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Usefulness of Fetal Urine Production Measurement for Prediction of Perinatal Outcomes in Uteroplacental Insufficiency
Author(s) -
Lee Seung Mi,
Jun Jong Kwan,
Kim Su Ah,
Lee Eun Ja,
Kim Byoung Jae,
Park Chan-Wook,
Park Joong Shin
Publication year - 2014
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.7863/ultra.33.12.2165
Subject(s) - medicine , fetal distress , placental insufficiency , apgar score , pregnancy , gestational age , urine , fetus , obstetrics , gestation , urology , placenta , genetics , biology
Objectives To evaluate whether fetal urine production measurement is useful for predicting adverse outcomes in patients with uteroplacental insufficiency. Methods We enrolled patients with uteroplacental insufficiency at 24 to 40 weeks' gestation and normal pregnancies matched for gestational age and divided them into 3 groups according to perinatal outcomes: group 1 (n = 141), a control group of normal pregnancies; group 2 (n = 29), uteroplacental insufficiency without adverse outcomes; and group 3 (n = 18), uteroplacental insufficiency with adverse outcomes. An adverse outcome was defined as 1 or more of the following: (1) cesarean delivery because of fetal distress; (2) admission to the neonatal intensive care unit; (3) cord arterial pH less than 7.15 at birth; and (4) low 5‐minute Apgar score (<7). The fetal urine production rate was obtained by serial bladder volume measurement using virtual organ computer‐aided analysis. For bladder volume determination, we scanned the bladder in the 3‐dimensional mode and defined the bladder surface contour in the reference plane, repeating the rotation of the reference plane with an angle of 30° and determining the surface contour on each plane. Statistical methods, including the Mann‐Whitney U test, Fisher exact test, χ 2 test, and Kruskal‐Wallis analysis of variance, were used. Results Group 3 had a lower mean fetal urine production rate than groups 1 and 2, whereas the urine production rate was not different between groups 1 and 2 (group 1, 49.0 mL/h; group 2, 59.4 mL/h; group 3, 20.7 mL/h; P < .001 between groups 1 and 3 and between groups 2 and 3). This difference between groups 2 and 3 remained significant after adjusting for the amniotic fluid index, umbilical artery Doppler pulsatility index, and presence of fetal growth restriction. Conclusions Uteroplacental insufficiency cases with adverse perinatal outcomes had a lower fetal urine production rate than those without adverse outcomes. This difference might be used to predict adverse perinatal outcomes in uteroplacental insufficiency.