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Prenatal diagnosis of LUTO: improving diagnostic accuracy
- Source :
- Ultrasound in Obstetrics & Gynecology, 52(6), 739-743. John Wiley & Sons Ltd., Ultrasound in Obstetrics and Gynecology, 52(6), 739-743, Fontanella, F, Duin, L K, Adama van Scheltema, P N, Cohen-Overbeek, T E, Pajkrt, E, Bekker, M, Willekes, C, Bax, C J, Gracchi, V, Oepkes, D & Bilardo, C M 2018, ' Prenatal diagnosis of LUTO: improving diagnostic accuracy ', Ultrasound in Obstetrics and Gynecology, vol. 52, no. 6, pp. 739-743 . https://doi.org/10.1002/uog.18990, Ultrasound in Obstetrics & Gynecology, Ultrasound in obstetrics & gynecology, 52(6), 739-743. John Wiley and Sons Ltd, Ultrasound in Obstetrics and Gynecology, 52(6), 739-743. John Wiley and Sons Ltd, Ultrasound in Obstetrics & Gynecology, 52(6), 739-743. Wiley
- Publication Year :
- 2018
-
Abstract
- Objective: To propose a clinical score for the optimal antenatal diagnosis of fetal lower urinary tract obstruction (LUTO) in the second and third trimesters of pregnancy, as an alternative to the commonly used ultrasound triad of megacystis, keyhole sign and hydronephrosis. Methods: This was a national retrospective study carried out at the eight tertiary fetal medicine units (FMUs) in The Netherlands. Only cases referred for megacystis from the second trimester onwards and with a clear postnatal diagnosis were included in the study. At referral, data were collected on amniotic fluid volume, renal cortical appearance, bladder volume, hydronephrosis, fetal ascites, ureteral size, keyhole sign, fetal sex and gestational age. Multivariate analysis was performed, starting by including all antenatal variables, and then excluding the weakest predictors using the backward stepwise strategy. Results: Over a 7-year period, 312 fetuses with a diagnosis of megacystis were referred to the eight Dutch tertiary FMUs. A final diagnosis was achieved in 143 cases, including 124 of LUTO and 19 reclassified after birth as non-obstructive megacystis. The optimal bladder volume cut-off for prediction of LUTO was 35 cm3 (area under the curve (AUC) = 0.7, P = 0.03). The clinical score formulated on the basis of the multivariate analysis included fetal sex, degree of bladder distension, ureteral size, oligo- or anhydramnios and gestational age at referral. The combination of these five variables demonstrated good accuracy in discriminating LUTO from non-obstructive megacystis (AUC = 0.84, P < 0.001), compared with the poor performance of the ultrasound triad (AUC = 0.63, P = 0.07). Conclusions: We propose a clinical score that combines five antenatal variables for the prospective diagnosis of congenital LUTO. This score showed good discriminative capacity in predicting LUTO, and better diagnostic accuracy compared with that of the classic ultrasound triad. Future studies to validate these results should be carried out in order to refine antenatal management of LUTO and prevent inappropriate fetal interventions. © 2017 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
- Subjects :
- Male
medicine.medical_specialty
Duodenum
Urinary Bladder
Gestational Age
Prenatal diagnosis
Hydronephrosis
Vesicoureteral reflux
03 medical and health sciences
0302 clinical medicine
Obstetrics and gynaecology
Pregnancy
Fetal megacystis
medicine
Humans
megacystis
Radiology, Nuclear Medicine and imaging
030212 general & internal medicine
lower urinary tract obstruction
Retrospective Studies
Original Paper
VESICOURETERAL REFLUX
030219 obstetrics & reproductive medicine
prenatal diagnosis
Radiological and Ultrasound Technology
business.industry
Obstetrics
Obstetrics and Gynecology
Gestational age
General Medicine
Megacystis
medicine.disease
Original Papers
Fetal Diseases
Pregnancy Trimester, First
FETAL MEGACYSTIS
Reproductive Medicine
POSTERIOR URETHRAL VALVES
Pregnancy Trimester, Second
LUTO
Female
URINARY-TRACT OBSTRUCTION
business
Urinary tract obstruction
INTERVENTION
Subjects
Details
- ISSN :
- 09607692
- Database :
- OpenAIRE
- Journal :
- Ultrasound in Obstetrics & Gynecology, 52(6), 739-743. John Wiley & Sons Ltd., Ultrasound in Obstetrics and Gynecology, 52(6), 739-743, Fontanella, F, Duin, L K, Adama van Scheltema, P N, Cohen-Overbeek, T E, Pajkrt, E, Bekker, M, Willekes, C, Bax, C J, Gracchi, V, Oepkes, D & Bilardo, C M 2018, ' Prenatal diagnosis of LUTO: improving diagnostic accuracy ', Ultrasound in Obstetrics and Gynecology, vol. 52, no. 6, pp. 739-743 . https://doi.org/10.1002/uog.18990, Ultrasound in Obstetrics & Gynecology, Ultrasound in obstetrics & gynecology, 52(6), 739-743. John Wiley and Sons Ltd, Ultrasound in Obstetrics and Gynecology, 52(6), 739-743. John Wiley and Sons Ltd, Ultrasound in Obstetrics & Gynecology, 52(6), 739-743. Wiley
- Accession number :
- edsair.doi.dedup.....8d27eb7de414bef7111677c7c13a7a2d