Pathological findings in fetuses terminated for suspected LUTO diagnosis - experience from a high-risk fetal center
Juliane Richter, MD1, Hayley Good, Student2, Jin K. Kim, MD1, Patrick Shannon, MD3, Joana Dos Santos, MD1, Natasha Brownrigg, NP1, Michael Chua, MD1, Armando J. Lorenzo, MD1, Mandy Rickard, NP1, Tim Van Mieghem, MD4, Shiri Shinar, MD5.
1Division of Urology, Hospital for Sick Children (Sickkids), Toronto, ON, Canada, 2Faculty of Medicine, University of Toronto, Toronto, ON, Canada, 3Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada, 4Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON, Canada, 56. Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON, Canada.
BACKGROUND:
Pregnancies complicated by prenatally-suspected lower urinary tract obstruction (LUTO) are associated with high rates of terminations due to potentially poor outcomes. We assessed autopsy findings of fetuses terminated for suspected LUTO to evaluate the diagnostic accuracy and spectrum of underlying pathologies.
METHODS:
We performed a retrospective review of all pregnancies referred to a high-risk fetal center in a universal access to care health care system for suspected LUTO that opted for termination of pregnancy from 2009 to 2022. Ultrasound features, genetic investigations, placental findings and distribution of post-mortem diagnoses were assessed.
RESULTS:
Of a total of 190 pregnancies with suspected LUTO evaluated during the study period, 79 (42%) were terminated. We excluded 35 fetuses with incomplete data, resulting in 44 available for analysis. Pregnancies were terminated at a mean gestation of 22 + 5 weeks. A LUTO diagnosis was confirmed in 37 (84.1%) fetuses (35 males and 2 females) and the remaining seven showed other pathologies. Pulmonary hypoplasia was found in 62.2% (n=23) and placental pathologies in 56.8% of confirmed LUTO compared to 33.4% and 71.4% in non-LUTO cases, respectively. Overall, a total of 31 fetuses underwent additional prenatal investigations with genetic anomalies detected only in fetuses with a confirmed LUTO diagnosis (13.6%).
CONCLUSIONS:
In our healthcare system, almost half of prenatally-suspected LUTO pregnancies are terminated. The sonographic diagnostic accuracy for LUTO is reasonable at 84%. However, the remaining 16% still had significant pathologies. Genetic abnormalities are uncommon and are rarely the trigger for TOP.
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