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Fetal pyelectasis: is it always "physiologic"?

A M Adra1, A A Mejides, M S Dennaoui

  • 1Department of Obstetrics and Gynecology, University of Miami School of Medicine, FL 33101, USA.

American Journal of Obstetrics and Gynecology
|October 1, 1995
PubMed
Summary

Fetal pyelectasis measuring 8 mm or larger after 28 weeks gestation predicts neonatal renal pathology. This finding necessitates postnatal urologic evaluation to manage potential kidney abnormalities.

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Area of Science:

  • Pediatric Nephrology
  • Fetal Medicine
  • Urology

Background:

  • Fetal pyelectasis is a common finding during prenatal ultrasound.
  • Identifying fetuses at risk for significant renal pathology is crucial for timely intervention.

Purpose of the Study:

  • To determine the predictive value of fetal pyelectasis measurements for identifying neonatal renal pathologic processes.

Main Methods:

  • Retrospective review of 84 cases of fetal pyelectasis (1989-1993).
  • Inclusion criteria: anteroposterior diameter of renal pelvis >= 4 mm before 33 weeks or >= 7 mm after 33 weeks (without caliectasis). Exclusion criteria: anteroposterior diameter > 10 mm.
  • Postnatal evaluation included renal sonography, voiding cystourethrogram, and renal flow/function studies.

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Main Results:

  • Renal pathology was found in 44% of 68 infants with complete postnatal workup.
  • Ureteropelvic junction obstruction and vesicoureteral reflux were the most common pathologies (37% and 33%, respectively).
  • A fetal anteroposterior diameter >= 8 mm after 28 weeks' gestation predicted renal pathology with 87% sensitivity and 66.7% positive predictive value.

Conclusions:

  • Fetal pyelectasis with an anteroposterior diameter >= 8 mm after 28 weeks' gestation is a strong predictor of neonatal renal pathology.
  • These fetuses require thorough postnatal urologic evaluation.
  • Most identified cases were managed conservatively, with only 13% requiring surgery.