Termination of pregnancy for renal malformations

Pediatr Nephrol. 2015 Sep;30(9):1443-9. doi: 10.1007/s00467-015-3085-7. Epub 2015 Mar 28.

Abstract

Background: We studied the correlation between prenatal diagnosis and postmortem investigations in pregnancies terminated for renal malformations.

Methods: Over a 5-year period, 77 cases of termination of pregnancy (TOP) for renal malformations were reviewed. Chromosomal anomalies (n = 9) and cases without conventional or virtual autopsy were excluded (n = 15). In 53 cases, prenatal ultrasound diagnosis and conventional autopsy findings were compared. In addition, we compared the accuracy of conventional and virtual autopsy findings in 17 cases.

Results: Full agreement was observed in 60.4% (32/53) of cases. In 26.4% (14/53) of the cases, the presence of additional malformations did not alter the final diagnosis. However, in 11.3% (6/53) the final diagnosis was adjusted because of major additional findings. One case showed a total disagreement. Conventional and virtual autopsy were in full agreement in 52.9% (9/17). Postmortem magnetic resonance imaging (MRI) description and detection of malformations was less complete and failed to correctly diagnose 5/17 cases (29.4%). In 17.6% (3/17) of the cases, postmortem MRI revealed malformations not confirmed by conventional autopsy.

Conclusions: A high correlation between prenatal ultrasound and postmortem investigations was observed. Conventional autopsy remains the gold standard to reveal additional major and minor malformations, leading to a correct final diagnosis. The added value of virtual necropsy for renal pathology was limited.

MeSH terms

  • Aborted Fetus / pathology*
  • Abortion, Eugenic / methods
  • Autopsy* / methods
  • Autopsy* / statistics & numerical data
  • Female
  • Fetal Diseases / diagnosis*
  • Fetal Diseases / surgery
  • Germany
  • Humans
  • Magnetic Resonance Imaging / methods
  • Outcome Assessment, Health Care
  • Pregnancy
  • Prenatal Diagnosis* / methods
  • Prenatal Diagnosis* / statistics & numerical data
  • Prospective Studies
  • Ultrasonography, Prenatal / methods
  • Urogenital Abnormalities / diagnosis*
  • Urogenital Abnormalities / surgery
  • Urologic Diseases / congenital
  • Urologic Diseases / diagnosis*