The Detection and Assessment of Fetal Urinary-Tract Anomalies Via Ultrasound
Garcia, Eduardo Javier
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The case studies of 36 prenatal examinations diagnosed, via ultrasound, for fetal uropathic conditions over a 37 month period, were examined to determine the divergence between the intrauterine diagnostic ultrasound findings and the diagnoses made after delivery. Data concerning these cases was generated through the use of 4 different sources: an initial list of cases afflicted with some type of uropathy from Hutzel Hospital's computer network; hospital charts from the Medical Records Department at Hutzel; ultrasound reports from the Ultrasound Department at Hutzel; and post-delivery neonatal follow-up reports from the Medical Records Department at the Children's Hospital of Michigan. Upon obtaining the desired information for each case, the following data was looked at for each case: 1.) name and social security/hospital number of mother and child; 2.) maternal age; 3.) parity; 4.) gestational age of the fetus at first ultrasound (U/S); 5.) gestational age at U/S diagnosis; 6.) amniotic fluid volume; 7.) maternal alpha fetal protein results; 8.) karyotype of the fetus; 9.) fetal presentation; 10.) gestational age of the fetus at delivery; 11.) mode of delivery; 12.) whether or not a therapeutic abortion was performed; 13.) sex of the fetus; 14.) family and maternal history; 15.) fetal urine electrolytes, (blood urea nitrogen and creatinine levels); 16.) U/S findings; 17.) autopsy findings; 18.) neonatal follow-up and postnatal treatment. Correct diagnoses were made in 26 of the cases, (67 per cent) and predominated in male sexual phenotypes. Oligohydramnios was found to be the major limiting factor in neonatal survival and the primary means of uropathy detection, (50 per cent of the cases had this condition). In addition to this, it was found that other major congenital anomalies involving other organ systems were associated with oligohydramnios with a high frequency. The importance of the difference in gestational ages of the fetus between initial ultrasound examination and ultrasound diagnosis of uropathies, 20 weeks and 28 weeks respectively, was examined. Finally, since there exists an association between urinary-tract anomalies and some major congenital anomalies, such as pulmonary hypoplasia, the early evaluation of uropathies, before irreversible damage was done, was found to be imperative in the management of the pregnancy.