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The postnatal significance of mild fetal pyelectasis
Author(s) -
Chudleigh T. M.,
Chitty L. S.
Publication year - 2001
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1046/j.1469-0705.2001.abs24-2.x
Subject(s) - medicine , urinary system , hydronephrosis , fetus , obstetrics , prenatal diagnosis , gestation , prospective cohort study , pregnancy , surgery , biology , genetics
Purpose: To determine the incidence of significant renal pathology in fetuses with mild pyelectasis in the second trimester, and to define prognostic criteria with which to identify those fetuses requiring detailed postnatal follow up. Methods: A prospective, observational, multicenter study of unselected fetuses identified during routine second trimester anomaly screening. Mild pyelectasis was defined as an antero‐posterior diameter of 5–10 mm. All fetuses with unilateral or bilateral pyelectasis identified between 16 and 25 completed weeks of gestation were recruited. Results: Four hundred and twenty‐five fetuses with mild pyelectasis were recruited from a population of 101600 pregnancies. Dilatation was bilateral in 270 and unilateral in 155 cases. Multicystic or horseshoe kidney was subsequently diagnosed in four cases. Prenatal pyelectasis improved in 90 cases, remained unchanged in 124 cases and deteriorated in 177 cases. One prenatal scan only was performed in 30 cases. Neonatal renal findings were abnormal in 185 cases. Pathological findings were present in 48 cases of which 16 resulted in surgery. The primary diagnosis was obstruction in 15 cases, duplex kidney in 11 and upper tract dilatation in 22 cases leading to surgery in eight, five and three cases, respectively. Significantly, more cases of pathology were present in fetuses where the dilatation increased to 10 mm or greater in the third trimester than in those where it remained unchanged. Conclusions: Postnatal upper urinary tract dilatation is demonstrated in 43.9% of fetuses with mild second trimester pyelectasis. Urinary tract pathology is present in 11.4% of such fetuses and 3.8% require surgery. All cases with persistent pyelectasis, particularly those with progressive dilatation, should be investigated postnatally.