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[Isolated antenatal pyelic dilatation: postnatal follow-up and care for vesico-ureteral reflux]
M De Spirlet1, H B Lottmann, S Omnès
1Service de Gynécologie Obstétrique, de Chirurgie Infantile et de Cytogénétique, Hôpital Robert Debré, 48, boulevard Sérurier, 75019 Paris et Faculté Paris VII Lariboisière-Saint Louis, Paris.
Insights
Isolated antenatal pyelic dilatation carries a low risk of aneuploidia (chromosome anomalies). However, associated postnatal vesico-ureteral reflux necessitates comprehensive prenatal ultrasound screening for affected infants.
Area of Science:
- Pediatric Urology
- Prenatal Diagnosis
- Medical Genetics
Background:
- Isolated antenatal pyelic dilatation is a common finding in prenatal ultrasounds.
- The risk of associated aneuploidia (chromosome anomalies) requires careful assessment.
- Understanding the urological implications is crucial for postnatal care.
Purpose of the Study:
- To evaluate the risk of aneuploidia in fetuses with isolated antenatal pyelic dilatation.
- To outline appropriate urological management strategies for affected children.
Main Methods:
- Retrospective analysis of prenatal and postnatal follow-up data.
- Inclusion of 350 cases with isolated antenatal pyelic dilatation.
Main Results:
- An overall rate of 1.3% for chromosome anomalies was observed.
- Trisomy 21 (Down syndrome) occurred in 0.3% of cases.
- Vesico-ureteral reflux was present in 13% of infants, with similar rates in both sexes.
Conclusions:
- The decision to perform karyotyping for isolated pyelic dilatation is complex, influenced by subtle findings like amniotic fluid volume.
- The significant incidence of postnatal vesico-ureteral reflux underscores the importance of thorough prenatal ultrasound screening.
Objective:
To assess the risk of aneuploidia in case of isolated antenatal pyelic dilatation and to detail urological care for these children.
Methods:
Prenatal and postnatal follow-up was analyzed in 350 cases.
Results:
The overall rate of chromosome anomalies was 1.3%. Trisomy 21 was found alone in one case (0.3%). The sex ratio was 26% girls and 74% boys. Vesico-ureteral reflux was similar in both sexes (13%).
Conclusion:
The question of proposing karyotyping in case of isolated pyelic dilatation remains unsolved because minimal subjective signs such as slightly excessive amniotic fluid can completely change the assessment of the risk of aneuploidia. The frequency of postnatal vesico-ureteral reflux associated with prenatal pyelic dilatation warrants complete prenatal ultrasound screening.