1. Antenatal staging of congenital lower urinary tract obstruction
- Author
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L. K. Duin, Titia E. Cohen-Overbeek, Christine Willekes, P. N. Adama van Scheltema, F. Fontanella, Caterina M. Bilardo, Dick Oepkes, Mireille N. Bekker, Eva Pajkrt, Amsterdam Reproduction & Development (AR&D), Obstetrics and gynaecology, Obstetrics & Gynecology, Obstetrie & Gynaecologie, MUMC+: MA Medische Staf Obstetrie Gynaecologie (9), RS: GROW - R4 - Reproductive and Perinatal Medicine, Obstetrics and Gynaecology, APH - Personalized Medicine, APH - Quality of Care, ARD - Amsterdam Reproduction and Development, and Reproductive Origins of Adult Health and Disease (ROAHD)
- Subjects
medicine.medical_specialty ,Urethral Obstruction ,vesicoamniotic shunt ,Urinary Bladder ,Oligohydramnios ,Gestational Age ,Conservative Treatment ,Severity of Illness Index ,Ultrasonography, Prenatal ,ULTRASONOGRAPHY ,RUPTURE ,Predictive Value of Tests ,Pregnancy ,Severity of illness ,MANAGEMENT ,medicine ,Humans ,megacystis ,Radiology, Nuclear Medicine and imaging ,lower urinary tract obstruction ,Perinatal Mortality ,Retrospective Studies ,Univariate analysis ,Radiological and Ultrasound Technology ,Obstetrics ,business.industry ,Infant, Newborn ,Obstetrics and Gynecology ,Gestational age ,Infant ,General Medicine ,medicine.disease ,Fetal Diseases ,FETAL CYSTOSCOPY ,Logistic Models ,fetal therapy ,Reproductive Medicine ,ROC Curve ,Predictive value of tests ,Gestation ,LUTO ,Female ,Urinary tract obstruction ,business ,INTERVENTION ,Glomerular Filtration Rate - Abstract
Objective To propose a staging system for congenital lower urinary tract obstruction (LUTO) capable of predicting the severity of the condition and its prognosis.Methods This was a national retrospective study carried out at the eight Academic Hospitals in The Netherlands. We collected prenatal and postnatal data of fetuses at high risk of isolated LUTO that were managed conservatively. Postnatal renal function was assessed by the estimated glomerular filtration rate (eGFR), calculated using the Schwartz formula, considering the length of the infant and the creatinine nadir in the first year after birth. Receiver-operating characteristics (ROC) curve analysis, univariate analysis and multivariate logistic regression analysis with stepwise backward elimination were performed in order to identify the best antenatal predictors of perinatal mortality and postnatal renal function.Results In total, 261 fetuses suspected of having LUTO and managed conservatively were included in the study. The pregnancy was terminated in 110 cases and perinatal death occurred in 35 cases. Gestational age at appearance of oligohydramnios showed excellent accuracy in predicting the risk of perinatal mortality with an area under the ROC curve of 0.95 (P Conclusions Gestational age at appearance of oligo-or anhydramnios and BV at diagnosis can accurately predict mortality and morbidity in fetuses with LUTO. Our proposed staging system can triage reliably fetuses with LUTO and predict the severity of the condition and its prognosis. Copyright (c) 2018 ISUOG. Published by John Wiley & Sons Ltd.
- Published
- 2019