Prenatal parental decision-making and postnatal outcome in renal oligohydramnios

Abstract

Over one third of pregnancies with ROH were terminated and the parental decision was based on risk factors associated with adverse outcome. Neonatal death was rare in the actively treated infants and the overall outcome promising. Our study illustrates that only careful analysis of the whole process, from prenatal diagnosis via parental decision-making to postnatal outcome, allows sensible interpretation of outcome data.

Causes of renal oligohydramnios: impact on prenatal counseling and postnatal outcome

“…Of note, the rate of mechanical ventilation is hard to compare between different studies since it is strongly dependent on the decision of whether, and if so, to what extent to treat patients (Table 1). Renal replacement therapy during the first 6 weeks of life was performed in around one-third of the children; thus 66% did not require dialysis initially [19]. These numbers are comparable (Table 1) with those reported in previous studies, and in some children discontinuation of dialysis is even possible [13].…”

“…Mehler et al [19] report that invasive ventilation was necessary in 12 of the 38 (32%) neonates who were actively treated; this also implies that 68% of neonates did not require invasive ventilator support despite a history of ROH. Of note, the rate of mechanical ventilation is hard to compare between different studies since it is strongly dependent on the decision of whether, and if so, to what extent to treat patients (Table 1).…”

“…As stated above, the outcome was associated with the underlying cause of ROH, even though the gestational age and bodyweight at birth did not differ. A better survival was observed for infants with a history of urinary tract obstruction (85%) and ARPKD (71%) compared with those with renal agenesis or kidney hypo −/dysplasia (30%), a diagnosis that until recently was regarded as incompatible with life [19]. Thus, overall outcome seems to be even better compared to that reported in previous studies (Table 1), although the local policy regarding TOP might bias comparison of studies because fetuses with worse prognosis may be underrepresented.…”

“…In addition to TOP or active postnatal treatment, Mehler et al [19] describe a palliative treatment approach as an option (Fig. 1).…”

“…Clinical impact of the study by Mehler et al [19] In their retrospectively analyzed, well-described cohort of 103 pregnancies, Mehler et al present all steps in the care of pregnant women with ROH and in newborns with a history of ROH, from prenatal counseling based on the renal pathology to postnatal treatment and outcome [19]. The authors found that 38 of the 103 (37%) pregnancies were terminated after prenatal counseling-unfortunately, often after counseling by obstetricians only.…”