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PFM.21 Treatment in fetal lower urinary tract obstruction: a prospective registry
  1. RK Morris1,
  2. LJ Middleton1,
  3. GL Malin2,
  4. E Quinlan-Jones1,
  5. JP Daniels1,
  6. KS Khan3,
  7. JJ Deeks1,
  8. MD Kilby1
  1. 1University of Birmingham, Birmingham, UK
  2. 2University of Nottingham, Nottingham, UK
  3. 3Quenn Mary’s University, London, UK

Abstract

Objective Describe the influences on decision making in fetal lower urinary tract obstruction (LUTO) and identify prenatal prognostic features.

Methods The PLUTO study included a registry of cases of isolated LUTO with conservative management or vesicoamniotic shunting (VAS). Logistic regression analysis examined prognostic features affecting outcome. For comparison of effectiveness the outcomes were survival to 2 years and renal function.

Results 45 women were registered, 78% (35/45) received conservative management. 27 women entered the registry due to clinician preference for an intervention (23 conservative, 4 VAS. Eighteen due to a patient preference for an intervention (12 conservative, 6 VAS. Influences will be explored further. Women in the conservative registry group were more likely: to have normal liquor volume at diagnosis (>5th centile) (p = 0.05) and have a later diagnosis >24 weeks compared to randomised group (p = 0.003). These variables were associated with improved survival to 28 days in a mutivariable logistic regression analysis.

At two years there was 20% (2/10) alive in the shunt group and 66% (23/35) in the conservative, RR 0.30 (95% CI 0.09, 1.08) p = 0.01. At 2 years in both groups 14 had normal renal function (one in shunt, 13 in conservative). There was a high false positive antenatal diagnosis rate in the conservative group (24%, 5/21 v 0% in shunt) as noted by postnatal diagnosis.

Conclusion The majority of fetuses in the registry had conservative management, associated with better outcomes. A significant proportion of prenatal cases had normal liquor, gestational age >24 weeks and false positive diagnosis.

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