Prenatal parental decision-making and postnatal outcome in renal oligohydramnios

  • Katrin Mehler
  • Ingo Gottschalk
  • Kathrin Burgmaier
  • Ruth Volland
  • Anja K. Büscher
  • Markus Feldkötter
  • Titus Keller
  • Lutz T. Weber
  • Angela Kribs
  • Sandra Habbig
Original Article

Abstract

Background

Previous studies on renal oligohydramnios (ROH) report highly variable outcome and identify early onset of ROH and presence of extrarenal manifestations as predictors of adverse outcome in most cases. Data on termination of pregnancy (TOP) and associated parental decision-making processes are mostly missing, but context-sensitive for the interpretation of these findings. We provide here a comprehensive analysis on the diagnosis, prenatal decision-making and postnatal clinical course in all pregnancies with ROH at our medical centre over an 8-year period.

Methods

We report retrospective chart review data on 103 consecutive pregnancies from 2008 to 2015 with a median follow-up of 554 days.

Results

After ROH diagnosis, 38 families opted for TOP. This decision was associated with onset of ROH (p < 0.001), underlying renal disease (p = 0.001) and presence of extrarenal manifestations (p = 0.02). Eight infants died in utero and 8 cases were lost to follow-up. Of the 49 liveborn children, 11 received palliative and 38 underwent active care. Overall survival of the latter group was 84.2% (n = 32) corresponding to 31% of all pregnancies (32 out of 103) analysed. One third of the surviving infants needed renal replacement therapy during the first 6 weeks of life.

Conclusions

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.

Keywords

ROH Neonatal dialysis Lung hypoplasia Palliative care Termination of pregnancy Newborn Renal replacement therapy 

Notes

Compliance with ethical standards

Conflicts of interest

All authors declare that they have no conflicts of interest related to the study.

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Copyright information

© IPNA 2017

Authors and Affiliations

  • Katrin Mehler
    • 1
  • Ingo Gottschalk
    • 2
  • Kathrin Burgmaier
    • 3
  • Ruth Volland
    • 4
  • Anja K. Büscher
    • 5
  • Markus Feldkötter
    • 6
  • Titus Keller
    • 1
  • Lutz T. Weber
    • 3
  • Angela Kribs
    • 1
  • Sandra Habbig
    • 3
  1. 1.Neonatology and Pediatric Intensive Care, Children’s and Adolescents’ HospitalUniversity Hospital of CologneCologneGermany
  2. 2.Prenatal Medicine, Department of Obstetrics and GynecologyUniversity Hospital of CologneCologneGermany
  3. 3.Pediatric Nephrology, Children’s and Adolescents’ HospitalUniversity Hospital of CologneCologneGermany
  4. 4.Pediatric Oncology and HematologyChildren’s and Adolescents’ Hospital, University Hospital of CologneCologneGermany
  5. 5.Clinic for Pediatrics II, Pediatric NephrologyUniversity of EssenEssenGermany
  6. 6.Pediatric Nephrology, Children’s University HospitalBonnGermany

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