태아의 비뇨기계 기형과 동반하는 주요 장기 기형에 대한 보고
Incidence of congenital defects coexisting with fetal urinary tract anomaly
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
목적: 태아의 비뇨기계 기형과 이에 동반되는 기형의 종류 및 발생 빈도에 대하여 알아보고자 한다. 연구 방법: 1998년 8월부터 2008년 7월까지 연세대학교 의료원에서 산전 진찰 및 분만을 시행한 산모 중 비뇨기계 기형으로 진단된 태아에서 동반된 기형의 종류와 빈도를 조사하였다. 결과: 총 12,431명의 대상군 중 236명 (1.8%)의 태아에서 비뇨기계 기형이 진단되었으며, 그 중 25예에서 동반 기형을 가진 것으로 나타났다. 동반 기형의 종류로 가장 흔한 것은 심혈관계 기형으로 9예에서 관찰되었고, 그 외에 뇌혈관계와 소화기계를 비롯한 다양한 장기에서 동반된 기형이 있었다. 9명의 콩팥 무발생을 가진 태아 중에서 6예에서 동반 기형을 가진 것으로 나타나 비뇨기계 기형 중 타장기 기형을 동반하는 비율이 가장 높았다. 결론: 태아의 비뇨기계 기형이 발견된 경우, 심혈관계를 포함한 여러 장기의 기형이 있을 수 있으므로 세심한 산전 진찰과 상담 그리고 출산 후의 적절한 태아 치료가 필요할 것으로 사료된다.
Abstract
Objective: Due to advances in diagnosing fetal anomalies by ultrasound, prognosis of babies with anomalies, especially in urinary tract, has improved. However, multiple anomalies with poor prognosis are still noted. We analyze congenital defects which coexist with fetal urinary tract anomalies. Methods: We identified all pregnancies complicated by fetal urinary tract anomalies which were followed and delivered from 1998 August to 2008 July at Yonsei University Health System. Fetal urinary tract defects were subdivided to hydronephrosis, multicystic dysplastic kidney, polycystic kidney disease, renal agenesis, renal duplication and horse-shoe kidney. A retrospective study was performed regarding both medical records and ultrasound findings. Results: 236 (1.8%) in total 12,431 cases were identified with urinary tract defects and 25 (12.3%) cases had coexisting other anomalies. Hydronephrosis was found in 156 (68.2%) cases. Multicystic dysplastic kidney was found in 37 (15.6%) cases, renal duplication in 11 (4.7%), renal agenesis in 9 (3.8%), polycystic disease in 6 (2.5%) and horse-shoe kidney in 2 (1.0%). In 25 cases with coexisting anomalies, the most common type was congenital heart defect which was found in 9 (27.6%) cases. They were composed of 8 (24.5%) atrial septal defect and 1 (3.1%) ventricular septal defect combined with pulmonary atresia. Other coexisting anomalies were cerebral or gastrointestinal tract associated anomalies, Mullerian duct anomalies and polydactyly. Six in 9 (66.7%) fetuses with one kidney had other anomalies. Conclusion: Urinary tract anomalies in fetus seem to be associated with a variety of other malformation, especially cardiac anomalies. Detailed ultrasound or echocardiography should be carefully performed because of frequent coexisting fetal congenital anomalies. Furthermore, comprehensive prenatal counseling and postnatal evaluation and management will be needed.
참고문헌 (18)
- Levi S, "Mass screening for fetal malformations: the Eurofetus study", Ultrasound Obstet Gynecol, 22, pp.555~558 (2003)
- Thomas DF, "Prenatally diagnosed urinary tract abnormalities: long-term outcome", Semin Fetal Neonatal Med, 13, pp.189~195 (2008)
- Mallik M, "Antenatally detected urinary tract abnormalities; more detection but less action", Pediatr Nephrol, 23, pp.897~904 (2008)
- Hubert KC, "Current diagnosis and management of fetal genitourinary abnormalities", Urol Clin North Am, 34, pp.89~101 (2007)
- Luck CA, "Value of routine ultrasound scanning at 19 weeks: a four year study of 8849 deliveries", BMJ, 304, pp.1474~1478 (1992)
- Oliveira EA, "Outcome of fetal urinary tract anomalies associated with multiple malformations and chromosomal abnormalities", Prenat Diagn, 21, pp.129~134 (2001)
- Kim EK, "A study on fetal urinary tract abnormality: antenatal ultrasonographic diagnosis and postnatal follow-up", J Obstet Gynaecol Res, 22, pp.569~573 (1996)
- Dillon E, "The antenatal diagnosis of fetal abnormalities: a 10 year audit of influencing factors", Br J Radiol, 70, pp.341~346 (1997)
- Grandjean H, "The performance of routine ultrasonographic screening of pregnancies in the Eurofetus Study", Am J Obstet Gynecol, 181, pp.446~454 (1999)
- Grandjean H, "Sensitivity of routine ultrasound screening of pregnancies in the Eurofetus database. The Eurofetus Team", Ann N Y Acad Sci, 847, pp.118~124 (1998)
- Levi S, "Ultrasound in prenatal diagnosis: polemics around routine ultrasound screening for second trimester fetal malformations", Prenat Diagn, 22, pp.285~295 (2002)
- Stoll C, "Euroscan study group. Prenatal diagnosis of dysmorphic syndromes by routine fetal ultrasound examination across Europe", Ultrasound Obstet Gynecol, 21, pp.543~551 (2003)
- Brumfield CG, "Fetal obstructive uropathies. Importance of chromosomal abnormalities and associated anomalies to perinatal outcome", J Reprod Med, 36, pp.662~666 (1991)
- Cocchi G, "Urinary tract abnormalities (UTA) and associated malformations: data of the Emilia-Romagna Registry. IMER Group. Emilia-Romagna Registry on Congenital Malformations", Eur J Epidemiol, 12, pp.493~497 (1996)
- Pathak S, "An update: Ultrasound structural fetal anomaly screening", Arch Dis Child Fetal Neonatal Ed (2009)
- Hoffman JI, "Incidence of congenital heart disease: Ⅰ. Postnatal incidence", Pediatr Cardiol, 16, pp.103~113 (1995)
- Czarniak P, "Prevalence of congenital kidney and urinary tract anomalies in neonates and infants with congenital heart disease", Przegl Lek, 63, pp.124~126 (2006)
- Zeijl C, "Clinical outcome and follow-up of sonographically suspected in utero urinary tract anomalies", J Clin Ultrasound, 27, pp.21~28 (1999)