| Objective:The aim is to evaluate the prognosis and outcome of fetus through the method of prenatal ultrasound to diagnosis,detect,analysis the index of the latepregnancy fetal with severe pyelectasis.Methods: The Clinical research selected thirty patients(39 sick kidneys)with severe pyelectasis of the third trimester who were found in our hospital and our prenatal ultrasound examination from December,2015 to December,2016.O f these patients,21 had unilateral severepyelectasis,and 9 had bilateral severepyelectasis.In this study,the degree of renal pelvic aneurysm(APD),renal parenc hyma thickness(RPT),renal artery resistance index(RI),renal arterial pulse index(Pulsation index,PI),renal artery(PSV)/ end diastolic velocity(EDV)ratio(S / D)and neonatal renal function(RF)were used as the index of examination.Prognosis and outcome after birth of this part of the fetus were analyzed,and all patients were asked to exam Doppler ultrasonography at 2 weeks,1 month,6 months and 5-7 days before and after delivery for the first time prenatal diagnosis of severe pyelectasis.Patients with pyelectasis after birth were followed up every 3 months,repeated examination of Doppler ultrasound,urography or MRI and renal function,recorded the degree of Renal pelvis anteroposterior diameter separation(APD),Renal parenchymal thinning,Renal vascular resistance index(RI),Pulsatility index(PI)and systolic bloodpressure/diastolic blood pressure(S / D)ratio,and regularly detected renal function in children.The longest follow-up time was 1 year.Results:(1)There were 25 cases of live births and 5 cases of induced fetuses in 30 cases of the late pregnancy fetal with severe pyelectasis;the postnatal follow-up of 25 cases of live birth found 8 cases of pyelectasis was significantly reduced or no significant change in 1 year,who were taken to conservative treatment;3 cases of pyelectasis was disappeared in 1 year;14 cases of pyelectasis was deteriorated in 1 year;who were treated with surgery;Another 5 cases terminated pregnancy by induction of labor in prenatal,only 1 case in th e case of induction of labor performed a karyotype analysis of the amniotic fluid,and the results were confirmed to be 18-trisomy syndrome.(2)25 cases of live births with severe pyelectasis in the late pregnancy were divided into three groups according to their prognosis after birth: group I:pyelectasis was disappeared in postpartum;group II: renal pelvis expansionwas relieved or no change in postpartum;group III: renal pelvis expansionwas aggravated in postpartum.The follow-up results showed that between the pregnancy outcome and renal artery resistance index RI were statistically significant between the groups and there was significant difference between the groups(F renal artery RI = 13.14,P <0.05);the results showed that with the fetal pyelectasis of the severity of the progressive increase,the corresponding renal artery resistance index RI would increase.However,there was no significant difference in PI and S / D ratio between the three groups(F renal artery PI = 0.3012,F renal art ery S / D rat io = 0.3073,P > 0.05).The results of follow-up showed that the pregnancy outcome and APD,renal parenchymal thickness were statistically significant(FAPD = 0.3012,FRPT = 0.743,P <0.05).The results showed that with the fetal pyelectasis of the severity of the progressive increase,the prognosis after birth would be worse.The average range of anterior and posterior diameter of the renal pelvis(APD)of severe pyelectasis of the fetus was about 2.42cm;the average thickness of the renal parenchyma thinning thickness was about 0.27cm;the average range of renal artery resistance index RI value was about 0.85.(3)The correlative analysis between RI and APD was found to be statistically significant(r = 0.4898,P <0.05)between fetalpostpartum pyelectasisreduce or no change group and fetal postpartum pyelectasisaggravated group,and there was significant difference between the two groups.It was a low positive correlation between RI and APD.(4)This study found that comparing the pregnancy outcome of the late pregnancy fetus with unilateral and bilateral severe pyelectasis,the difference was statistically significant(?2 = 19.96,P <0.05).The follow-up results showed that regardless of sex of the patients with the same degree of severe pyelectasis,when comparing the pregnancy outcome of the late pregnancy fetus,there is no statistically significant(?2=0.21,P>0.05).Conclusion:(1)The prognosis of the late pregnancy fetal with severe pyelectasis was related to APD,RPT,renal artery resistance index(RI)and whether the bilateral combined with pyelectasis.(2)Those late pregnancy fetus whose APD> 2.42 cm,renal parenchymal thickness <0.27 cm and renal artery RI> 0.85,should focus on prenatal ultra-sound diagnosis and monitoring in the clinical,if necessary,selected the appropriate gestational age as soon as possible terminated pregnancy.(3)If the fetal pyelectasis is not found obvious remission or progressive increase in the postpartum follow-up observation process,it often prompted the existence of structural abnormalities of the kidney,and urinary tract obstruction of the disease should be highly suspected.At this time,it should be alert that patients with urinary system function is damaged.Because most of the fetus with severe pyelectasis of t he third trimester had pathological obstruction of the water symptoms,it needed active surgical treatment to relieve these symptoms. |
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