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Objective To propose a clinical score for the optimal antenatal diagnosis of fetal lower urinary tract obstruction (LUTO) in the second and third trimesters of pregnancy, as an alternative to the commonly used ultrasound triad of megacystis, keyhole sign and hydronephrosis. Methods This was a national retrospective study carried out at the eight tertiary fetal medicine units (FMUs) in The Netherlands. Only cases referred for megacystis from the second trimester onwards and with a clear postnatal diagnosis were included in the study. At referral, data were collected on amniotic fluid volume, renal cortical appearance, bladder volume, hydronephrosis, fetal ascites, ureteral size, keyhole sign, fetal sex and gestational age. Multivariate analysis was performed, starting by including all antenatal variables, and then excluding the weakest predictors using the backward stepwise strategy. Results Over a 7-year period, 312 fetuses with a diagnosis of megacystis were referred to the eight Dutch tertiary FMUs. A final diagnosis was achieved in 143 cases, including 124 of LUTO and 19 reclassified after birth as non-obstructive megacystis. The optimal bladder volume cut-off for prediction of LUTO was 35 cm(3) (area under the curve (AUC) = 0.7, P = 0.03). The clinical score formulated on the basis of the multivariate analysis included fetal sex, degree of bladder distension, ureteral size, oligo-or anhydramnios and gestational age at referral. The combination of these five variables demonstrated good accuracy in discriminating LUTO from non-obstructive megacystis (AUC = 0.84, P

ObjectivesTo assess the perinatal mortality and the postnatal outcome in fetal lower urinary tract obstructions (LUTO) according to the prenatal management.MethodsThis was a retrospective study of all cases with suspected LUTO encountered in a ten-year period (2005 – 2014) in all 8 academic centres in the Netherlands and eventually treated at the Leiden University Medical Center. Antenatal management, sonographic findings and postnatal outcome were documented. The postnatal renal function (estimated Glomerular Filtration Rate or eGFR) was calculated using the Schwartz formula, considering the length of the infants and the nadir creatinine within one year of postnatal surgical intervention.Results341 fetuses were included: 275 cases with conservative management, 29 cases with vesico-amniotic shunting and 37 LUTO managed with vesicocentesis. The survival rate was respectively 76.7%, 82.6% and 60%. Oligohydramnios, abnormal karyotype and severe associated anomalies were significantly different comparing shunting to conservative management (respectively 100% vs 55%; 0% vs 15%; 24% vs 3%). Subgroup analysis was unable to show a significant difference in survival rate and postnatal renal function in vesico-amniotic shunt placement versus conservative management (survival rate: 68% vs 79%, p > 0.05; eGFR: 52 ml/min/1.73 m2 vs 61 ml/min/1.73 m2, p > 0.05).ConclusionsLUTO cases treated over the past ten years with vesico-amniotic shunt did not show any significant improvement in perinatal survival and postnatal renal function. The study suggests that prenatal selection of cases eligible for the treatment needs further refinement.

Objective To audit the current Dutch policy of prenatal detection of isolated open spina bifida based on offering detailed ultrasound examination only on indication. Methods A retrospective analysis of prenatally diagnosed isolated spina bifida cases and of newborns diagnosed with this condition was carried out in three university hospitals. The data were collected from databases and clinical records of the departments of prenatal diagnosis, obstetrics, neonatology, child neurology and neurosurgery of the three centers. Results Between January 1996 and December 1999 88 cases of isolated open spina bifida were diagnosed prenatally by ultrasound investigation. Thirty-eight cases (43%) were diagnosed before the 24th week of gestation. Of these, 35 (92%) ended in termination of the pregnancy at the parents' request. Of the remaining 50 cases (57%) diagnosed after the 24th week of gestation, eight (16%) pregnancies were terminated beyond the legal limit for termination due to the severity of the condition. Of the 88 cases of isolated spina bifida, 25 infants (28%) were still alive at the age of 4 years. In the same audit period 112 newborn infants with isolated open spina bifida were admitted to the neonatology, child neurology, or neurosurgery ward of the three centers. Of these cases, 47 (42%) bad been diagnosed prenatally and 65 (58%) were an unexpected finding at birth. In 24 infants (21%) surgical treatment was withheld because of the severity of the condition and predicted poor outcome, whereas the remaining 88 infants (79%) underwent surgical repair. Conclusion The current practice in The Netherlands of offering ultrasound screening to high-risk patients only leads to the early detection of a minority of cases of spina bifida. Most cases are diagnosed either after the 24th week of gestation or they remain undiagnosed until after birth. When spina bifida is diagnosed before the 24th week of gestation the vast majority of parents opt for termination. In order to reduce the birth prevalence of spina bifida in The Netherlands the introduction of a policy of routine ultrasound screening should be considered. Copyright (C) 2003 ISUOG. Published by John Wiley Sons, Ltd