Prenatal diagnosis and management of abnormalities in the urologic system

Risk of congenital anomalies detected during antenatal serum screening in women with pregestational diabetes

BACKGROUND

Most studies comparing women with and without pregestational diabetes mellitus have not systematically screened for fetal anomalies in early pregnancy, potentially leading to selection bias.

AIM

To evaluate the risk for certain congenital anomalies in women participating in an antenatal maternal screening program.

DESIGN

Retrospective cohort study.

METHODS

We studied all women who underwent antenatal maternal serum screening in Ontario from 1994 to 2000. Fetal anomalies were documented antenatally by ultrasonography or at autopsy, and postnatally diagnosed birth defects were recorded after 20 weeks gestational age for all live- and stillborn affected infants. We compared the risk of open neural tube defects and urinary tract defects among women with and without pregestational diabetes.

RESULTS

Of 413,219 women screened during pregnancy, 2069 (0.5%) had diabetes. Compared to non-diabetic women, the adjusted odds ratios (95%CI) for neural tube and urinary tract defects among women with diabetes were 2.5 (0.9-6.8) and 2.6 (1.4-4.9), respectively.

DISCUSSION

Among women who undergo second trimester maternal serum screening, pregestational diabetes is associated with an increased risk of having a fetus with an open neural tube defect or urinary tract disorder.

Features described and illustrated in 1684 suggesting Meckel-Gruber syndrome

In 1684, Mr. Christopher Krahe described a monstrous child, born in Denmark on Friday, February 29, 1684. The description is suggestive of a diagnosis of Meckel-Gruber syndrome (dysencephalia splanchnocystica). This may represent the oldest description and illustration of the syndrome, of which the first detailed description is attributed to Johann Friedrich der Jüngere in 1822.

The early development of the fetal kidney-an in utero sonographic evaluation between 13 and 22 weeks' gestation

OBJECTIVES

To establish a nomogram for early fetal kidney development during early gestation.

METHODS

The study is a prospective, cross-sectional evaluation of 275 male and female fetuses between 13 and 22 weeks in normal singleton pregnancies. Measurements of fetal kidney length were performed by high resolution transvaginal ultrasonography between 14 and 17 weeks' gestation, and by transabdominal ultrasonography beyond 18 weeks' gestation.

RESULTS

Adequate kidney length measurements were obtained in all 275 normal fetuses as well as in six fetuses with urinary tract anomalies. Kidney length as a function of gestational age was expressed by the regression equation: (square root) kidney length (mm) = -11.66 + 1.52 x gestational age (weeks). The correlation coefficient, r = 0.983 was found to be highly statistically significant (p < 0.0001). The normal mean and the 90% prediction limits were defined. Four cases with single kidney and two cases with posterior urethral valve had kidney length above the 95% upper limit.

CONCLUSION

The present data offer a normal range of fetal kidney length from early stages of gestation that may allow intrauterine assessment of its development. It may also be helpful in the early prenatal diagnosis of renal abnormalities.