Ultrasonographic study and Doppler flow velocimetry of maternal kidneys and liver in low-risk pregnancy

Sonographic Assessment of Renal Volume in Normotensive Pregnant Women and Women With Pregnancy-Induced Hypertension in Enugu Metropolis

Objective:

Renal volume (RV) assessment during obstetric sonography is rarely considered in our locality. Understanding the changes in RV in both normotensive pregnant (NP) and pregnancy-induced hypertensive (PIH) women is important in making correct diagnosis regarding pregnancy outcome. This study is aimed at determining the RV in NP and PIH women and correlating RV with fetal gestational age (FGA), body mass index (BMI), and parity in NP women.

Materials and Methods:

This cross-sectional study involved 450 patients recruited at a Tertiary Hospital. A pilot study was done to determine the interobserver variability in RV measurement. RV was calculated using the following formula: L × W × AP × 0.523. Parity, BMI, and blood pressure were documented, while FGA was calculated as an average of FGAs obtained from the measurements of fetal biometric parameters.

Results:

Mean RV of PIH women was significantly higher than that of NP women ( P < .05). RV shows a positive significant relationship with BMI and FGA, while it shows a negative relationship with parity in NP ( P < .05).

Conclusion:

Reference range values of RV were generated for clinical use in our locality, while there is statistically significant difference between RV in NP and PIH women.

Management of pregnancy in women with cirrhosis

Although pregnancy is rare in women with cirrhosis, it is increasingly prevalent in an era of modern assisted conception techniques and improved awareness, monitoring and management of underlying liver disease. After overcoming the difficulties of subfertility and becoming pregnant, women undergo a 'high-risk' pregnancy which can be complicated by variceal haemorrhage (≤50%) and hepatic decompensation (≤25%). Management of these complications are similar to non-pregnant individuals. However, there are a few caveats to consider. These pregnancies are associated with adverse maternal and foetal outcomes, such as mortality (0%-8%) and prematurity (19%-67%) in the newborn, and mortality (0%-14%), pregnancy-induced hypertension (5%-22%) and post-partum haemorrhage (5%-45%) in the mother. Pre-pregnancy counselling, use of predictive scores and appropriate variceal screening during pregnancy can stratify patients and improve outcomes. This review focusses on the complications that can occur during pregnancy in women with cirrhosis.

Maternal Physiologic Renal Pelvis Dilatation in Pregnancy: Sonographic Reference Data

OBJECTIVES

The purpose of this study was to produce sonographic reference data for maternal renal pelvis dilatation in asymptomatic pregnant women.

METHODS

A prospective cross-sectional study was undertaken on pregnant women presenting for outpatient obstetric imaging. For each side, the renal length and axial anteroposterior diameter of the renal pelvis were measured. Maternal demographics, gravidity and parity, number of fetuses, and estimated fetal weight (when available) were recorded.

RESULTS

A total of 700 women enrolled, with 191 excluded. The 509 women analyzed included 465 singleton and 44 twin pregnancies. A total of 815 sonographic investigations were performed: 716 in singleton pregnancies and 99 in twin pregnancies. The gestational age range was 10 to 40 weeks. Charts depicting the anteroposterior renal pelvis diameter versus gestational age were constructed to determine normative sonographic reference data for maternal renal pelvis dilatation in singleton pregnancies. Although the mean renal pelvis diameter increased as pregnancy progressed, measurements of greater than 10 mm remained relatively uncommon, being identified in 9.7% of right and 2.1% of left kidneys in the third trimester. Only 4.1% of right and 0.4% of left third-trimester measurements exceeded 15 mm. Right renal pelvis measurements on average were greater than the left by 1.54 mm (95% confidence interval [CI], 1.20 to 1.87 mm). Twins had significantly larger renal pelvis measurements than singletons on average, measuring 2.11 mm (95% CI, 1.50 to 2.72 mm) larger on the right and 1.69 mm (95% CI, 0.73 to 2.65) on the left.

CONCLUSIONS

We present sonographic reference data for asymptomatic pregnancy-related renal pelvis dilatation in singleton pregnancies from a large cohort of women.