OP33.08: Prenatal diagnosis of renal duplex systems. Ultrasonographic features and postnatal outcomes

10–14 October 2010, Prague, Czech Republic

OP33.07 Evaluation and outcome of prenatal non visualization of gallbladder

Short oral presentation abstracts

of prenatally diagnosed duplex systems seems to be essentially benign within the available follow up.

O. Shen1,2 , R. Rabinowitz1 , S. Yagel2 , G. Moran3

Supporting information can be found in the online version of this abstract.

1

Obstetrics and Gynecology, Shaare Zedek Medical Center, Jerusalem, Israel; 2 Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Mt. Scopus, Jerusalem, Israel; 3 Genetics, Shaare Zedek Medical Center, Jerusalem, Israel Objectives: Nonvisualization of the fetal gallbladder on prenatal ultrasound in the second trimester is uncommon. In most cases, the gallbladder will eventually be detected. Associations with cystic fibrosis, aneuploidy, agenesis of the gallbladder and biliary atresia have been reported. We present our experience and review the literature. Methods: Cases of nonvisualization of the gallbladder were confirmed by 2 examiners on at least 2 occasions and at least a week apart from 18–22 wks. Cases with no additional sonographic malformations were designated as isolated. Further evaluation included follow up scans and a meticulous search for fetal anomalies. All were offered genetic consultation. Cystic fibrosis testing and amniocentesis for karyotype and digestive enzymes in amniotic fluid were performed at the discretion of the referring physician. Results: A total of 20 cases of nonvisualization of the gallbladder were detected. Of these, 5 had additional malformations. In 4 of these cases the associated anomalies were severe, and fetuses were aborted due to aneuploidy or the severity of the associated anomalies. Of the remaining 15 cases, one was aborted due to cystic fibrosis. In all the other 14 cases development was normal with follow up of 4 months to 4 years. Conclusions: When prenatal nonvisualization of the fetal gallbladder is associated with other severe malformation, aneuploidy should be suspected. When isolated, if cystic fibrosis is ruled out, the outcome is good.

OP33.08 Prenatal diagnosis of renal duplex systems. Ultrasonographic features and postnatal outcomes M. B. Adiego, P. Martinez, J. Perez, T. Illescas, E. Barron DELTA-Ultrasound Diagnostic Center in Obstetrics and Gynecology, Madrid, Spain Objectives: To assess the accuracy of ultrasound diagnosis of duplex renal systems and to describe the natural history of prenatally diagnosed duplex systems. Methods: Observational retrospective study of cases with antenatal diagnosis of duplex system. The ultrasound features leading to the suspicion of duplex system included: a) identification of two separate renal poles, b) dilatation or cystic areas in an upper or lower pole, c) dilated ureter and d) cystic anechoic structure within the bladder suggesting ureterocele. Results of postnatal follow-up were obtained from hospital records. Results: Of a total of 24 cases of suspected duplex systems 22 were followed until complete postnatal diagnosis. Duplex system was confirmed in 95.4% (21/22). Presence of two separate dilated renal poles was the most prevalent ultrasound feature followed by dilatation of a single pole in addition to ipsilateral dilated ureter and / or ureterocele. In half of the cases (47.6%) duplex systems had a benign course but in 38.1% urinary tract infection occurred and in 29% some kind of surgical procedure was needed. Conclusions: Duplex systems can be accurately diagnosed when there is even minimal pelvis dilatation. Antenatal diagnosis allows planning of postnatal care with a high accuracy. The natural history

Ultrasound in Obstetrics & Gynecology 2010; 36 (Suppl. 1): 52–167

Images of duplex systems, dilated ureter and ureterocele.

OP33.09 Echogenic kidneys in the fetus: correlation with postnatal outcome J. L. Byrne1 , P. J. Woodward2 , T. C. Winter2 , J. R. Sherbotie3 , A. Kennedy2 1 Obstetrics & Gynecology, University of Utah Hospital and Clinics, Salt Lake City, UT, USA; 2 Radiology, University of Utah Hospital and Clinics, Salt Lake City, UT, USA; 3 Pediatric Nephrology and Hypertension, University of Utah Hospital and Clinics, Salt Lake City, UT, USA

Objectives: To demonstrate the ultrasound findings and clinical outcome in a series of fetuses with echogenic kidneys. Methods: Prospective review of a series of 25 cases of echogenic fetal kidneys seen in a single academic center over a 2.5 year period. Results: Cases were found on routine mid-trimester ultrasound. Kidneys were described as echogenic if they were brighter than liver parenchyma. None of the cases exhibited obvious cystic changes. Enlargement of the kidneys was noted in several cases. 11 of the 25 cases exhibited normalization of echogenicity during the course of gestation. Of those 11 cases, 8 were male and more likely to also have transient pelviectasis during gestation. Of the 14 cases with persistent echogenicity ± renal enlargement, only 4 were normal by imaging and function at the time of birth. Significant abnormalities identified in the remaining cases included 3 cases of autosomal recessive polycystic kidneys, 2 cases of Beckwith-Wiedemann, 1 case of cystic renal dysplasia, 2 cases of trisomy 13, and 1 case with a yet unspecified abnormality. 1 case remains undelivered. Conclusions: The wide spectrum of outcome in cases of echogenic fetal kidneys makes prediction of prognosis difficult. Preservation of normal renal architecture and size and normal amniotic fluid are important prognostic indicators. According to our series of echogenic fetal kidneys, there is about a 50% chance of resolution prior to birth. The higher preponderance of male gender with the associated pelviectasis may be causal in ‘false positive’ cases. Of cases with persistence of abnormal echogenicity ± renal enlargement throughout gestation, about 2/3 will have significant renal impairment, often with an associated genetic syndrome. Postnatal imaging and evaluation of renal function in order to determine appropriate follow-up is essential. A multidisciplinary approach to management including involvement of pediatric subspecialists and genetic counseling is recommended.

OP34: FIRST TRIMESTER IV: GROWTH AND PREDICTING PREGNANCY OUTCOME OP34.01 Estimation of onset of pregnancy: crown–rump length, last menstrual period or both? J. Stirnemann1,2 , J. Thalabard2 , J. Bernard1 , Y. Ville1 1

Obstetrics and Fetal Medicine, GHU Necker-Enfants Malades, University Paris Descartes, Paris, France; 2 Applied Mathematics and Statistics, MAP5, UMR CNRS 8145, Universit´e Paris Descartes, Paris, France Objectives: Crown–rump length (CRL) has been proven the most accurate method of estimation of onset of pregnancy (DOP) and

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