Fetal megacystis at 10–14 weeks of gestation

Abstract

During the study period, 24,492 pregnant women attended the Harris Birthright Research Centre at 10-14 weeks of gestation, at which time, in addition to the measurements of nuchal translucency thickness and crown-rump length (CRL), data on fetal abnormalities were recorded onto a computer database. Cases of megacystis were identified and the records were reviewed. Additionally, the relationship of the longitudinal bladder diameter with the CRL and the bladder diameter/CRL ratio (expressed as a percentage) were examined with the use of data from 300 normal fetuses at 10-14 weeks. Megacystis was present in 15 of the 24,492 pregnancies (1 in 1,633) and in these cases the minimum longitudinal bladder diameter was 8 mm and the minimum bladder diameter/CRL ratio was 13%. In the 300 control fetuses the bladder was visualized in 278 (92.7%) of the cases and the longitudinal bladder diameter increased with the CRL (bladder diameter = 0.065 x CRL - 0.69; r = 0.47, p < 0.001), none of the measurements was more than 6 mm and the median bladder diameter/CRL ratio was 5.4% (range 0-10.4%) which did not change significantly with gestation (r = 0.1, p = 0.09). The bladder was visible in all cases with a minimum CRL of 67 mm. In three of the 15 cases with megacystis, there were chromosomal abnormalities. In the chromosomally normal group, there were seven cases with spontaneous resolution, whereas in four cases there was progression to severe obstructive uropathy. The bladder diameter was 8-12 mm and the bladder diameter/CRL ratio 13-22% in all cases with resolution and in one case with progressive megacystis; in the other three cases with progressive obstruction, the bladder length was more than 16 mm and the bladder diameter/CRL ratio was more than 28%.

Vesicocentesis at 10–14 weeks of gestation for treatment of fetal megacystis

“…This is supported by previous studies involving 31 cases of fetal megacystis ( Table 1) which showed that in five of seven cases treated by bladder drainage between 10 and 14 weeks, the postnatal renal function was normal in four and reduced to 50% in one 2,6,7,8 . In a …”

“…Two studies reporting on 21 cases of fetal megacystis found that the incidence of chromosomal abnormality was 20-25% with the most common being trisomies 21, 18 and 13 2,3 . Other anomalies such as the VACTERL syndrome and cystic hygroma have also been associated with the condition 3,4 .…”

“…One such defect is fetal megacystis, which, although it only occurs in 0.06-0.3% of cases at this gestation, presents a management dilemma 2,3 . Without intervention the condition may resolve spontaneously 4 or may progress to severe obstructive uropathy 5 which later in pregnancy may or may not be suitable for, or even improved by, bladder drainage.…”

Prognosis of Diagnosed Megacyctis in the First Trimester Fetus at Our Clinic

“…Ancak ağır olgular progresif obstrüktif renal hasara ilerlerler. 6 Hayatın erken evrelerinde tam obstrüksiyon oluştuğunda renal hipoplazi ve displazi ile sonuçlanır. Aralıklı obstrüksiyonlarda ise normal renal gelişim olabilir.…”

Fetal Abdominal Anomaliler

“…Mesane izlenemediğinde inceleme mutlaka tekrarlanmalıdır. Mesane uzun çapı 10-14. haftalarda 7 mm'nin altında veya CRL'nin %10'undan dü-şük olmalıdır [61,62].…”