RESUMEN
INTRODUCTION: Treatment of oligohydramnios in the mid-trimester is challenging, because of the high incidence of adverse perinatal outcomes mainly due to bronchopulmonary dysplasia. Antenatal amnioinfusion has been proposed as a possible treatment for oligohydramnios with intact amnions, but there are few relevant studies. This study aimed to evaluate the effectiveness of transabdominal amnioinfusion in the management of oligohydramnios without fetal lethal malformations in the second and early third trimesters. MATERIAL AND METHODS: It is a historical cohort study. A total of 79 patients diagnosed with oligohydramnios at 18-32 weeks gestation were enrolled. In the amnioinfusion group (n = 39), patients received transabdominal amnioinfusion with the assistance of real-time ultrasound guidance. In the expectant group (n = 41), patients were treated with 3000 mL of intravenous isotonic fluids daily. The perioperative complications and perinatal outcomes were analyzed. RESULTS: Compared with the expectant group, the delivery latency was significantly prolonged, and the rate of cesarean delivery was significantly reduced in the amnioinfusion group (p < 0.05). Although the rate of intrauterine fetal death was significantly reduced, the incidence of spontaneous miscarriage, premature rupture of membranes (PROMs), and threatened preterm labor were significantly higher in the amnioinfusion group than in the expectant group (p < 0.05). There was no significant difference in terms of perinatal mortality (28.9% vs. 41.4%, p > 0.05). Multivariate logistic regression revealed that amnioinfusion (odds ratio [OR] 0.162, 95% confidence interval [CI] 0.04-0.61, p = 0.008) and gestational age at diagnosis (OR 0.185, 95% CI 0.04-0.73, p = 0.016) were independently associated with neonatal adverse outcomes. Further subgrouping showed that amnioinfusion significantly reduced the frequency of bronchopulmonary hypoplasia for patients ≤26 weeks (26.7% vs. 75.0%, p = 0.021). The rates of other neonatal complications were similar in both groups. CONCLUSIONS: Amnioinfusion has no significant effect on improving the perinatal mortality of oligohydramnios in the second and early third trimesters. It may lead to a relatively high rate of PROM and spontaneous abortion. However, amnioinfusion may significantly improve the latency period, the rate of cesarean delivery, and neonatal outcomes of oligohydramnios, especially for women ≤26 weeks with high risk of neonatal bronchopulmonary hypoplasia.
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Oligohidramnios , Segundo Trimestre del Embarazo , Tercer Trimestre del Embarazo , Humanos , Femenino , Oligohidramnios/terapia , Embarazo , Adulto , Líquido Amniótico , Resultado del Embarazo , Recién Nacido , Estudios de Cohortes , Espera Vigilante , Cesárea , Resultado del Tratamiento , Edad Gestacional , Amnios , Ultrasonografía PrenatalRESUMEN
Technological advancements before and after delivery have greatly altered the counseling of pregnant patients facing a fetal diagnosis of severe oligohydramnios or anhydramnios secondary to congenital anomalies of the kidneys and urinary tract. Once considered a nearly uniformly lethal abnormality, long-term survival may now be possible secondary to prenatal innovations aimed at restoring the amniotic fluid volume and the availability of more advanced neonatal dialysis techniques. However, these available therapies are far from perfect. The procedures are onerous for pregnant patients without a guarantee of success, and families must prepare themselves for the complex life-long medical care that will be necessary for surviving individuals. Multidisciplinary counseling is imperative to help pregnant individuals understand the complexity of these conditions and assist them in exercising their right to informed decision-making. Moreover, as with any developing field of medicine, providers must contend with ethical questions related to the treatment options, including questions regarding patient-hood, distributive justice, and the blurred lines between research, innovation, and standard care. These ethical questions are best addressed in a multidisciplinary fashion with consideration of multiple points of view from various subspecialties. Only by seeing the entirety of the picture can we hope to best counsel patients about these highly complex situations and help navigate the most appropriate care path.
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Análisis Ético , Humanos , Femenino , Embarazo , Riñón/anomalías , Sistema Urinario/anomalías , Recién Nacido , Anomalías Urogenitales/terapia , Anomalías Urogenitales/diagnóstico , Oligohidramnios/terapia , Diagnóstico Prenatal/éticaRESUMEN
OBJECTIVE: Oligohydramnios (defined as amniotic fluid volume < 5 cm or deepest vertical pocket < 2 cm) is regarded as an ominous finding on prenatal ultrasound. Amniotic fluid, however, is not static, and to date, there have been no studies comparing perinatal outcomes in patients who are diagnosed with oligohydramnios that resolves and those who have persistent oligohydramnios. STUDY DESIGN: This is a secondary analysis of a National Institutes of Health-funded retrospective cohort study of singleton gestations delivered at a tertiary care hospital between 2002 and 2013 with mild hypertensive disorders and/or fetal growth restriction (FGR). Maternal characteristics, delivery, and neonatal information were abstracted by trained research nurses. Patients with a diagnosis of oligohydramnios were identified, and those with resolved versus persistent oligohydramnios at the time of delivery were compared. The primary outcome was a composite of neonatal resuscitation at delivery: administration of oxygen, bag-mask ventilation, continuous positive airway pressure, intubation, chest compression, or cardiac medication administration. Secondary outcomes included FGR, timing, and mode of delivery. RESULTS: Of 527 women meeting study criteria, 42 had oligohydramnios that resolved prior to delivery, whereas 485 had persistent oligohydramnios. There were no significant differences in patient demographics between groups. The gestational age at diagnosis was significantly lower for patients with resolved versus persistent oligohydramnios (median: 33.0 [interquartile range, IQR: 29.1-35.9] vs. 38.0 [IQR: 36.4-39.3], p < 0.001). There was not a substantial difference in rate of neonatal resuscitation (41 vs. 32%, p = 0.31). Patients with resolved oligohydramnios were more likely to have developed FGR than those with persistent oligohydramnios (55 vs. 36%, p < 0.02). There were no significant differences for gestational age at delivery, birth weight, or neonatal intensive care unit admission. CONCLUSION: Patients whose oligohydramnios resolved were diagnosed earlier yet had similar rates of neonatal resuscitation but higher rates of FGR than those who had persistent oligohydramnios. KEY POINTS: · When diagnosed earlier in pregnancy, oligohydramnios was more likely to resolve prenatally.. · Patients who were diagnosed with oligohydramnios earlier in pregnancy had higher rates of FGR.. · There were no differences in the rates of the composite outcome of need for neonatal resuscitation when comparing those with resolved versus those with persistent oligohydramnios. No differences in composite neonatal morbidity were noted between those with resolved versus persistent oligohydramnios..
Asunto(s)
Oligohidramnios , Humanos , Oligohidramnios/diagnóstico por imagen , Oligohidramnios/terapia , Femenino , Embarazo , Estudios Retrospectivos , Recién Nacido , Adulto , Resultado del Embarazo , Retardo del Crecimiento Fetal , Resucitación , Ultrasonografía Prenatal , Edad Gestacional , Parto Obstétrico/métodosRESUMEN
OBJECTIVE: To elucidate an etiology in a case with persistent oligohydramnios by prenatal diagnosis and actively treat the case to achieve good prognosis. METHODS: We performed whole exome sequencing (WES) of DNA from the fetus and parents. Serial amnioinfusions were conducted until birth. Pressors were required to maintain normal blood pressure. The infant angiotensin-converting enzyme (ACE) activity, angiotensin II (Ang II, a downstream product of ACE), and compensatory enzymes (CEs) activities were measured. Compensatory enzyme activities in plasma from age-matched healthy controls were also detected. RESULTS: We identified a fetus with a severe ACE mutation prenatally. The infant was born prematurely without pulmonary dysplasia. Hypotension and anuria resolved spontaneously. He had almost no ACE activity, but his Ang II level and CE activity exceeded the upper limit of the normal range and the upper limit of the 95% confidence interval of controls, respectively. His renal function also largely recovered. CONCLUSION: Fetuses with ACE mutations can be diagnosed prenatally through WES. Serial amnioinfusion permits the continuation of pregnancy in fetal ACE deficiency. Compensatory enzymes for defective ACE appeared postnatally. Renal function may be spared by preterm delivery; furthermore, for postnatal vasopressor therapy to begin, improving renal perfusion pressure before nephrogenesis has been completed.
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Oligohidramnios , Peptidil-Dipeptidasa A , Embarazo , Recién Nacido , Masculino , Femenino , Humanos , Peptidil-Dipeptidasa A/genética , Diagnóstico Prenatal , Feto , Oligohidramnios/diagnóstico por imagen , Oligohidramnios/terapia , Parto ObstétricoRESUMEN
Importance: Early anhydramnios during pregnancy, resulting from fetal bilateral renal agenesis, causes lethal pulmonary hypoplasia in neonates. Restoring amniotic fluid via serial amnioinfusions may promote lung development, enabling survival. Objective: To assess neonatal outcomes of serial amnioinfusions initiated before 26 weeks' gestation to mitigate lethal pulmonary hypoplasia. Design, Setting, and Participants: Prospective, nonrandomized clinical trial conducted at 9 US fetal therapy centers between December 2018 and July 2022. Outcomes are reported for 21 maternal-fetal pairs with confirmed anhydramnios due to isolated fetal bilateral renal agenesis without other identified congenital anomalies. Exposure: Enrolled participants initiated ultrasound-guided percutaneous amnioinfusions of isotonic fluid before 26 weeks' gestation, with frequency of infusions individualized to maintain normal amniotic fluid levels for gestational age. Main Outcomes and Measures: The primary end point was postnatal infant survival to 14 days of life or longer with dialysis access placement. Results: The trial was stopped early based on an interim analysis of 18 maternal-fetal pairs given concern about neonatal morbidity and mortality beyond the primary end point despite demonstration of the efficacy of the intervention. There were 17 live births (94%), with a median gestational age at delivery of 32 weeks, 4 days (IQR, 32-34 weeks). All participants delivered prior to 37 weeks' gestation. The primary outcome was achieved in 14 (82%) of 17 live-born infants (95% CI, 44%-99%). Factors associated with survival to the primary outcome included a higher number of amnioinfusions (P = .01), gestational age greater than 32 weeks (P = .005), and higher birth weight (P = .03). Only 6 (35%) of the 17 neonates born alive survived to hospital discharge while receiving peritoneal dialysis at a median age of 24 weeks of life (range, 12-32 weeks). Conclusions and Relevance: Serial amnioinfusions mitigated lethal pulmonary hypoplasia but were associated with preterm delivery. The lower rate of survival to discharge highlights the additional mortality burden independent of lung function. Additional long-term data are needed to fully characterize the outcomes in surviving neonates and assess the morbidity and mortality burden. Trial Registration: ClinicalTrials.gov Identifier: NCT03101891.
Asunto(s)
Terapias Fetales , Soluciones Isotónicas , Enfermedades Renales , Enfermedades Pulmonares , Oligohidramnios , Femenino , Humanos , Lactante , Recién Nacido , Embarazo , Terapias Fetales/métodos , Edad Gestacional , Riñón/diagnóstico por imagen , Enfermedades Renales/complicaciones , Enfermedades Renales/congénito , Enfermedades Renales/mortalidad , Enfermedades Renales/terapia , Estudios Prospectivos , Infusiones Parenterales/métodos , Oligohidramnios/etiología , Oligohidramnios/mortalidad , Oligohidramnios/terapia , Enfermedades Fetales/etiología , Enfermedades Fetales/mortalidad , Enfermedades Fetales/terapia , Enfermedades Pulmonares/congénito , Enfermedades Pulmonares/etiología , Enfermedades Pulmonares/mortalidad , Enfermedades Pulmonares/terapia , Soluciones Isotónicas/administración & dosificación , Soluciones Isotónicas/uso terapéutico , Ultrasonografía Intervencional , Resultado del Embarazo , Resultado del Tratamiento , Nacimiento Prematuro/etiología , Nacimiento Prematuro/mortalidadRESUMEN
OBJECTIVE: This meta-analysis aims to review the effect of serial transabdominal amnioinfusion (TAI) on short-term and long-term perinatal outcomes in mid-trimester preterm premature rupture of membranes (PPROM). METHODS: Literature searches of PubMed, Web of Sciences, Scopus, and Cochrane Library were performed from their inception to April 2022. Studies comparing conventional treatment with serial TAI in women with proven PPROM at less than 26 + 0 weeks of gestation with oligohydramnios were included. Studies that included oligohydramnios due to other reasons such as fetal growth retardation or renal anomalies were excluded. Risk of bias in observational studies was assessed using the tool of the Cochrane Review group identified as risk of bias in non-randomized studies - of interventions. The risk of bias assessments for RCTs were performed according to the Cochrane risk-of-bias tool for randomized trials. An I2 score was used to assess the heterogeneity of included studies. The analyses were performed by using random-effect model, and the results were expressed as relative risk (RR) or mean difference with 95% confidence intervals (CIs). RESULTS: Overall, eight relevant studies including five observational studies (n = 252; 130 women allocated to the intervention) and three RCTs (n = 183; 93 women allocated to the intervention) were eligible. The pooled latency period was 21.9 days (95% CI, 13.1-30.8) and 5.8 days (95% CI, -11.6-23.2) longer in the TAI group in the observational studies and RCTs, respectively. The perinatal mortality rate reduced in the intervention group when tested in observational studies (RR 0.68; 95% CI, 0.51-0.92), but not in RCTs (RR 0.79; 95% CI, 0.56-1.13). The rate of long-term healthy survival was higher in the children whose mothers were treated with the TAI (35.7%) than those were treated with the standard management (28.6%) (RR 1.30, 95% CI 0.47-3.60, "best case scenario"). CONCLUSIONS: The efficacy of serial TA on early PPROM associated morbidity and mortality is not attested. Additional randomized control trials with adequate power are needed.
Asunto(s)
Rotura Prematura de Membranas Fetales , Oligohidramnios , Embarazo , Recién Nacido , Niño , Femenino , Humanos , Segundo Trimestre del Embarazo , Oligohidramnios/terapia , Rotura Prematura de Membranas Fetales/terapia , Parto Obstétrico/métodosRESUMEN
This Viewpoint discusses the long-term medical, emotional, and financial implications of using amnioinfusion to treat anhydramnios; outlines the ongoing Renal Anhydramnios Fetal Therapy (RAFT) trial, which aims to document outcomes and survival in infants after amnioinfusion; and suggests that amnioinfusions be withheld in early anhydramnios, pending the findings of the RAFT trial.
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Líquido Amniótico , Infusiones Parenterales , Oligohidramnios , Femenino , Humanos , Embarazo , Parto Obstétrico , Oligohidramnios/terapia , Infusiones Parenterales/ética , Ética MédicaRESUMEN
The most severe forms of congenital anomalies of the kidney and urinary tract present in fetal life with early pregnancy renal anhydramnios and are considered lethal due to pulmonary hypoplasia without fetal therapy. Due to the high rate of additional structural anomalies, genetic abnormalities, and associated syndromes, detailed anatomic survey and genetic testing are imperative when stratifying which pregnancies are appropriate for fetal intervention. Restoring amniotic fluid around the fetus is the principal goal of prenatal treatment. The ongoing multi-center Renal Anhydramnios Fetal Therapy (RAFT) trial is assessing the safety and efficacy of serial amnioinfusions to prevent pulmonary hypoplasia so that the underlying renal disease can be addressed.
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Terapias Fetales , Oligohidramnios , Embarazo , Femenino , Humanos , Oligohidramnios/terapia , Riñón/anomalías , Líquido Amniótico , Parto Obstétrico , Ultrasonografía PrenatalRESUMEN
PURPOSE: Anhydramnios secondary to anuria before 22 weeks of gestational age and congenital bilateral renal agenesis before 26 weeks of gestational age are collectively referred to as early-pregnancy renal anhydramnios. Early-pregnancy renal anhydramnios occurs in at least 1 in 2000 pregnancies and is considered universally fatal when left untreated because of severe pulmonary hypoplasia precluding ex utero survival The Renal Anhydramnios Fetal Therapy (RAFT) trial is a nonrandomized, nonblinded, multicenter clinical trial designed to assess the efficacy, safety, and feasibility of amnioinfusions for patients with pregnancies complicated by early-pregnancy renal anhydramnios. The primary objective of this study is to determine the proportion of neonates surviving to successful dialysis, defined as use of a dialysis catheter for ≥14 days. METHODS: A consortium of 9 North American Fetal Therapy Network (NAFTNet) centers was formed, and the RAFT protocol was refined in collaboration with the NAFTNet Scientific Committee. Enrollment in the trial began in April 2020. Participants may elect to receive amnioinfusions or to join the nonintervention observational expectant management group. Eligible pregnant women must be at least 18 years of age with a fetal diagnosis of isolated early-pregnancy renal anhydramnios. FINDINGS: In addition to the primary study objective stated above, secondary objectives include (1) to assess maternal safety and feasibility of the serial amnioinfusion intervention (2) to perform an exploratory study of the natural history of untreated early pregnancy renal anhydramnios (3) to examine correlations between prenatal imaging and lung specific factors in amniotic fluid as predictive of the efficacy of serial percutaneous amnioinfusions and (4) to determine short- and long-term outcomes and quality of life in surviving neonates and families enrolled in RAFT IMPLICATIONS: The RAFT trial is the first clinical trial to investigate the efficacy, safety, and feasibility of amnioinfusions to treat the survival-limiting pulmonary hypoplasia associated with anhydramnios. Although the intervention offers an opportunity to treat a condition known to be almost universally fatal in affected neonates, the potential burdens associated with end-stage kidney disease from birth must be acknowledged. CLINICALTRIALS: gov identifier: NCT03101891.
Asunto(s)
Terapias Fetales , Oligohidramnios , Líquido Amniótico , Femenino , Edad Gestacional , Humanos , Recién Nacido , Estudios Multicéntricos como Asunto , Oligohidramnios/terapia , Embarazo , Calidad de VidaRESUMEN
OBJECTIVE: Assessing amniotic fluid determines an important dimension of fetal health. Significant relationships of oligohydramnios, which occurs in 1-2% of pregnancies, with abnormal pregnancy outcomes such as intrauterine growth retardation (IUGR), fetal anomalies, umbilical cord compression, fetal distress, preterm childbirth, meconium-stained amniotic fluid, perinatal mortality and cesarean section necessitate the measurement of amniotic fluid volume in many prenatal fetal health assessments. Amniotic fluid volume may significantly fluctuate between different gestational ages. Reduced uteroplacental perfusion can cause oligohydramnios by decreasing fetal renal blood flow and urine output. The appropriate management of isolated term oligohydramnios (ITO) is controversial. This study was performed aimed to assess the effect of maternal intravenous hydration on amniotic fluid index in oligohydramnios. RESULT: Forty-eight hours after completing fluid therapy, statistically significant differences were observed in the mean AFI in the intervention group (4.06 ± 0.33) and the control group (3.61 ± 0.35) (P < 0.0001) and also between the intervention group (0.532 ± 0.45) and the controls (-0.036 ± 0.18) (P < 0.0001). CONCLUSION: The results of the present study suggested that maternal intravenous hydration significantly increases AFI in women with oligohydramnios.
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Oligohidramnios , Líquido Amniótico , Cesárea , Femenino , Edad Gestacional , Humanos , Recién Nacido , Oligohidramnios/diagnóstico por imagen , Oligohidramnios/terapia , Embarazo , Resultado del EmbarazoRESUMEN
OBJECTIVE: The objective of this article was to evaluate the outcome of transabdominal amnioinfusion in pregnant patients with oligohydramnios. METHOD: This is a prospective observational study involving 80 cases of oligohydramnios treated with transabdominal amnioinfusion guided by ultrasound, in the period between 2011 and 2016. The patients were treated in two centers; however, all the procedures were performed by the same operator. RESULTS: The mean gestational age at the first treatment was 24 weeks. Some patients received more than one amnioinfusion. The mean interval between the first infusion and delivery was 31 d. Perinatal and neonatal mortalities were 45% and 35%, respectively. There were five cases of chorioamnioitis and in majority of the cases; the final diagnosis was made after amnioinfusion. CONCLUSION: The procedure has been proven to be very safe. The result showed a high perinatal mortality which was not surprising, as these pregnancies were complicated by a major fetal malformation. Significantly, this study showed that the diagnosis accuracy of the concomitant congenital fetal malformation was significantly improved. The diagnosis accuracy had a major impact on the management of patients, especially the mode of delivery.
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Rotura Prematura de Membranas Fetales , Oligohidramnios , Embarazo , Recién Nacido , Femenino , Humanos , Lactante , Oligohidramnios/diagnóstico por imagen , Oligohidramnios/terapia , Rotura Prematura de Membranas Fetales/etiología , Parto Obstétrico/efectos adversos , Edad Gestacional , Mortalidad InfantilRESUMEN
Twin-twin transfusion syndrome occurs in multiple gestations and involves a chronic flow of blood from one twin to another twin and is a rare entity. We present a case of 32-years-old primigravida with a twin pregnancy who presented with increasing abdominal girth inappropriate with her gestational age at 21 weeks of her pregnancy. Ultrasound findings were suggestive of twin-twin transfusion syndrome. The patient was provided with treatment options but due to polyhydramnios and short cervix, the patient went into spontaneous labour the same day with a poor pregnancy outcome. Twin-twin transfusion syndrome leads to a high rate of perinatal morbidity due to its poorly understood aetiology and difficulty in diagnosing and treatment. Early diagnosis during antenatal ultrasound is important in reducing morbidity and mortality rates. Keywords: case reports; fetoscopy; oligohydramnios; polyhydramnios; twins.
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Transfusión Feto-Fetal , Oligohidramnios , Polihidramnios , Embarazo , Femenino , Humanos , Lactante , Adulto , Transfusión Feto-Fetal/diagnóstico por imagen , Transfusión Feto-Fetal/terapia , Polihidramnios/diagnóstico por imagen , Polihidramnios/etiología , Ultrasonografía Prenatal , Resultado del Embarazo , Oligohidramnios/diagnóstico por imagen , Oligohidramnios/terapia , Edad GestacionalRESUMEN
BACKGROUND: There is no established treatment for fetal growth restriction during pregnancy. We report two cases that represent an example of an amnioinfusion-based management strategy for severe fetal growth restriction with umbilical cord complications. CASE PRESENTATION: We encountered two cases of fetal growth restriction with abnormal fetal Doppler velocity. In one case, fetal ultrasound revealed a hypercoiled umbilical cord with a single umbilical artery and oligohydramnios, while fetal Doppler revealed a reversed end-diastolic flow in the umbilical artery and reversed a-waves of the ductus venosus. Umbilical cord compression was confirmed at 22 weeks and 2 days of gestation, and nine amnioinfusions were performed to relieve the umbilical cord compression. A cesarean section was performed at 31 weeks and 2 days of gestation because of severe preeclampsia. The Asian infant is now a normally developed 6-month-old. In another Asian case, fetal ultrasound revealed a hypercoiled cord, while fetal Doppler revealed a reversed end-diastolic flow in the umbilical artery and intermittent reversed a-waves of the ductus venosus. Umbilical cord compression was confirmed at 24 weeks and 5 days of gestation, and seven amnioinfusions were performed. A cesarean section was performed at 31 weeks and 1 day of gestation because of nonreassuring fetal status. At the age of 1 month, the Asian infant was stable on respiratory circulation. In both cases, fetal Doppler findings improved significantly following amnioinfusions. CONCLUSIONS: Amnioinfusion is a symptomatic treatment for umbilical cord compression. However, to determine the therapeutic effect of amnioinfusion, complete resolution of the umbilical cord compression should be ascertained by ultrasonography.
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Retardo del Crecimiento Fetal , Oligohidramnios , Cesárea , Femenino , Retardo del Crecimiento Fetal/diagnóstico por imagen , Retardo del Crecimiento Fetal/terapia , Humanos , Lactante , Oligohidramnios/diagnóstico por imagen , Oligohidramnios/terapia , Embarazo , Ultrasonografía Prenatal , Arterias Umbilicales/diagnóstico por imagen , Cordón Umbilical/diagnóstico por imagenRESUMEN
PURPOSE OF REVIEW: Congenital lower urinary tract obstruction (LUTO) is a rare group of conditions characterized by high perinatal morbidity and mortality if associated with oligohydramnios or anhydramnios in early pregnancy. Although foetal intervention has the potential to improve perinatal survival in a select group of foetuses with LUTO, the actual selection of those candidates most likely to benefit from intervention remains challenging. RECENT FINDINGS: Foetuses with LUTO who are potential candidates for prenatal intervention should undergo detailed multidisciplinary evaluation to ensure proper assessment and counselling. Using a combination of multiple ultrasound-based renal parameters, including measurement of foetal bladder volumes before and after vesicocentesis and kidney size and morphology, combined with repeated foetal urine biochemistry may allow for better selection than any single test. SUMMARY: Foetal intervention should be offered to women carrying a foetus with LUTO only after appropriate evaluation and counselling. A combined approach utilizing ultrasound and biochemical measurements of foetal renal function appears best. Research focusing on the development of more accurate markers is needed.
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Enfermedades Fetales , Oligohidramnios , Femenino , Enfermedades Fetales/diagnóstico por imagen , Enfermedades Fetales/terapia , Humanos , Riñón/diagnóstico por imagen , Oligohidramnios/diagnóstico por imagen , Oligohidramnios/terapia , Embarazo , Ultrasonografía , Ultrasonografía PrenatalRESUMEN
Full-term deliveries are defined as occurring between 39 weeks and 40 weeks and 6 days. Because contemporary research suggests improved outcomes with delivery in the term period compared with the early term period, nonindicated delivery should be pursued no earlier than 39 weeks. There are, however, multiple medical, obstetric, and fetal indications for delivery before 39 weeks, and the obstetric provider must weigh the risks and benefits of delivery versus expectant management on both the mother and fetus. This review serves to provide a basic framework of evidentiary support toward optimizing the term delivery.
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Parto Obstétrico/métodos , Trabajo de Parto Inducido/métodos , Nacimiento a Término , Desprendimiento Prematuro de la Placenta/terapia , Cesárea/métodos , Colestasis Intrahepática/terapia , Anomalías Congénitas , Diabetes Gestacional/terapia , Femenino , Retardo del Crecimiento Fetal , Humanos , Hipertensión/terapia , Hipertensión Inducida en el Embarazo/terapia , Obesidad Materna , Oligohidramnios/terapia , Embarazo , Complicaciones del Embarazo/terapia , Complicaciones Cardiovasculares del Embarazo/terapia , Embarazo en Diabéticas , Embarazo Gemelar , Índice de Severidad de la Enfermedad , Mortinato , Factores de TiempoRESUMEN
Early pregnancy renal anhydramios (EPRA) comprises congenital renal disease that results in fetal anhydramnios by 22 weeks of gestation. It occurs in over 1 in 2000 pregnancies and affects 1500 families in the US annually. EPRA was historically considered universally fatal due to associated pulmonary hypoplasia and neonatal respiratory failure. There are several etiologies of fetal renal failure that result in EPRA including bilateral renal agenesis, cystic kidney disease, and lower urinary tract obstruction. Appropriate sonographic evaluation is required to arrive at the appropriate urogenital diagnosis and to identify additional anomalies that allude to a specific genetic diagnosis. Genetic evaluation variably includes karyotype, microarray, targeted gene testing, panels, or whole exome sequencing depending on presentation. Patients receiving a fetal diagnosis of EPRA should be offered management options of pregnancy termination or perinatal palliative care, with the option of serial amnioinfusion therapy offered on a research basis. Preliminary data from case reports demonstrate an association between serial amnioinfusion therapy and short-term postnatal survival of EPRA, with excellent respiratory function in the neonatal period. A multicenter trial, the renal anhydramnios fetal therapy (RAFT) trial, is underway. We sought to review the initial diagnosis ultrasound findings, genetic etiologies, and current management options for EPRA.
Asunto(s)
Anomalías Múltiples/diagnóstico por imagen , Anomalías Congénitas/diagnóstico por imagen , Enfermedades Renales Quísticas/diagnóstico por imagen , Enfermedades Renales/congénito , Riñón/anomalías , Enfermedades Pulmonares/diagnóstico por imagen , Pulmón/anomalías , Oligohidramnios/diagnóstico por imagen , Obstrucción Ureteral/diagnóstico por imagen , Obstrucción Uretral/diagnóstico por imagen , Anomalías Múltiples/etiología , Aborto Inducido , Líquido Amniótico , Ensayos Clínicos como Asunto , Femenino , Humanos , Infusiones Parenterales , Riñón/diagnóstico por imagen , Enfermedades Renales/complicaciones , Enfermedades Renales/diagnóstico por imagen , Enfermedades Renales Quísticas/complicaciones , Pulmón/diagnóstico por imagen , Enfermedades Pulmonares/etiología , Oligohidramnios/etiología , Oligohidramnios/terapia , Cuidados Paliativos , Embarazo , Insuficiencia Renal , Ultrasonografía Prenatal , Obstrucción Ureteral/complicaciones , Obstrucción Uretral/complicacionesRESUMEN
Fetal lower urinary tract obstruction (LUTO), which often results in marked perinatal morbidity and mortality, is caused by a heterogeneous group of anatomical defects that lead to blockage of the urethra. The classic prenatal presentation of LUTO includes megacystis with hydronephrosis. While mild forms of the disease can be associated with favorable outcomes, more severe disease commonly leads to dysplastic changes in the fetal kidneys, and ultimately oligohydramnios, which can result in secondary pulmonary hypoplasia and renal failure at birth. The aim of this review is to provide practitioners with a general overview of the diagnosis and treatment of LUTO based on disease severity, along with some points to consider when counseling prospective parents of fetuses with this condition.
Asunto(s)
Riñón/diagnóstico por imagen , Oligohidramnios/diagnóstico por imagen , Uretra/diagnóstico por imagen , Obstrucción Uretral/diagnóstico por imagen , Vejiga Urinaria/diagnóstico por imagen , Anomalías Múltiples/diagnóstico por imagen , Anomalías Múltiples/etiología , Consejo , Femenino , Terapias Fetales , Humanos , Riñón/anomalías , Pulmón/anomalías , Pulmón/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Enfermedades Pulmonares/etiología , Masculino , Oligohidramnios/etiología , Oligohidramnios/terapia , Embarazo , Atención Prenatal , Diagnóstico Prenatal , Índice de Severidad de la Enfermedad , Ultrasonografía Prenatal , Uretra/anomalías , Obstrucción Uretral/cirugía , Obstrucción Uretral/orina , Vejiga Urinaria/anomalíasRESUMEN
Objective: To evaluate the maternal and perinatal outcomes of labor induction in women at term with oligohydramnios.Methods: A retrospective cohort of women with a singleton pregnancy, who had oligohydramnios at or beyond term (37-42 weeks) and underwent induction of labor for oligohydramnios were studied. Antenatally diagnosed fetal anomalies and intrauterine fetal demise were excluded. The women were categorized into two groups: 1) women with isolated oligohydramnios (n = 166) and 2) women with oligohydramnios associated with other maternal or fetal complications (n = 43). Maternal and perinatal outcomes were collected from the records of all deliveries, data compiled, and appropriate statistical tests were applied.Results: The study included 209 women with mean gestational age of 38.76 ± 1.00 weeks and mean induction-delivery interval of 17.45 ± 8.70 hours (16.98 hours in group 1 versus 19.23 hours in group 2). Most (75%) women delivered vaginally. Only one of the neonates had an Apgar score of less than 7 at 5 min. Average neonatal ICU length of stay was 5.52 days (5.27 days in group 1 versus 6.17 days in group 2). Among all the maternal and neonatal outcomes studied, only the mean birth weights among the two groups was found to be statistically significant (p = 0.0017).Conclusions: Women with isolated oligohydramnios and their neonates were not found to suffer any additional harm due to labor induction at term than women who had oligohydramnios associated with other complications.
Asunto(s)
Trabajo de Parto Inducido/efectos adversos , Oligohidramnios/terapia , Resultado del Embarazo/epidemiología , Puntaje de Apgar , Peso al Nacer , Femenino , Humanos , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Trabajo de Parto Inducido/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Oligohidramnios/diagnóstico por imagen , Embarazo , Tercer Trimestre del Embarazo , Estudios Retrospectivos , Ultrasonografía PrenatalRESUMEN
AIM: Given the scarcity of relevant reports, this study aimed to elucidate whether pregnancy can be prolonged by maintaining the amniotic fluid volume with continuous transabdominal amnioinfusion (TA) for patients with mid-trimester preterm premature rupture of membranes (PPROM) and oligoamnios. METHODS: We retrospectively examined patients who were managed during hospitalization at our department after developing PPROM between week 22 day 0 and week 25 day 6 of gestation and subsequent oligoamnios (amniotic fluid index [AFI] <5 cm) within 7 days after PPROM onset. Cases between 2006 and 2011 comprised the conventional management group (n = 14); cases administered continuous TA between 2012 and 2017 comprised the continuous TA group (n = 14). The primary outcome was the number of days between PPROM and delivery. The secondary outcomes were the proportion of normal amniotic fluid volume (AFI ≥ 5 cm) maintained between PPROM and delivery and the perinatal prognosis for the mother and infant. RESULTS: The continuous TA group had significantly more days between PPROM and delivery and a significantly higher proportion of days that a normal amniotic fluid volume was maintained during that period, regardless of antimicrobial agents administered. Although no significant differences in the perinatal prognosis of disease were found between groups, there was a decreasing trend of composite perinatal mortality and morbidity, and the incidence rates were reduced by half. CONCLUSION: Continuous TA for PPROM with oligoamnios may allow significant prolongation of the gestation period while maintaining the amniotic fluid volume and may lead to improved perinatal prognosis.
Asunto(s)
Líquido Amniótico/fisiología , Rotura Prematura de Membranas Fetales/terapia , Infusiones Parenterales/métodos , Oligohidramnios/terapia , Trimestres del Embarazo/fisiología , Adulto , Amnios/fisiopatología , Parto Obstétrico , Femenino , Rotura Prematura de Membranas Fetales/etiología , Rotura Prematura de Membranas Fetales/fisiopatología , Edad Gestacional , Humanos , Oligohidramnios/etiología , Oligohidramnios/fisiopatología , Embarazo , Resultado del Embarazo , Pronóstico , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: There are two methods to diagnose oligohydramnios: maximal vertical pocket (MVP) and amniotic fluid index (AFI). Following a recent large Cochrane review and other studies, MVP is being recommended as the method of choice by professional societies, after it was shown to result in fewer inductions of labor and C-sections (CS), without compromising neonatal outcome. There is controversy regarding the management of isolated oligohydramnios (IO). It is unclear whether this finding reflects an underlying pathological process, and therefore management protocols differ between different institutions. Studies have shown a higher rate of CS (RR of >2) in IO. Whether this is a true complication of IO or is a result of different confounders like labor inductions and primigravidity is unclear. The effects on neonatal outcomes are also unclear; whereas some authors did not show any adverse effects, others have shown higher rates of neonatal intensive care unit (NICU) admissions, lower Apgar scores and higher rate of Meconium aspiration syndrome. Some studies have shown a higher rate of undiagnosed small for gestational age (SGA) in IO pregnancies. There is no consensus regarding the optimal management and time of delivery. Until now, common practice was to induce labor at term, and some advocate induction in late preterm. Recently, the growing awareness to early term morbidity has led practitioners to question the benefit of early induction. There are several studies that have shown maternal hydration to improve AFI, but there is insufficient data to show the effect on outcomes. In conclusion, many questions regarding IO are still unanswered, and further research, specifically RCT studies, is needed.