目的:评估肾性羊水过少的长期结局和胎儿,新生儿,和新生儿死亡。
方法:这项回顾性队列研究包括2002年至2023年间产前检测到肾性羊水过少的胎儿。失去随访的患者被排除在外。胎儿,新生儿,并评估了长期结果,并对其危险因素进行分析。
结果:在131个患有肾性羊水过少的胎儿中,46例(35%)终止妊娠,11例(8%)胎儿宫内死亡,26人(20%)有新生儿死亡,9人(7%)有新生儿后死亡,和39(30%)存活。Logistic回归分析显示,发病胎龄较早(比值比1.16,95%置信区间(CI)1.01-1.37)与宫内胎儿死亡显着相关;羊水过多(比值比12.7,95%CI1.52-106.7)与新生儿死亡显着相关。尽管双侧肾发育不全的新生儿存活率,双侧多囊性发育不良肾(MCDK),单侧MCDK伴对侧肾脏发育不全低于其他肾脏疾病,1例双侧肾脏发育不全和2例双侧MCDK在胎儿介入治疗后存活。Kaplan-Meier总生存率为57%,55%,51%,持续1年、3年和5年,分别。在Cox比例风险模型中,出生体重<2000g(风险比7.33,95%CI1.48-36.1)和胃肠道合并症(风险比4.37,95%CI1.03-18.5)是新生儿死亡的显著危险因素.
结论:肾性羊水过少后的长期生存是一个可行的目标,其适当的风险评估很重要。
OBJECTIVE: To assess the long-term outcome of renal oligohydramnios and risk factors for fetal, neonatal, and postneonatal death.
METHODS: This retrospective cohort study included fetuses with prenatally detected renal oligohydramnios between 2002 and 2023. Patients who were lost to follow-up were excluded. Fetal, neonatal, and long-term outcomes were evaluated, and their risk factors were analyzed.
RESULTS: Of 131 fetuses with renal oligohydramnios, 46 (35%) underwent a termination of pregnancy, 11 (8%) had an intrauterine fetal death, 26 (20%) had a neonatal death, nine (7%) had a postneonatal death, and 39 (30%) survived. Logistic regression analyses showed that an earlier gestational age at onset (OR 1.16, 95% CI 1.01-1.37) was significantly associated with intrauterine fetal death; anhydramnios (OR 12.7, 95% CI 1.52-106.7) was significantly associated with neonatal death as a prenatal factor. Although neonatal survival rates for bilateral renal agenesis, bilateral multicystic dysplastic kidney (MCDK), and unilateral MCDK with contralateral renal agenesis were lower than for other kidney diseases, 1 case of bilateral renal agenesis and two of bilateral MCDK survived with fetal intervention. Kaplan-Meier overall survival rates were 57%, 55%, and 51% for 1, 3, and 5 years, respectively. In the Cox proportional hazards model, birth weight <2000 g (hazard ratio 7.33, 95% CI 1.48-36.1) and gastrointestinal comorbidity (hazard ratio 4.37, 95% CI 1.03-18.5) were significant risk factors for postneonatal death.
CONCLUSIONS: Long-term survival following renal oligohydramnios is a feasible goal and its appropriate risk assessment is important.