scholarly journals Prenatal Megacystis – Is Prediction of Outcome and Renal Function Possible?

2017 ◽  
Vol 39 (04) ◽  
pp. 407-412 ◽  
Author(s):  
Regina Tschannen ◽  
Rita Gobet ◽  
Josef Wisser
Keyword(s):  
Renal Function ◽  
Amniotic Fluid ◽  
Gestational Age ◽  
Fluid Volume ◽  
Amniotic Fluid Volume ◽  
Age Related ◽  
Age Dependent ◽  
Fetal Urine ◽  
Beta 2 ◽  
Beta 2 Microglobulin

Abstract Objective To assess prenatal prognostic criteria for fetuses with megacystis in order to counsel parents. Methods In a retrospective observational study at a single tertiary referral center, we assessed the clinical course of 53 fetuses with megacystis cared for at the Department of Obstetrics of the University Hospital Zurich between 1995 and 2008 and followed them up for 2 to 12 years. We determined fetal karyotype, amniotic fluid volume and fetal urinary biochemistry as prenatal prognostic factors. The renal function of survivors was grouped according to age-related creatinine values. Using logistic regression analysis, gestational age-dependent discrimination curves and corresponding ROC curves for fetal urine, beta-2 microglobulin, osmolarity and chloride were calculated. Results 43 out of 53 fetuses underwent vesicocentesis, and spontaneous remission occurred in 3 fetuses. 15 fetuses survived, termination of pregnancy was requested in 23 cases, and 12 neonatal and 3 intrauterine deaths were observed. Reduced amniotic fluid volume showed a significant (p = 0.0027) increase of impaired renal function or perinatal death. Discrimination between survivors and non-survivors was complete for fetal urine beta-2 microglobulin with an area under the curve (AUC) of 1.0. For fetal urine osmolarity and fetal urinary chloride, the AUC was 0.81 and 0.76, respectively. Conclusion The assessment of prognosis for fetal megacystis should include fetal k aryotyping, determination of amniotic fluid and assessment of fetal urine biochemistry. Gestational age-dependent regression lines disclose clinically relevant discrimination and can be used as selection criteria for fetal interventions and parental counselling.

Development of human renal function: reference intervals for 10 biochemical markers in fetal urine

1996 ◽  
Vol 42 (11) ◽  
pp. 1855-1860 ◽  
Author(s):  
F Muller ◽  
M Dommergues ◽  
L Bussières ◽  
S Lortat-Jacob ◽  
C Loirat ◽  
...  
Keyword(s):  
Renal Function ◽  
Gestational Age ◽  
Obstructive Uropathy ◽  
Perinatal Care ◽  
Reference Intervals ◽  
Tubular Reabsorption ◽  
Reasonable Approximation ◽  
Fetal Urine ◽  
Beta 2 ◽  
Beta 2 Microglobulin

Abstract Evaluation of fetal renal function by analysis of fetal urine sampled in utero may improve perinatal care after a prenatal diagnosis of bilateral obstructive uropathy. We provide reference intervals for 10 fetal urinary compounds and examine their variation with gestational age. Forty-one fetuses with bilateral obstructive uropathy (urine sampled between 20 and 38 weeks of gestational age) had normal, healthy values for serum creatinine (< or = 50 mumol/L) at ages 1-2 years. These cases were thus assumed to represent a reasonable approximation to healthy values. Sodium and beta 2-microglobulin concentrations significantly decreased with gestational age; calcium, ammonia, and creatinine significantly increased; glucose, phosphorus, chloride, urea, and total protein concentrations did not vary. Our results provide reference values for prenatal evaluation of fetal renal function and suggest that glomerular filtration of macromolecules and tubular reabsorption of glucose and phosphorus are mature by 20 weeks of gestation, whereas tubular reabsorption of sodium and beta 2-microglobulin increases progressively during the second half of gestation.

Sonographic Assessment of Amniotic Fluid Volume using Single Deepest Pocket (SDP) among Igbo Women with Uncomplicated Singleton Pregnancies.

2019 ◽  
Vol 2 (1) ◽  
pp. 1-18
Author(s):  
Chijioke Okeudo ◽  
B.U. Ezem
Keyword(s):  
Amniotic Fluid ◽  
Gestational Age ◽  
Cross Sectional Study ◽  
Fluid Volume ◽  
Singleton Pregnancy ◽  
Cross Sectional ◽  
South Eastern ◽  
Amniotic Fluid Volume ◽  
The Mean ◽  
Singleton Pregnancies

Background: The amniotic fluid is fundamental for proper fetal development and growth. Ultrasound visualization of the amniotic fluid permits both subjective and objective estimates of the amniotic fluid. Objective: The objective of this study was to determine the reference values of normal single deepest pocket (SDP) – upper and lower limits, mean SDP and variation of the SDP with gestational age among Igbo women of South-Eastern Nigeria extraction carrying uncomplicated singleton pregnancy. Methodology: This was a prospective cross sectional study involving 400 women carrying uncomplicated singleton pregnancies and who were sure of the date of the first day of their last menstrual period. The single deepest pocket / maximum vertical pool were determined once at presentation at the hospital.. The study was conducted from January 1st to December 31st 2015. The second author carried out all the scanning. The SDP was obtained. Results: The womens’ mean and median ages were the same at 28 years. The gestational age range of the pregnancies was 14-41 weeks. The mean SDP was 5.8cm, while the 5th and 95th percentiles were 3.3cm and 8.5cm respectively. There was no difference in the mean SDP in both term and preterm. There was irregular but continuous rise of mean SDP to a peak of 6.8cm at gestational age of 39 weeks. In conclusion, the participants had a mean SDP of 5.8cm. There was also a positive correlation between SDP and Gestational age. We therefore recommend a longitudinal study to assess perinatal outcome and abnormal amniotic fluid volume among Igbo women of South-Eastern Nigeria. Key words: Single Deepest Pocket, Uncomplicated Singleton Pregnancy, Igbo Women.

Ovine fetal adaptations to chronically reduced urine flow: preservation of amniotic fluid volume

1996 ◽  
Vol 81 (6) ◽  
pp. 2588-2594 ◽  
Author(s):  
Stephanie E. Mann ◽  
Mark J. M. Nijland ◽  
Michael G. Ross
Keyword(s):  
Amniotic Fluid ◽  
Plasma Osmolality ◽  
Urine Osmolality ◽  
Urine Flow ◽  
Fluid Volume ◽  
Fetal Plasma ◽  
Arterial Blood ◽  
Amniotic Fluid Volume ◽  
Fetal Urine ◽  
Ovine Fetal

Mann, Stephanie E., Mark J. M. Nijland, and Michael G. Ross.Ovine fetal adaptations to chronically reduced urine flow: preservation of amniotic fluid volume. J. Appl. Physiol. 81(6): 2588–2594, 1996.—Adequate amniotic fluid (AF) volume is maintained by a balance of fetal fluid production (lung liquid and urine) and resorption (swallowing and intramembranous flow). Because fetal urine is the principle source of AF, alterations in urine flow and composition directly impact AF dynamics. Intra-amniotic 1-desamino-8-d-arginine vasopressin (DDAVP) is rapidly absorbed into fetal plasma and induces a marked fetal urinary antidiuresis. To examine the effect of intra-amniotic- DDAVP-induced fetal urinary responses on AF volume and composition, six chronically prepared ewes with singleton fetuses (gestation 128 ± 2 days) were studied for 72 h after a single intra-amniotic DDAVP (50-μg) injection. After DDAVP, fetal urine osmolality significantly increased at 2 h (157 ± 13 to 253 ± 21 mosmol/kg) and remained elevated at 72 h (400 ± 13 mosmol/kg). Urinary sodium (33.0 ± 4.5 to 117.2 ± 9.7 meq/l) and chloride (26.0 ± 2.8 to 92.4 ± 8.1 meq/l) concentrations similarly increased. AF osmolality increased (285 ± 3 to 299 ± 4 mosmol/kgH2O), although there was no change in fetal plasma osmolality (294 ± 2 mosmol/kg). Despite a 50% reduction in fetal urine flow (0.12 ± 0.03 to 0.05 ± 0.02 ml ⋅ kg−1 ⋅ min−1at 2 h and 0.06 ± 0.01 ml ⋅ kg−1 ⋅ min−1after 72 h), AF volume did not change (693 ± 226 to 679 ± 214 ml). There were no changes in fetal arterial blood pressures, pH,[Formula: see text], or[Formula: see text] after DDAVP. We conclude the following. 1) Intra-amniotic DDAVP injection induces a prolonged decrease in fetal urine flow and increases in urine and AF osmolalities. 2) Despite decreased urine flow, AF volume does not change. We speculate that, in response to DDAVP-induced fetal oliguria, reversed intramembranous flow (from isotonic fetal plasma to hypertonic AF) preserves AF volume.

Measurement of fetal urine production to differentiate causes of increased amniotic fluid volume

2009 ◽  
Vol 36 (2) ◽  
pp. 191-195 ◽  
Author(s):  
S. M. Lee ◽  
J. K. Jun ◽  
E. J. Lee ◽  
J. H. Lee ◽  
C.-W. Park ◽  
...  
Keyword(s):  
Amniotic Fluid ◽  
Fluid Volume ◽  
Amniotic Fluid Volume ◽  
Urine Production ◽  
Fetal Urine

The effect of low-dose aspirin on fetal urine output amniotic fluid volume

1993 ◽  
Vol 169 (4) ◽  
pp. 885-888 ◽  
Author(s):  
James E. Maher ◽  
John Owen ◽  
John Hauth ◽  
Robert Goldenberg ◽  
C.Richard Parker ◽  
...  
Keyword(s):  
Amniotic Fluid ◽  
Urine Output ◽  
Low Dose ◽  
Fluid Volume ◽  
Amniotic Fluid Volume ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Fetal Urine

Four-quadrant assessment of gestational age-specific values of amniotic fluid volume in uncomplicated pregnancies

1998 ◽  
Vol 77 (3) ◽  
pp. 290-294 ◽  
Author(s):  
Mohammed Haider Alley ◽  
Alexander Hadjiev ◽  
Valentina Mazneikova ◽  
Angel Dimitrov
Keyword(s):  
Amniotic Fluid ◽  
Gestational Age ◽  
Fluid Volume ◽  
Amniotic Fluid Volume ◽  
Four Quadrant

scholarly journals Inhibitor of intramembranous absorption in ovine amniotic fluid

2014 ◽  
Vol 306 (3) ◽  
pp. R185-R189 ◽  
Author(s):  
Robert A. Brace ◽  
Cecilia Y. Cheung ◽  
Debra F. Anderson
Keyword(s):  
Amniotic Fluid ◽  
Absorption Rate ◽  
Ringer Solution ◽  
Fluid Volume ◽  
Fetal Membrane ◽  
Fetal Sheep ◽  
Membrane Stretch ◽  
Amniotic Fluid Volume ◽  
Urine Production ◽  
Fetal Urine

Intramembranous absorption increases during intra-amniotic infusion of physiological saline solutions. The increase may be due partly to the concomitant elevation in fetal urine production as fetal urine contains a stimulator of intramembranous absorption. In this study, we hypothesized that the increase in intramembranous absorption during intra-amniotic infusion is due, in part, to dilution of a nonrenal inhibitor of intramembranous absorption that is present in amniotic fluid. In late-gestation fetal sheep, amniotic fluid volume and the four primary amniotic inflows and outflows were determined over 2-day intervals under three conditions: 1) control conditions when fetal urine entered the amniotic sac, 2) during intra-amniotic infusion of 2 l/day of lactated Ringer solution when urine entered the amniotic sac, and 3) during the same intra-amniotic infusion when fetal urine was continuously replaced with lactated Ringer solution. Amniotic fluid volume, fetal urine production, swallowed volume, and intramembranous absorption rate increased during the infusions independent of fetal urine entry into the amniotic sac or its replacement. Lung liquid secretion rate was unchanged during infusion. Because fetal membrane stretch has been shown not to be involved and because urine replacement did not alter the response, we conclude that the increase in intramembranous absorption that occurs during intra-amniotic infusions is due primarily to dilution of a nonrenal inhibitor of intramembranous absorption that is normally present in amniotic fluid. This result combined with our previous study suggests that a nonrenal inhibitor(s) together with a renal stimulator(s) interact to regulate intramembranous absorption rate and, hence, amniotic fluid volume.

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