Comparison Between 4D and 2D Ultrasound in Detection of The Causes of Oligohydramnios (An Observation Study)

Document Type : Original Article

Authors

1 Obstetrics and Gynecology department, Faculty of Medicine, Beni-Suef University, Egypt

2 Obstetrics and Gynecology department, Matai General hospital, Egypt

Abstract

The objective of this study is to compare between 2D and 4D Ultrasound in the detection of the causes of Oligohydramnios. A total 100 pregnant women with oligohydraminos were included in this study. The results showed that 6 cases (6.0%) had positive TORCH infection and the examined fetuses were abnormal in 36 cases (36.0%). Causes for oligohydraminos were detected in 37 cases (37.0%) and the most common detected cause was autosomal recessive polycystic kidney in 13 cases (35.2%) followed by bilateral multicystic dysplastic kidney in 8 cases (21.6%) and posterior urethral valve in 6 cases (16.2%) and obstructive uropathy was recorded in 4 cases (10.8%) however, 3 cases, 2 cases and 1 case was recorded for bilateral renal agenesis, Meckle Gruber syndrome and unilateral renal aplasia, respectively. The mean duration of examination was significantly higher in 4D compared to 2D. Thermal index was slightly lower in 4D while in contrary, mechanical index was significantly higher in 4D compared to 2D. In detection of fetal causes for oligohydraminos, the 2D ultrasound had a sensitivity of 94.6%, specificity of 100%, PPV was 100%, NPV was 96.9% and the accuracy was 98.0%. While, the 4D ultrasound had a sensitivity of 97.3%, specificity of 100%, PPV was 100%, NPV was 98.7% and the accuracy was 98.7%. In conclusion, both 2D and 4D US are equally effective in detecting causes of oligohydramnios but, the difference between the two procedures was not statistically significant "with a slight preference for 4D US".

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Main Subjects


1. Beall MH, Beloosesky R, Ross MG. High risk pregnancy; Abnormalities of amniotic fluid volume. The placental membrans and amniotic fluid retention; in The placental from development to disease. Wiley-Blackwell, 2011, 12; 197–208.
2. Ekin A, Gezer C, Taner CE, Solmaz U, et al. Prognostic Value of Fetal Thymus Size in Intrauterine Growth Restriction. J Ultrasound Med 2016; 35:511–517.
3. Han CS. Fetal Biophysical Profile.Obstet Imaging Fetal Diagnosis Care [Internet]. Elsevier; 2018;537–540.
4. Hamza A, Herr D, Solomayer EF, and Meyberg-Solomayer G. Polyhydramnios: Causes, Diagnosis and Therapy. Geburtshilfe Frauenheilkd. 2013; 73(12): 1241-1246.
5. Adel NM, Abd-ElGawad EA, Abdel Hakeem AK.  Diagnostic value of four dimensional ultrasound in detection of fetal causes of oligohydraminos: An observational study. The Egyptian Journal of Radiology and Nuclear Medicine 48 (2017)1141–1147.
6. Touboul C, Boulvain M, Picone O, et al. Normal fetal urine production rate estimated with 3-dimensional ultrasonography using the rotational technique (virtual organ computer-aided analysis). Am J ObstetGynecol 2008;199:57e1–5.
7. Hindryckx A and De Catte L. Prenatal diagnosis of congenital renal  and  urinary tract malformations. Facts Views Vis Obgyn. 2011; 3(3): 165– 174.
8. Al-Gailani S. Making birth defects ‘preventable’: Pre-conceptional vitamin supplements and the politics of risk reduction. Stud HistPhilosBiol Biomed Sci. 2014; 47: 278–289.
9. Behairy NH and Talaat S. Fetal Neurosonography: Ultrasound Findings in Different Types, Associated Syndromes and Impact on Fetal Outcome . Med. J. Cairo Univ., 2012; 80, (1): 605-611.
10. Kristoffer LH, Nielsen MB, and Ewertsen C. Ultrasonography of the  Kidney: A Pictorial Review. Diagnostics (Basel). 2016; 6(1):2.
11. O’Neill WC. Renal relevant radiology: Use of ultrasound in kidney disease and nephrology procedures. Clin. J. Am. Soc. Nephrol. 2014;9:373–381.
12. Fischer, R, Glob. libr. women's med., (ISSN: 1756-2228) 2008.
13. Nguyen HT, Herndon CDA, Cooper C, et al. The society for fetal urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol 2010;6:212–31.
14. Cunningham FG, Williams JW (John W. Williams Obstetrics. McGraw-Hill Medical; 2010. https://www.ncbi.nlm.nih.gov/nlmcatalog/101510655.
15. Figueroa L, McClure EM, Swanson J, Nathan R, Garces AL, et al. (2020). Oligohydramnios: a prospective study of fetal, neonatal and maternal outcomes in low-middle income countries. Reproductive Health, 17 (1).
16. Pasquini L, Seravalli V, Sisti G, Battaglini C, Nepi F, Pelagalli R, Di Tommaso M (2016). Prevalence of a positive TORCH and parvovirus B19 screening in pregnancies complicated by polyhydramnios. Prenatal Diagnosis, 2016; 36(3), 290–293.  
17. Mohammed YA, Shawky RM, Soliman AA, Ahmed MM. Chromosomal study in newborn infants with congenital anomalies in AssiutUniversity hospital: Cross-sectional study. Egyptian Journal of Medical Human Genetics, 2011; 12(1), 79–90. 
18. Madendag Y, Madendag IC, Sahin E, Aydin E, Sahin ME, & Acmaz G. How Well Do the Popular Ultrasonic Techniques Estimate Amniotic Fluid Volume and Diagnose Oligohydramnios, in Fact? Ultrasound Quarterly, 2019; 35(1), 35–38.
19. Kehl S, Schlekle A, Thomas A, et al. Single deepest vertical pocket or amniotic fluid index as an evaluation test for predicting adverse pregnancy outcome (SAFE Trial): A multicenter, open label, randomized controlled trial. Ultrasound Obstet Gynecol 2016;47:674-679.
20. Schreuder MF, Westland R, Van Wijk AE. Unilateral multicystic dysplastic kidney: a meta-analysis of observational studies on the incidence, associated urinary tract malformations and the contralateral kidney. Nephrol Dial Transplant 2009;24:1810–8.
21. Lausman A, McCarthy FP, Walker M, Kingdom J. Screening, diagnosis, and management of intrauterine growth restriction. Obstet Gynecol 2012;34 (1):17–28.
22. Brace RA. Physiology of amniotic fluid volume regulation. Clin Obstet Gynecol. 2013;40(2):280-89.
23. Ten Broek CM, Bots J, Varela-Lasheras I, Bugiani M, Galis F, Van Dongen, S. Amniotic Fluid Deficiency and Congenital Abnormalities both Influence Fluctuating Asymmetry in Developing Limbs of Human Deceased Fetuses. PLoS ONE, 2013; 8(11), e81824.
24. Magann EF, Sandlin AT, Ounpraseuth ST. Amniotic fluid and the clinical relevance of the sonographically estimated amniotic fluid volume: oligohydramnios. J Ultrasound Med. 2011;30(11):1573-85
25. Friedman, P., & Ogunyemi, D. Oligohydramnios. Obstetric Imaging: Fetal Diagnosis and Care, 2018; 511–515.e1.  
26. Vanderheyden T, Kumar S, Fisk NM. Fetal renal impairment. Semin Neonatol. 2003;8:279-289.
27. Graham JM. Smith’s Recognizable Patterns of Human Deformation. 3rd ed. Philadelphia: Saunders; 2007.
28. Kurjak A, Berivoj M, Wiku A, et al., How useful is 3D and 4D ultrasound in perinatal medicine?. J. Perinat. Med. 2007; 35 10–27
29. Gonçalves LF, Nien JK, Espinoza J, et al. What does 2-dimensional imaging add to 3- and 4-dimensional obstetric ultrasonography? J Ultrasound Med 2006; 25: 691-699.
30. Öcal DF, Nas T, Güler I. The place of four-dimensional ultrasound in evaluating fetal anomalies.Ir J Med Sci 2015; 184: 607-612.
31. Lissauer D, Morris RK, Kilby MD. Fetal lower urinary tract obstruction. Semin Fetal Neonatal Med. 2007;12:464-470.
32. Merz E, Bahlmann F, Weber G. Volume scanning in the evaluation of fetal malformations: a new dimension in prenatal diagnosis. Ultrasound Obstet Gynecol 1995; 5: 222-227.
33. Yagel S, Cohen SM, Messing B, Valsky DV. Three-dimensional and four-dimensional ultrasound applications in fetal medicine. Curr Opin Obstet Gynecol 2009; 21: 167-174.
34. Kırmızı D. A. The Significance of 4D Ultrasonography in Fetal Anomaly Screening. East J Med, 2017; 22(4): 230-232.