Study On Fetal Hydronephrotic Progress And Prognosis Using Ultrasound

Objective: The clinical significance and prognosis of fetal hydronephrosis was studied by constrasting the different ultrasonogrosis in order to provide help for antepartum intervention or postpartum treatment.Materials and Methods: The routine ultrasound examinations were given to 115 pregnant women with fetal hydronephrosis in Qilu Hospital Shandong University. The woman were separated into two groups: within 28 weeks pregnant, fetal hydronephrotic anterposterior renal pelvic diameter (APD)≥ 4mm and beyond 28 weeks pregnant APD≥8mm. Keep the detailed records of APD and thickness of the corticorenal and the dilatation of renal calices, re-examined every 2~4 weeks until the fetal was born. Re-examined the neonatal kidneys separately after one week, one month, three months and six months, keep records of the development of the midtrimester of pregnancy and late pregnancy. Make a single factor analysis to the fetal hydronephrosis of the late pregnancy and get different conclusions. Evaluate the predictive value of every factor to the hydronephrosis by the diagnostic ratio. Make an ultrasound score for every factor. Accumulated scores of every kidney and compared with the conclusion, so as to research the actual value of ultrasound score to the hydronephrosis.Results: In the midtrimester of pregnancy, the fetal hydronephrosis totally 39 kidneys (28 people) which 35.9% disappeared or reduced relatively; 53.8% were not changful relatively or developed slightly; 10.3% developed into the pathological hydronephrosis. In late pregnancy, totally 138 kidneys (106 people) which 82.6% were physiological hydronephrosis and 17.4% were pathologicalhydronephrosis.In late pregnancy, the analysis result of single factor to the fetal hydronephrosis: ?APD^lcm or APD^ 1.2cm, diagnostic sensitivity of pathological hydronephrosis was 100% or 83.3%, the specificity was 55.3% or 86.8%, the positive predictive value was 32% or 57.1%, the negative predictive value was 100% or 96.1%. ? The thickness of the corticorenal<4mm, diagnostic sensitivity of pathological hydronephrosis was 58.3%, the specificity was 98.2%, the positive predictive value was 87.5%, the negative predictive value was 91.8%. ?the dilatation diameter of renal calices>6mm, sensitivity of pathological hydronephrosis was 87.5%, the specificity was 97.4%, the positive predictive value was 87.5%, the negative predictive value was 97.4%.The results of the ultrosound scores to fetal kidneys: the scores^ 4, totally 106 kidneys, which were all physiological hydronephrosis; There were 8x 6^ and 6 kidneys of which the scores were 5, 6, 7 separately, The percentages of the pathological hydronephrosis were separately 37.5%> 66.7%n 83.3%. the scores ^8, totally 12 kidneys, they were all pathological hydronephrosis.Coclusion: The pregnant<28 weeks, fetal hydronephrosis need to be re-examined and can not be predict by the only ultrosound examination. The pregnant^28 weeks, although APD> the thickness of the corticorenal and the dilatation of renal calices can be used as different factors to predict the fetal hydronephrosis, the method of ultrosound score had the larger clinical value by the synthetic analysis of the three factors.