92:137–41.10.1016/S0029-7844(98)00136-7Search in Google Scholar
[27] Sairam S, Al-Habib A, Sasson S, Thilaganathan B. Natural history of fetal hydronephrosis diagnosed on mid-trimester ultrasound. Ultrasound Obstet Gynecol. 2001;17:191–6.10.1046/j.1469-0705.2001.00333.xSearch in Google Scholar PubMed
[28] 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;118:154–9.10.1016/j.ejogrb.2004.04.023Search in Google Scholar PubMed
[29] Srinivasan HB, Srinivasan N, Dhungel P, London R, Lampley C, Srinivasan G. Natural history of fetal renal pyelectasis. J Matern Fetal Neonatal Med. 2013;26:166–8.10.3109/14767058.2012.722726Search in Google Scholar PubMed
[30] Thornburg LL, Pressman EK, Chelamkuri S, Hulbert W, Rabinowitz R, Mevorach R. Third trimester ultrasound of fetal pyelectasis: predictor for postnatal surgery. J Pediatr Urol. 2008;4:51–4.10.1016/j.jpurol.2007.04.005Search in Google Scholar PubMed
[31] Zhan X, Tao G, Cheng L, Liu F, Li H, Liu S. Ultrasound score: a new method to differentiate fetal physiological and pathological hydronephrosis. Eur J Obstet Gynecol Reprod Biol. 2010;151:26–32.10.1016/j.ejogrb.2010.02.046Search in Google Scholar PubMed
The authors stated that there are no conflicts of interest regarding the publication of this article.
©2013 by Walter de Gruyter Berlin Boston
