Feldman D M, DeCambre M, Kong E, Borgida A, Jamil M, McKenna P, Egan J F
Division of Maternal-Fetal Medicine, University of Connecticut Health Center, Farmington 06030-2950, USA.
J Ultrasound Med. 2001 Oct;20(10):1065-9. doi: 10.7863/jum.2001.20.10.1065.
To determine the antenatal course and neonatal follow-up of isolated fetal hydronephrosis.
We reviewed our ultrasonography database from January 1989 to June 1999 for all cases of unilateral or bilateral fetal hydronephrosis that had at least 1 follow-up ultrasonographic examination. Cases were defined as mild, moderate, or severe depending on the renal pelvis anteroposterior diameter and gestational age. Data were analyzed using the chi2 test with the Fisher exact test where appropriate. Medical records were reviewed, and telephone interviews were performed to determine which infants received follow-up after birth.
Of 57,966 ultrasonographic examinations in 20,049 women during the study period, 393 patients met criteria for evaluation. Of these, 347 (88%) had fetuses with mild hydronephrosis. Most of these had complete resolution during the pregnancy. Forty patients had fetuses classified as having moderate hydronephrosis, and 6 patients had fetuses with severe hydronephrosis. Of those classified as moderate hydronephrosis, 15% resolved, 25% improved, 48% remained unchanged, and 12% worsened during the pregnancy. There were no cases of in utero resolution in the severe group; however, 4 of 6 cases improved to moderate or mild, and 2 cases remained unchanged. Of the cases identified prenatally, 25 received consultation by a pediatric urologist in the newborn period, and 7 of these required surgical intervention.
Our population-based data suggest that most cases of mild hydronephrosis will resolve before delivery. In contrast, cases of moderate or severe hydronephrosis are less likely to have resolution in utero and are more likely to worsen or remain unchanged. Of those fetuses with persistent hydronephrosis, only a small number required some surgical intervention after birth. This information is useful in counseling the patient whose fetus is noted to have isolated hydronephrosis.
确定孤立性胎儿肾积水的产前病程及新生儿随访情况。
我们回顾了1989年1月至1999年6月期间超声检查数据库中所有单侧或双侧胎儿肾积水且至少进行过1次随访超声检查的病例。根据肾盂前后径和孕周将病例分为轻度、中度或重度。数据在适当情况下采用卡方检验及Fisher精确检验进行分析。查阅病历，并进行电话访谈以确定哪些婴儿出生后接受了随访。
在研究期间，对20,049名女性进行了57,966次超声检查，其中393例患者符合评估标准。其中，347例（88%）胎儿为轻度肾积水。这些病例中的大多数在孕期积水完全消退。40例胎儿被分类为中度肾积水，6例胎儿为重度肾积水。在分类为中度肾积水的病例中，15%在孕期积水消退，25%有所改善，48%保持不变，12%病情恶化。重度组没有宫内消退的病例；然而，6例中有4例改善为中度或轻度，2例保持不变。在产前确诊的病例中，25例在新生儿期接受了小儿泌尿科医生的会诊，其中7例需要手术干预。
我们基于人群的数据表明，大多数轻度肾积水病例在分娩前会消退。相比之下，中度或重度肾积水病例在宫内消退的可能性较小，且更有可能病情恶化或保持不变。在那些持续性肾积水的胎儿中，只有少数在出生后需要一些手术干预。这些信息对于为其胎儿被发现有孤立性肾积水的患者提供咨询很有用。
