Antenatal hydronephrosis (ANH) is one of the most common abnormal findings detected on prenatal ultrasound (US), and it has been reported in 1-5% of all pregnancies. The likelihood of significant postnatal pathologic abnormality in the urinary tract correlates with the degree of anterior-posterior diameter (APD) according to the gestational age. Detection of urologic anomalies prenatally permits fetal interventions that avoid complications in rare cases of bladder outlet obstruction with oligohydramnios even though their final benefits still remain controversial. There is no clear consensus on the extent and mode of postnatal imaging after a diagnosis of ANH. US is the mainstay of the postnatal evaluation and helps guide further testing with voiding cystourethrography (VCUG) and diuretic renography. Although most algorithms continue to recommend generous VCUG for identification of lower urinary tract anomalies, VCUG may be safely reserved for high grade ANH cases or any grade of ANH with dilated distal ureter without increasing the risk of urinary tract infection (UTI). There are conflicting studies about efficacy of postnatal prophylactic antibiotics. It still seems reasonable to consider use of a prophylactic antibiotic to prevent infant UTIs in high-risk populations, such as females and uncircumcised males with high grades of hydronephrosis, hydroureteronephrosis, or vesicouretral reflux.
Anti-Bacterial Agents ; Child ; Consensus ; Diagnosis ; Diagnostic Imaging ; Female ; Gestational Age ; Humans ; Hydronephrosis* ; Infant ; Male ; Oligohydramnios ; Pregnancy ; Prenatal Diagnosis ; Radioisotope Renography ; Ultrasonography ; Ureter ; Urinary Bladder Neck Obstruction ; Urinary Tract ; Urinary Tract Infections

Antenatal hydronephrosis (ANH) is one of the most common abnormal findings detected on prenatal ultrasound (US), and it has been reported in 1-5% of all pregnancies. The likelihood of significant postnatal pathologic abnormality in the urinary tract correlates with the degree of anterior-posterior diameter (APD) according to the gestational age. Detection of urologic anomalies prenatally permits fetal interventions that avoid complications in rare cases of bladder outlet obstruction with oligohydramnios even though their final benefits still remain controversial. There is no clear consensus on the extent and mode of postnatal imaging after a diagnosis of ANH. US is the mainstay of the postnatal evaluation and helps guide further testing with voiding cystourethrography (VCUG) and diuretic renography. Although most algorithms continue to recommend generous VCUG for identification of lower urinary tract anomalies, VCUG may be safely reserved for high grade ANH cases or any grade of ANH with dilated distal ureter without increasing the risk of urinary tract infection (UTI). There are conflicting studies about efficacy of postnatal prophylactic antibiotics. It still seems reasonable to consider use of a prophylactic antibiotic to prevent infant UTIs in high-risk populations, such as females and uncircumcised males with high grades of hydronephrosis, hydroureteronephrosis, or vesicouretral reflux.
Anti-Bacterial Agents ; Child ; Consensus ; Diagnosis ; Diagnostic Imaging ; Female ; Gestational Age ; Humans ; Hydronephrosis* ; Infant ; Male ; Oligohydramnios ; Pregnancy ; Prenatal Diagnosis ; Radioisotope Renography ; Ultrasonography ; Ureter ; Urinary Bladder Neck Obstruction ; Urinary Tract ; Urinary Tract Infections

PURPOSE: Pulmonary hypertension (PH) is known as a major risk factor for preterm infants deaths, and associated with low gestational age, low birth weight, longer duration of oxygen therapy, low Apgar scores, and oligohydramnios. The aim of this study was to determine the risk factors for PH in preterm infants with chronic lung disease. METHODS: A retrospective review was performed of data from 86 infants (<32 weeks of gestation) who diagnosed with chronic lung disease at Severance Children's Hospital from July 2006 to June 2011. PH was diagnosed on the basis of echocardiogram demonstrating elevated right ventricle pressure. The infants were divided into two groups: PH group (n=18) or control group (n=67). RESULTS: PH group showed lower gestational age and underwent longer duration of oxygen therapy, mechanical ventilation, and hospitalization compared with control group. PH group received more surfactant therapy, and the frequency of the development of intraventricular hemorrhage (IVH) (> or =G3) and severe chronic lung disease was higher in PH group than control group. According to multivariate analysis, IVH (> or =G3) (OR=5.00, 95% CI=1.10-22.63, P=0.037) and severe BPD (OR=2.43, 95% CI=1.03-15.41, P=0.045) were found to be significant risk factors for PH in preterm infants with chronic lung disease. CONCLUSION: Pulmonary hypertension was significantly increased in preterm infants with chronic lung disease when associated with IVH (> or =G3). We suggest that effort for early diagnosis and management for PH would be helpful in preterm infants with chronic lung disease when severe IVH was combined.
Bronchopulmonary Dysplasia ; Early Diagnosis ; Female ; Gestational Age ; Heart Ventricles ; Hemorrhage ; Hospitalization ; Humans ; Hydrogen-Ion Concentration ; Hypertension, Pulmonary ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Lung ; Lung Diseases ; Multivariate Analysis ; Oligohydramnios ; Oxygen ; Pregnancy ; Respiration, Artificial ; Retrospective Studies ; Risk Factors

PURPOSE: In Korea, neonatal clinical features and feeding pattern are not reported systematically. So we report the neonatal presentation of Prader-Willi syndrome. METHODS: This is a retrospective study of 14 neonate with Prader-Willi syndrome whose diagnosed in neonatal intensive care unit, Samsung Medical Center between January 1st 1997 and December 30th 2011. RESULTS: The birth characteristics of patients, maternal age was 31.5+/-4.5 years and 5 (35.7%) were primiparous. Oligohydramnios were reported in 2 cases (14.2%), polyhydramnios were reported in 4 cases (28.5%). 5 pregnancies (35.7%) had complained that decreased fetal movements. Mean gestational age were 38.1+/-2.2 weeks and 12 patients (85%) were term infants, one patient (7.1%) was post term infant, the other patient was preterm infants (7.1%). The average weight at birth were 2509.0+/-442.5 grams. All 14 patients (100%) had hypotonia and a weak cry at birth. 9 patients (64.5%) had the characteristic facial dysplasia. In all, nine male patients (100%) had cryptorchidism. All patients had weak sucking power, so they started to eat via nasogastric tube at birth. The mean duration of use nasogastric tube were 3.2+/-2.0 months. The median age of diagnosis were 1.5 months. 7 cases (50%) were diagnosed within one month of life. Median time of starting GH treatment was 2.0 years. The mean interval of from diagnosis to treatment of growth hormone were 2.2+/-2.0 years. CONCLUSION: Early diagnosis of Prader-Willi syndrome is a very important to improve long-term prognosis.
Cryptorchidism ; Early Diagnosis ; Feeding Behavior ; Female ; Fetal Movement ; Gestational Age ; Growth Hormone ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Intensive Care, Neonatal ; Korea ; Male ; Maternal Age ; Muscle Hypotonia ; Oligohydramnios ; Parturition ; Phenotype ; Polyhydramnios ; Prader-Willi Syndrome ; Pregnancy ; Prognosis ; Retrospective Studies

Cantrell's Pentalogy is a rare condition that consists of defects involving the abdominal wall, lower sternum, anterior diaphragm, pericardium, and heart. In the literature to date, pregnant women with Cantrell's Pentalogy have not been discussed. We performed successful vaginal delivery of a 23-yr-old nulliparous, primigravid woman who had been diagnosed with this condition. Diagnosis was based on cardiac catheterization, angiography, and echocardiogram, and abdominopelvic CT. Vaginal delivery may be an option for women with Cantrell's Pentalogy and may be attempted with caution.
Abdominal Muscles/abnormalities ; Abdominal Wall/abnormalities ; *Abnormalities, Multiple ; Diaphragm/abnormalities ; Echocardiography ; Female ; Humans ; Oligohydramnios/diagnosis ; Pregnancy ; *Pregnancy Complications ; Pregnancy Outcome ; Sternum/abnormalities ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVES: To compare the systematic evaluations in hospitalization of mildly preeclamptic women whose placental dysfunction was exacerbated with those whose placental dysfunction was not exacerbated. METHODS: There were seventy six mildly preeclamptic women after systematic evaluations in hospitalization, in which twenty eight women showed exacerbated placental dysfunction. Outcome markers considered suggestive of exacerbation of placental dysfunction included oligohydramnios (amniotic fluid index less than 5 cm), clinical diagnosis of intrapartum fetal distress and progression to severe preeclampsia. A clinical diagnosis of fetal distress was made when the monitoring revealed recurrent late, persistent tachycardia with loss of variability or prolonged decelerations. RESULTS: There were no significant differences in the amount of 24 hours urine protein, the concentrations in serum protein, creatinine, aspartate transaminase and alanine transaminase and hematocrit. But in exacerbated group, the concentrations of serum albumin and urine creatinine and creatinine clearance were significantly lower and the concentrations of serum uric acid and lactate dehydrogenase were significantly higher than not exacerbated group. CONCLUSION: In mildly preeclamptic women diagnosed after systematic evaluation in hospitalization, we must give attention to those whose concentrations of serum albumin and urine creatinine and creatinine clearance are low and concentrations of serum uric acid and lactate dehydrogenase are high.
Alanine Transaminase ; Aspartate Aminotransferases ; Creatinine ; Deceleration ; Diagnosis ; Female ; Fetal Distress ; Hematocrit ; Hospitalization* ; Humans ; L-Lactate Dehydrogenase ; Oligohydramnios ; Pre-Eclampsia ; Pregnancy ; Serum Albumin ; Tachycardia ; Uric Acid

OBJECTIVE:The purpose of this study was to compare the sensitivity of proton Magnetic Resonance Spectrography (MRS) for estimating absolute metabolite concentrations and ratio of fetal brains. METHODS:Between September 2005 and August 2006, our study was prospective single center trial and included 39 healthy women (Group 1: fetuses with risk factor of fetal distress or hypoxic damage [n=15], Group 2: fetal CNS anomalies on ultrasound [n=12], Group 3: normal fetuses [n=12]). We quantified resonances for the main proton MRS-detectable brain and calculated metabolite ratios of the three groups. We compared the obtained metabolite levels of the three groups with electronic fetal cardiotocography, Doppler ultrasound examination, Apgar score, and umbilical artery blood gas analysis. RESULTS:Abnormal amniotic fluid, abnormal Doppler studies, and abnormal cardiotocograms were significantly more prevalent in Group 1 compared with those of Group 2 and 3. In Group 1, choline (Cho) levels (7.86+/-3.51mmol/L) were significantly higher than in Group 2 or 3 (p=0.024). The ratios of N-acetylasparate (NAA)/creatinine-phosphocreatine (Cr) and Cho/Cr were increased whereas the ratios of NAA/Cho, lactate (Lac)/Cho, Lac/NAA, and Lac/Cr were decreased; however, there was no statistical significance. In patients who have oligohydramnios and absence of umbilical diastolic flow, choline and N-acetylasparate levels were significantly elevated (p<0.05, p<0.05, respectively). But, MRS metabolites and ratios showed no significant differences for low Apgar scores, umbilical arterial academia, uterine artery notching, maternal blood pressure or abnormal fetal cardiotocograms. CONCLUSION:This study demonstrates the possibility of performing proton MRS to assess the metabolic information of the fetal brain. Further technical progress may be useful of improving the degree of detection of hypoxic changes or an impending hypoxic state for prenatal diagnosis.
Amniotic Fluid ; Apgar Score ; Blood Gas Analysis ; Blood Pressure ; Brain* ; Cardiotocography ; Choline ; Female ; Fetal Distress ; Fetus ; Humans ; Lactic Acid ; Magnetic Resonance Spectroscopy* ; Oligohydramnios ; Pregnancy ; Prenatal Diagnosis ; Prospective Studies ; Protons* ; Risk Factors ; Ultrasonography ; Umbilical Arteries ; Uterine Artery

Although congenital renal tumors are rare, congenital mesoblastic nephroma (CMN) is the most common renal tumor in early infancy. It is non-metastatic, well differentiated, amenable to surgical removal, and carries a good prognosis. Polyhydramnios has been detected in most of the published cases of CMN. However, we experienced a rare case of fetal CMN associated with oligohydramnios. A 28-yr old woman at 34 weeks of gestation was referred to our hospital for oligohydramnios and a fetal abdominal mass. An ultrasonography revealed a huge, well-encapsulated mass arising from the right kidney. An emergency cesarean section was performed due to fetal distress. After birth, despite intensive neonatal care, the baby died because of renal failure, disseminated intravascular coagulopathy, pulmonary edema, together with other problems.
Pregnancy ; Oligohydramnios/*diagnosis/therapy ; Nephroma, Mesoblastic/*diagnosis/therapy ; Kidney Neoplasms/*diagnosis/therapy ; Infant, Newborn ; Humans ; Fetal Diseases/etiology/prevention & control ; Female ; Fatal Outcome ; Cesarean Section ; Adult

Fetal bilateral renal agenesis is a lethal congenital anomaly characterized by bilateral pulmonary hypoplasia, deformities and death due to severe oligohydramnios. This syndrome is associated with malformations of genitourinary tract, cardiovascular system, vertebral bodies or imperforated anus in more than half of the affected individuals. An early and reliable prenatal diagnosis is extremely important because it may offer options for pregnancy termination as early as possible. The criteria for the ultrasonographic diagnosis of bilateral renal agenesis are severe oligohydramnios, nonvisualization of the bladder, empty renal fossae. But poor sonographic resolution of severe oligohydramnios makes it difficult to diagnose the disease. We present a case of bilateral renal agenesis diagnosed at the 18th weeks gestation by using Transvaginal Ultrasonography and Color Doppler.
Anal Canal ; Cardiovascular System ; Congenital Abnormalities ; Diagnosis ; Female ; Oligohydramnios ; Pregnancy ; Prenatal Diagnosis ; Ultrasonography* ; Urinary Bladder

PURPOSE: Ultrasonography is being widely used as a standard test in obstetric care, studies on congenital hydronephrosis. Focusing on specific prenatal history and frequently associated anomalies in newborn infants with hydronephrosis, this investigation was intended to suggest particulars that need to be considered in making an accurate diagnosis of fetal hydronephrosis. METHODS: From May 2000 to May 2005, retrospective study was conducted on 67 patients (93 kidney) who had been diagnosed by renal ultrasonography during neonatal periods. Hydronephrosis was defined as having a pelvic diameter more than 5 mm, and was classified into three groups according to their severity;mild (grade I, II), moderate (grade III) and severe (grade IV). RESULTS: This study included 67 cases with 54 male and 13 female infants. There were 35 cases with a specific prenatal history in 22 infants such as oligohydramnios, intrauterine growth retardation, preeclampsia and others. 33 cases in 23 infants had associated anomalies such as urogenital anomalies, cardiac anomalies. Of these 67 infants (97 kidneys), 49.5% was mild, 30.1% moderate, 20.4% severe hydronephrosis. Infants with moderate hydronephrosis had more specific prenatal history and associated anomaly than the mild hydronephrosis did (68.2% vs 31.8%, P<0.001 73.7% vs 26.3%, P<0.001). CONCLUSION: Particular attention should be paid for cases with congenital hydronephrosis with a specific prenatal history to find out any associated congenital anomalies (such as urogenital or cardiac anomalies). This will enable clinicians to establish a more appropriate treatment and postnatal care.
Diagnosis ; Female ; Fetal Growth Retardation ; Humans ; Hydronephrosis* ; Infant ; Infant, Newborn* ; Male ; Oligohydramnios ; Postnatal Care ; Pre-Eclampsia ; Pregnancy ; Retrospective Studies ; Ultrasonography