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OBJECTIVES: We performed a meta-analysis to examine the performance of second-trimester (14-24 weeks' gestation) isolated fetal pyelectasis as a marker for trisomy 21 and to calculate its associated weighted pooled likelihood ratios. METHODS: PubMed, Ovid MEDLINE and Cochrane databases were searched using the terms 'pyelectasis' and 'pelviectasis'. Studies were included if fetuses with isolated pyelectasis were reported separately from fetuses with other soft markers of aneuploidy and/or structural anomalies and if knowledge of the fetal karyotype was unknown at the time of ultrasound examination. RESULTS: Individual study statistics were pooled as weighted positive and negative likelihood ratios with 95% CIs, using a random-effects model. Ten observational studies were included (2148 cases of isolated pyelectasis). Isolated fetal pyelectasis was defined in seven out of 10 studies as a renal pelvis anteroposterior diameter of ≥ 4 mm. Isolated fetal pyelectasis was associated with pooled positive and negative likelihood ratios of 2.78 (95% CI, 1.75-4.43) and 0.99 (95% CI, 0.98-1.00), respectively. CONCLUSIONS: The detection of isolated fetal pyelectasis on mid-trimester ultrasound is associated with an increased likelihood of trisomy 21. If the finding of isolated fetal pyelectasis is used to adjust the trisomy 21 risk from maternal serum screening tests, a positive likelihood ratio of 2.78 should be used in the calculation.

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OBJECTIVE: To follow the natural progression of fetal renal pyelectasis detected in the mid second trimester ultrasound in an unselected obstetric population. STUDY DESIGN: Single-centered, retrospective study that included all level II ultrasounds done from Jan 2008 to Dec 2009. The initial level II ultrasound was done in the mid second trimester. The renal pyelectasis detected on the antenatal ultrasound (AUS) was classified as mild (5-7 mm), moderate (7.1-9 mm), or severe (>9.1 mm). Postnatal outcomes were classified as "Resolved", "Improving", or "Worsened". RESULTS: Ninety-eight cases of fetal renal pyelectasis were detected. Sixteen patients were excluded. Of the remaining 82 cases of fetal pyelectasis, 32 (39%) were mild, 21 (25.6%) moderate, and 29 (35.4%) severe. In 74 (90.2%) infants, pyelectasis resolved, remained stable, or improved in the postnatal ultrasound. In eight (9.8%) infants, pyelectasis worsened. CONCLUSION: Totally, 90.2% of pyelectasis detected on AUS resolved spontaneously, remained stable or improved. The magnitude of fetal renal pyelectasis did not correlate with postnatal outcome. All fetal renal pyelectasis ≥ 5 mm detected on the mid second trimester ultrasound should be followed antenatally. Those fetuses with persistent pyelectasis should be evaluated after birth and followed until resolution of pyelectasis or until a diagnosis is obtained.

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Introducción: el uso del método ecográfico en Pediatría en Atención Primaria (AP) mejora la calidad asistencial y favorece la eficiencia. Material y métodos: en el presente estudio se realizaron un total de 250 ecografías en un periodo de 12 meses, de mayo de 2009 a mayo de 2010. Resultados: los resultados encontrados por regiones anatomoecográficas fueron en un 45% abdominales, en un 25% craneales, en un 15% de cadera, un 10% parotídeas y tiroideas y un 5% de partes blandas. Dentro de estas, la patología más relevante fue el reflujo gastroesofágico, con un 7,2% de casos del total de las ecografías realizadas. El 1,6% presentó pielectasia renal; el 1,6%, cefalohematoma; el 1,2%, displasia de cadera; el 1,2%, parotiditis aguda; el 1,2%, adenopatía; el 0,4%, atresia de vías biliares; el 0,4%, angioma cervical, y el 0,4%, adenopatía abscesificada. Conclusión: de esto se deriva que la ecografía es una herramienta útil, siendo de especial interés en AP las ecografías abdominal y craneal, seguidas de las de cuello y tiroides y de cadera (AU)

Introduction: The use of ultrasound in pediatric Primary Care improves both the quality and efficiency of care. Material and methods: This study undertook 250 ultrasounds over a 12 month period from May 2009 to April 2010. Results: The results found for each anatomical region were 45% abdominal, 25% cranial, 15% of the hip, 10% of parotid and thyroids and 5% of tender areas. From these, the most relevant pathology was Gastroesophageal Reflux, accounting for 7.2% of all ultrasounds undertaken. Renal pyelectasia accounted for 1.6%, cephalhematoma 1.6%, dysplasia of the hip 1.2%, acute parotitis 1.2%, adenopathy 1.2%, cervical angioma 0.4%, and abscessed adenopathy 0.4%. Conclusions: From this analysis, we conclude that ultrasound is a useful tool for the detection of abdominal and cranial pathologies and secondarily, for thyroid, hip and cervical pathologies (AU)

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OBJECTIVE: Previous studies are contradictory with regard to the association of isolated pyelectasis and aneuploidy. Our objective was to test the hypothesis that isolated pyelectasis is associated with aneuploidy and calculate likelihood ratios using a large ultrasound database. METHODS: A retrospective cohort study of pregnancies presenting to our prenatal ultrasound unit at 16 to 22 weeks was conducted. Pyelectasis was defined as fetal renal pelvis> 4 mm in the anterior-posterior dimension. Fetuses with co-existing major structural anomalies or markers of aneuploidy were excluded. Association between isolated pyelectasis and aneuploidy was assessed and screening efficiency was evaluated. Results were also stratified by maternal age. RESULTS: Among 62 103 patients who had obstetric ultrasounds during the study period, 1055 (1.7%) were diagnosed with isolated pyelectasis. The presence of isolated pyelectasis was significantly associated with any aneuploidy [OR 1.93 (CI 1.06-3.54)], and specifically trisomy 21 (T21) [OR 2.91 (CI 1.48-5.71)]. There was a greater than two-fold increase in the risk of T21 in the presence of isolated pyelectasis [LR+ 2.44 (CI 1.28-4.64)]. CONCLUSIONS: Our data confirm a significant association between isolated pyelectasis and increased risk of aneuploidy, particularly T21. These likelihood ratios can be used to adjust aneuploidy risk and in counseling patients regarding appropriateness of amniocentesis.

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