Masters Degrees (Obstetrics and Gynaecology)

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Browsing Masters Degrees (Obstetrics and Gynaecology) by Author "Bezuidenhout, Heidre"

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    Prenatal diagnosis and outcomes of congenital Lower Urinary Tract Obstruction (LUTO) at Tygerberg Hospital Fetal Medicine Unit: an audit of 12 years
    (Stellenbosch : Stellenbosch University, 2015-12) Bezuidenhout, Heidre; Urban, M.; Geerts, L.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics and Gynaecology.
    ENGLISH ABSTRACT: Objective: To determine the frequency, etiology, survival and associated morbidity of prenatally detected Lower Urinary Tract Obstruction (LUTO) to predict outcome and guide prenatal counselling and management. Methods: Retrospective record review of prenatal LUTO cases at the Tygerberg Hospital Fetal Medicine Unit between January 2003 and June 2014. Results: A total of 75 prenatal LUTO cases were detected in 12 years, giving an approximate frequency of 1.2 per 10,000 births calculated over a 3 year period. The median gestation at diagnosis was 22.4 weeks. Prenatally 39 (52%) were classified as ‘Isolated’, 16 (21%) as ‘Isolated with marker’ and 20 (27%) as ‘Complex’. Gender difference observed with predominance of males (60/68) (88%), male:female ratio 7.5:1. Males had predominantly ‘Isolated LUTO’ (n=36, 60%), and females ‘Complex LUTO’ (n=5, 63%). Survival outcomes included: TOP 26 (35%), IUD 1 (1%), Stillbirths 8 (11%), NND 12 (16%), Infant deaths 4 (5%), alive >1 year 16 (21%), Lost to follow-up/Unknown 8 (11%). The most common etiology was PUV (51%). Chromosomal aneuploidy was found in 9.3% (7/75), all in males, with Trisomy 21 the most common anomaly (4/7) (57%). Prenatal findings shown to be significantly associated with a ‘Poor outcome’ are bilateral renal cortex echogenic/cystic changes (p=0.029), anhydramnios (p=0.011) and pulmonary hypoplasia (p=0.003). Morbidity measures showed survivors beyond 1 year of age (n=16) had renal impairment (n=6, 37%), bladder dysfunction (n=4, 25%), recurrent UTI’’s (n=9, 56%). Conclusion: This study adds novel data on the burden and impact of congenital LUTO in a South African, developing country setting. It confirms high mortality and significant morbidity, and supports the predictive value of specific antenatal ultrasound findings. Recommendations for clinical practice include; systematic ultrasound examination for other major anomalies, including soft markers to better define the risk of underlying chromosomal anomalies, determination of gender and karyotyping. The overall poor prognosis makes extensive counselling of the parents essential, especially if detected late in pregnancy, and supports the development of standardised guidelines for congenital anomalies.