Prognosis of Isolated First-Trimester Fetal Megacystis with Spontaneous Resolution

Girard, Noémie; Lesegno, Benjamin Viaris de; Bussiere, P.; Egoroff, Catherine; Cordier, Anne-Gaël; Benachi, Alexandra

doi:10.1159/000458522

Cited by 9 publications

(5 citation statements)

References 8 publications

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“…Fontanella et al reported in 2017 [ 19 ] that diameter bladder is a predictor of spontaneous resolution if the diagnosis is made before 18 weeks (80% sensitivity and 79% specificity). They specified that spontaneous regression before 23 weeks is a marker of favorable neonatal outcome, without urological surgical intervention, which is consistent with the 2017 study by Girard et al [ 29 ].…”

Section: Discussionsupporting

confidence: 78%

Megacystis in the first trimester of pregnancy: Prognostic factors and perinatal outcomes

et al. 2021

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Objective To determine whether bladder size is associated with an unfavorable neonatal outcome, in the case of first-trimester megacystis. Materials and methods This was a retrospective observational study between 2009 and 2019 in two prenatal diagnosis centers. The inclusion criterion was an enlarged bladder (> 7 mm) diagnosed at the first ultrasound exam between 11 and 13+6 weeks of gestation. The main study endpoint was neonatal outcome based on bladder size. An adverse outcome was defined by the completion of a medical termination of pregnancy, the occurrence of in utero fetal death, or a neonatal death. Neonatal survival was considered as a favorable outcome and was defined by a live birth, with or without normal renal function, and with a normal karyotype. Results Among 75 cases of first-trimester megacystis referred to prenatal diagnosis centers and included, there were 63 (84%) adverse outcomes and 12 (16%) live births. Fetuses with a bladder diameter of less than 12.5 mm may have a favorable outcome, with or without urological problems, with a high sensitivity (83.3%) and specificity (87.3%), area under the ROC curve = 0.93, 95% CI (0.86–0.99), p< 0.001. Fetal autopsy was performed in 52 (82.5%) cases of adverse outcome. In the 12 cases of favorable outcome, pediatric follow-up was normal and non-pathological in 8 (66.7%). Conclusion Bladder diameter appears to be a predictive marker for neonatal outcome. Fetuses with smaller megacystis (7–10 mm) have a significantly higher chance of progressing to a favorable outcome. Urethral stenosis and atresia are the main diagnoses made when first-trimester megacystis is observed. Karyotyping is important regardless of bladder diameter.

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Section: Discussionsupporting

confidence: 78%

Megacystis in the first trimester of pregnancy: Prognostic factors and perinatal outcomes

et al. 2021

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“…In a study of 16 first trimester megacystis cases only two were associated with oligohydramnios, all had a bladder size greater than 9 mm, 10 were associated with additional findings, and four had abnormal karyotype (2 cases of trisomy 13, one case of trisomy 18 and one case of trisomy 21) 3 . Spontaneous resolution of first trimester megacystis has been described in the literature, with a 2.4% risk of chromosomal abnormalities in such cases and normal pediatric follow‐up in 96.4% of cases 4 …”

Section: Fetal Megacystis and Lower Urinary Tract Obstruction (Luto)mentioning

confidence: 94%

“…3 Spontaneous resolution of first trimester megacystis has been described in the literature, with a 2.4% risk of chromosomal abnormalities in such cases and normal pediatric follow-up in 96.4% of cases. 4 Fetal lower urinary tract obstruction (LUTO) occurs in 2.2-3.4 of 10,000 live births, but the incidence is higher owing to fetal loss. 5,6 The clinical course of LUTO is variable and dependent on etiology, duration, and age at onset of the obstruction.…”

Section: Fetal Megacystis and Lower Urinary Tract Obstruction (Luto)mentioning

confidence: 99%

Development and validation of a novel fetal vesico‐amniotic shunt, the vortex shunt

Blumenfeld,

Sheth,

Johnson

et al. 2023

Prenatal Diagnosis

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Fetal lower urinary tract obstruction (LUTO) is a severe malformation associated with an up to 80% mortality risk as well as significant renal and pulmonary morbidity in survivors. Fetal vesico‐amniotic shunts (VAS) bypass the bladder obstruction, improve amniotic fluid volume and enhance in‐utero pulmonary development. VAS has been shown to reduce respiratory morbidity and mortality in the neonatal period without proven benefit on long‐term renal and bladder function. Clinically available shunts are associated with an up to 80% dislodgement rate, leading to repeat invasive procedures which increase fetal and maternal risks. We developed a novel “Vortex” shunt, which incorporates enhanced fixation to reduce dislodgement, a one‐way valve to optimize in‐utero bladder function, and enhanced sonographic echogenicity that optimizes the accurate deployment. Following the validation of these characteristics in initial benchtop experiments we have moved to feasibility studies in the fetal lamb model. We hope that the Vortex shunt may ultimately facilitate shunt deployment, reduce dislodgement risk, improve neonatal morbidity and mortality, and decrease the significant healthcare expenditures associated with long‐term morbidity in LUTO survivors. In this manuscript, we review the natural history of LUTO, the risks and benefits of clinically available fetal shunts, and our development and early validation experiments.

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“…113 An enlarged bladder (length in the sagittal plane of ≥7 mm) has been associated with aneuploidy and lower urinary tract obstruction; however, in the euploid fetus, it may be a transient finding with a good outcome. 26,113,114 Fetal Spine and Extremities The fetal extremities are easily visible between 12 weeks 0 days and 13 weeks 6 days. 115 Major limb reduction anomalies can be detected at this gestational age.…”

Section: Fetal Neckmentioning

confidence: 99%

“…In some euploid fetuses, there is delayed return of the bowel into the abdominal cavity without other complications 113 . An enlarged bladder (length in the sagittal plane of ≥7 mm) has been associated with aneuploidy and lower urinary tract obstruction; however, in the euploid fetus, it may be a transient finding with a good outcome 26,113,114 …”

Section: Specifications Of the Examinationmentioning

confidence: 99%

AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12 Weeks 0 Days and 13 Weeks 6 Days

2020

J of Ultrasound Medicine

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This practice parameter is intended to provide the medical ultrasound community with recommendations for the performance and recording of high-quality ultrasound examinations. The parameter reflects what the AIUM considers the appropriate criteria for this type of ultrasound examination but is not intended to establish a legal standard of care. Examinations performed in this specialty area are expected to follow the parameter with recognition that deviations may occur depending on the clinical situation.This specialized diagnostic examination is an extension of the standard sonographic fetal assessment described in the AIUM-ACR-ACOG-SMFM-SRU Practice Parameter for the Performance of Standard Diagnostic Obstetric Ultrasound Examinations and the American College of Obstetricians and Gynecologist practice bulletin Ultrasound in Pregnancy. 1,2 The detailed obstetric ultrasound examination in the late first trimester is an indication-driven examination for women at increased risk for fetal or placental abnormalities that are potentially detectable between 12 weeks 0 days and 13 weeks 6 days' gestation. Performance and interpretation of this examination require advanced training, knowledge, and imaging

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Prognosis of Isolated First-Trimester Fetal Megacystis with Spontaneous Resolution

Cited by 9 publications

References 8 publications

Megacystis in the first trimester of pregnancy: Prognostic factors and perinatal outcomes

Megacystis in the first trimester of pregnancy: Prognostic factors and perinatal outcomes

Development and validation of a novel fetal vesico‐amniotic shunt, the vortex shunt

AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12 Weeks 0 Days and 13 Weeks 6 Days

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