Aneskevich, Kristin

Bock, Joanna

Clement, Michele R, MD

Costa, Ashley, MD

Johnson, Andrea

Rochon, Meredith, MD

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health Network LVHN Scholarly Works USF-LVHN SELECT Postnatal outcomes of genitourinary abnormalities diagnosed on antenatal ultrasound Andrea Johnson Meredith Rochon MD Michele R. Clement MD Ashley Costa MD Kristin Aneskevich See next page for additional authors Follow this and additional works at: https://scholarlyworks.lvhn.org/select-program  Part of the Medical Education Commons This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact LibraryServices@lvhn.org. Authors Andrea Johnson, Meredith Rochon MD, Michele R. Clement MD, Ashley Costa MD, Kristin Aneskevich, and Joanna Bock © 2018 Lehigh Valley Health NetworkLehigh Valley Health Network, Allentown, PennsylvaniaPrognosis of FGUA tends to be favorable, especiallyfor upper urinary tract lesions. We identified severalpredictors of need for postnatal interventionincluding renal pelvis dilation present in thirdtrimester US, abnormal genetic screening result,and presence of more severe lesions such asbladder outlet obstruction. This study also informedthat increasing severity of degrees of renal pelvisdilation can confer predictability of postnatalintervention. This study did change protocols inMaternal Fetal Medicine at LVHN, with newprotocols requiring less frequent exams for mildlesions. This has the potential to decrease cost ofcare by requiring fewer visits and increase accessby increasing available scheduling for MFM patients.Postnatal outcomes of genitourinary abnormalities diagnosed on antenatal ultrasoundREFERENCES• 274 women met inclusion criteria• FGUA were common in our population, complicating 3.4% of pregnancies• 97.4% of pregnancies resulted in liveborn neonates, pregnancies that ended in demise had comorbid FGUA and other significant abnormalities• Most common FGUA was upper urinary tract dilation (82.5%)• 59.2% of all FGUA resolved prior to delivery, 72.7% of upper urinary tract lesions resolved• Postnatal imaging was available for 85 of FGUA lesions that persisted to term• 18.8% (16/85) of fetuses with abnormalities that persisted to term required postnatal intervention• 6% (16/268) of total neonates observed with FGUA required postnatal intervention• Subgroup analysis of upper urinary tract dilation showed renal pelvis dilation < 7mm in third trimester resolved in 83% of cases, and dilation > 7mm in third trimester resolved in 18% of cases (p <0.00001) • FGUA were common in our population, complicating 3.4% of pregnancies, which is slightly higher than the 1-2% reported in the literature1. • Six percent of neonates with FGUA required postnatal intervention, consistent with other studies2,3. • Our study confirmed that upper urinary tract lesions are the most common diagnosis, and these frequently resolve spontaneously • Fetuses least likely to require postnatal intervention had renal pelvis dilation < 7mm in the third trimester and had no other associated abnormalities. This numeric limit matches currently reported literature5,6• This study will allow more precise counsel for patients receiving diagnosis of FGUA. They will have increased US and genetic surveillance, butshould feel reassured that most FGUA resolve without medical intervention.• This study also informed that degrees of anterior-posterior renal pelvis dilation, that is      ≥ 4mm in second trimester and ≥ 7mm in third trimester, can confer predictability of requirement for postnatal intervention. • This is  a retrospective cohort study of pregnant women with a FGUA identified on prenatal ultrasound interpreted at Maternal Fetal Medicine at Lehigh Valley Health Network (LVHN) with estimated due dates from October 2016 to November 2018 who subsequently delivered at LVHN and had available neonatal and delivery information. • Patients were identified by querying the ultrasound database for fetuses with a prenatally detected FGUA and other information was gathered by review of the electronic medical record (Epic and CPO). • Data collected included ultrasound, maternal, and postnatal categories encompassing type of abnormality, severity of abnormality, delivery data, neonatal information, requirement of additional imaging and need for additional evaluation or treatment. • Statistical analysis was completed by Dr. Rochon.Andrea Johnson, Mentor: Meredith Rochon, MD Michele Clement, MD, Ashley Faden, MD, Kristin Aneskevich, Joanna BockTable 3. Isolated UPJ obstruction outcomes by renal pelvis dilation and trimester*Resolved on last exam Postnatal interventionSecond trimester4 – 6 mm7 – 9 mm≥ 10 mm133/160 (83.1%)12/20 (60%)0/2 (0%)p<0.000016/160 (3.8%)0/20 (0%)0/2 (0%)p=0.856Third trimester7 – 9 mm≥ 10 mm2/29 (6.9%)0/26 (0%) p=0.4922/29 (6.9%)3/26 (11.5%) p=0.492*Data is for liveborn neonates. P-values calculated with Fisher exact.Table 2. Predictors of need for postnatal cystoscopic or surgical intervention for liveborn infants with prenatal diagnosis of genitourinary abnormalityOR (95% CI) p-valueAbnormal genetic screening/testing result 8.468 (2.148,33.385) 0.002Third trimester initial diagnosis 3.583 (1.227,10.467) 0.020Seen on third trimester ultrasound (initial or f/u exam) 4.926 (1.544,15.715) 0.007Type of lesionIsolated megaureterBladder outlet obstruction51.581 (2.017,1318.861)28.731 (4.410,187.181)0.0170.0004Data are in OR (95% CI)BackgroundTable 1. Natural history of prenatal genitourinary abnormalities by lesion on prenatal exam*Lesion F/u exam Progressed No change Improved ResolvedUpper urinary tract dilation/obstruction (n=226)Pyelectasis/HydronephrosisUPJ obstructionUVJ obstructionIsolated megaureterDuplicated collecting system2091987132522102302621122000152148400Lower urinary tract dilation/obstruction (n=10)Bladder outlet obstructionUreterocele1082330422110220Abnormal kidney location/number (n=19)Pelvic kidneyHorseshoe kidneyUnilateral renal agenesis19123422001363400003300Abnormal kidney appearance (n=28)Multicystic dysplastic kidney (MCDK)Renal cystSmallEchogenicLarge and echogenic279211248310401460161501022000000Total 265 38 61 8 157*Includes patients that had a follow-up exam and excludes pregnancies resulting in miscarriage or termination1. Dugoff L. Ultrasound diagnosis of structural abnormalities in the first trimester. Prenat Diagn. 2002;22(4):316-320. doi:10.1002/pd.309 2. Nguyen HT, Benson CB, Bromley B, et al. Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system). J Pediatr Urol. 2014;10(6):982-998. doi:10.1016/j.jpurol.2014.10.002 3. Creasy. Creasy and Resnik’s Maternal–Fetal Medicine: Principles and Practice Sixth EditionCreasyRobert K, ResnikRobert, IamsJay D, LockwoodCharles J, MooreThomas RISBN: 978-1-4160-4224-2Hardback, 1282pp.Philadelphia: Saunders Elsevier, 2009US$199 (UK £134). Vol 5. Elsevier Health Sciences; 2012. doi:10.1258/om.2011.11E0054. Coplen DE, Austin PF, Yan Y, Blanco VM, Dicke JM. The magnitude of fetal renal pelvic dilatation can identify obstructive postnatal hydronephrosis, and direct postnatal evaluation and management. J Urol. 2006;176(2):724-727; discussion 727. doi:10.1016/j.juro.2006.03.0795. Li NN, Ji LN, Chao S, et al. [Ultrasound screening and follow-up study of congenital anomalies of the kidney and urinary tract in neonates]. Beijing Da Xue Xue Bao. 2019;51(6):1062-1066. http://www.ncbi.nlm.nih.gov/pubmed/31848505. Accessed February 23, 2020.6. Dias T, Sairam S, Kumarasiri S. Ultrasound diagnosis of fetal renal abnormalities. Best Pract Res Clin Obstet Gynaecol. 2014;28(3):403-415. doi:10.1016/j.bpobgyn.2014.01.009Problem Statement• Fetal genitourinary abnormalities (FGUA) are the most common diagnosis discovered as part of standard obstetric ultrasound (US) screening1. • Dilation of the genitourinary system is found in 1% of all pregnancies and comprise 20-30% of all congenital abnormalities1. • There has historically been variability in management of these patients2. Most lesions do not require antenatal or postnatal intervention, however some FGUA can be devastating. • Certain characteristics have been associated with need for postnatal intervention such as type of FGUA, laterality, and amniotic fluid volume. • The degree of antenatal hydronephrosis may be used to elucidate likelihood of need for postnatal interventions3. These have been used to guide counseling, but exact criteria have not been used to predict outcomes4. This study describes a cohort with prenatally diagnosed FGUA with the hypothesis that increased severity of upper urinary tract dilation will be associated with increased need for postnatal intervention. ResultsMethodologyDiscussion

Postnatal outcomes of genitourinary abnormalities diagnosed on antenatal ultrasound

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Postnatal outcomes of genitourinary abnormalities diagnosed on antenatal ultrasound

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