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CMECNE

Renal Pyelectasis on Prenatal Ultrasound – Next Steps?

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Learning Objectives and CME/Disclosure Information

This activity is intended for healthcare providers delivering care to women and their families.

After completing this activity, the participant should be better able to:

1. Define renal pyelectasis
2. Summarize the management of a pregnancy with renal pyelectasis identified at the anatomical study

Estimated time to complete activity: 0.25 hours

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.

Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.

Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Read Disclaimer & Fine Print

Renal pyelectasis literally means “pelvis dilation” of the kidney, and is defined as an anteroposterior diameter of the renal pelvis of ≥ 4mm up to 20 weeks of gestation.

CLINICAL ACTIONS :

When seen in isolation, with no other fetal abnormalities

  • If aneuploidy screening has not yet been done, then screening or diagnostic testing should be offered
  • If patient opts for aneuploidy testing and result is negative, no further evaluation is required
    • Counsel patients that screening tests are not diagnostic and therefore there is still residual risk for chromosomal anomalies
  • If aneuploidy screen result is positive, refer for genetic counseling and consideration of diagnostic testing options
  • Ultrasound at 32 weeks of gestation is suggested to rule out persistent pyelectasis and possible obstruction of the urinary tract
    • If the renal pelvis is > 7 mm at 32 weeks, then post-natal follow up is suggested

If other anomalies are detected

  • ACOG guidance recommends offering invasive testing using microarray in the setting of fetal structural anomalies seen on prenatal ultrasound

SYNOPSIS:

Renal pyelectasis is reported in 0.6-4.5% of fetuses in the second trimester. It is most commonly a transient physiologic state in which the renal pelvis, the structure that is essentially the funnel for urine exiting the kidney into the ureter, is dilated and measures larger than what is considered normal for a particular gestational age. The presence of renal pyelectasis as an isolated finding, in the setting of a negative aneuploidy screen, is not itself an indication for invasive testing; however, ACOG does give all women the option (both high and low risk) for invasive testing.  Note, if the renal pelvis is still dilated in the third trimester, the urinary tract may require attention following delivery to ensure normal kidney function and prevent infection in the newborn.

KEY POINTS:

  • Normal renal pelvis measurement is up to 1cm throughout gestation
    • Values above 1cm are almost always pathological
  • Resolution of dilation based on second trimester measurement
    • Between 4 and 7 to 8 mm: 80% resolution
    • >9 mm: <15%
  • More commonly observed in male fetuses
  • A targeted ultrasound is essential to look for other fetal anatomic anomalies
  • Note: ACOG guidance recommends offering invasive, diagnostic testing for all pregnant women regardless of age and even in the presence of a normal anatomy scan
    • Offering invasive testing using microarray in the setting of fetal structural anomalies on prenatal ultrasound is recommended

Learn More – Primary Sources:

Multidisciplinary consensus on the classification of prenatal and postnatal urinary tract dilation (UTD classification system)

ACOG Practice Bulletin No. 162: Prenatal Diagnostic Testing for Genetic Disorders 

ACOG Practice Bulletin No. 226: Screening for Fetal Chromosomal Abnormalities

Identification of copy number variations among fetuses with ultrasound soft markers using next-generation sequencing

Locate a genetic counselor or genetics services:

Genetic Services Locator-ACMG

Genetic Services Locator-NSGC

Genetic Services Locator-CAGC

Take a post-test and get CME credits

TAKE THE POST TEST

2nd Trimester Ultrasound Reference Library, Now Available on Your Phone with ObGFirst

Learn More  »

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Related ObG Topics:

Genetic Counseling: Who to Refer and What They Should Expect
Down Syndrome / Trisomy 21: Clinical Findings and Prenatal Considerations
Practical obstetrics info for your women's healthcare practice

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Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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