Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center Groningen, University of Groningen, The Netherlands.
Department of Obstetrics, Gynaecology and Prenatal Diagnosis, Leiden University Medical Center, Leiden, The Netherlands.
Ultrasound Obstet Gynecol. 2018 Dec;52(6):739-743. doi: 10.1002/uog.18990. Epub 2018 Nov 9.
To propose a clinical score for the optimal antenatal diagnosis of fetal lower urinary tract obstruction (LUTO) in the second and third trimesters of pregnancy, as an alternative to the commonly used ultrasound triad of megacystis, keyhole sign and hydronephrosis.
This was a national retrospective study carried out at the eight tertiary fetal medicine units (FMUs) in The Netherlands. Only cases referred for megacystis from the second trimester onwards and with a clear postnatal diagnosis were included in the study. At referral, data were collected on amniotic fluid volume, renal cortical appearance, bladder volume, hydronephrosis, fetal ascites, ureteral size, keyhole sign, fetal sex and gestational age. Multivariate analysis was performed, starting by including all antenatal variables, and then excluding the weakest predictors using the backward stepwise strategy.
Over a 7-year period, 312 fetuses with a diagnosis of megacystis were referred to the eight Dutch tertiary FMUs. A final diagnosis was achieved in 143 cases, including 124 of LUTO and 19 reclassified after birth as non-obstructive megacystis. The optimal bladder volume cut-off for prediction of LUTO was 35 cm (area under the curve (AUC) = 0.7, P = 0.03). The clinical score formulated on the basis of the multivariate analysis included fetal sex, degree of bladder distension, ureteral size, oligo- or anhydramnios and gestational age at referral. The combination of these five variables demonstrated good accuracy in discriminating LUTO from non-obstructive megacystis (AUC = 0.84, P < 0.001), compared with the poor performance of the ultrasound triad (AUC = 0.63, P = 0.07).
We propose a clinical score that combines five antenatal variables for the prospective diagnosis of congenital LUTO. This score showed good discriminative capacity in predicting LUTO, and better diagnostic accuracy compared with that of the classic ultrasound triad. Future studies to validate these results should be carried out in order to refine antenatal management of LUTO and prevent inappropriate fetal interventions. © 2017 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
提出一种临床评分方法，用于优化妊娠中晚期胎儿下尿路梗阻（LUTO）的产前诊断，以替代常用的超声三联征（巨膀胱、钥匙孔征和肾积水）。
这是一项在荷兰 8 个三级胎儿医学中心进行的全国性回顾性研究。仅纳入自妊娠中期起因巨膀胱就诊且有明确产后诊断的病例。在转诊时，收集羊水体积、肾皮质外观、膀胱体积、肾积水、胎儿腹水、输尿管大小、钥匙孔征、胎儿性别和胎龄等数据。采用多元分析，首先包括所有产前变量，然后使用逐步向后策略排除最弱的预测因子。
在 7 年期间，8 家荷兰三级胎儿医学中心转诊了 312 例巨膀胱胎儿。143 例病例获得最终诊断，包括 124 例 LUTO 和 19 例出生后重新归类为非梗阻性巨膀胱。预测 LUTO 的最佳膀胱体积截断值为 35cm（曲线下面积（AUC）=0.7，P=0.03）。基于多变量分析制定的临床评分包括胎儿性别、膀胱充盈程度、输尿管大小、羊水过少或无羊水及转诊时的胎龄。这五个变量的组合在区分 LUTO 与非梗阻性巨膀胱方面具有良好的准确性（AUC=0.84，P<0.001），而超声三联征的性能较差（AUC=0.63，P=0.07）。
我们提出了一种临床评分，结合了 5 个产前变量，用于先天性 LUTO 的前瞻性诊断。该评分在预测 LUTO 方面具有良好的区分能力，与经典超声三联征相比具有更高的诊断准确性。为了优化 LUTO 的产前管理并防止不必要的胎儿干预，应开展进一步的验证研究。
