胎儿下尿路梗阻:关于管理和核心成果集的国际德尔菲共识。

IF 6.1 1区 医学 Q1 ACOUSTICS
H J Mustafa, A Khalil, S Johnson, S J Gordijn, W Ganzevoort, C Melling, C J Koh, G T Mandy, M D Kilby, A Johnson, R A Quintero, G Ryan, A A Shamshirsaz, A A Nassr
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引用次数: 0

摘要

目的就胎儿下尿路梗阻(LUTO)的诊断、预后、管理和核心结果集(COS)达成德尔菲式国际专家共识:方法:国际 LUTO 专家小组进行了三轮德尔菲程序。该小组获得了一份由文献综述得出的诊断、预后、管理和结果参数清单。在制定 COS 的过程中,还与患者小组进行了平行程序:共接触了 160 名专家,其中 99 人完成了第一轮,80 人(80/99,80.8%)完成了所有三轮。在妊娠头三个月,膀胱纵径的客观测量值(≥7 毫米为异常)应用于怀疑 LUTO。在第二个孕期,LUTO 的影像学参数可包括:a) 膀胱增大;b) 锁孔征;c) 膀胱壁增厚;d) 双侧输尿管肾积水;e) 男性。目前关于预后评分的文献缺乏共识。不过,专家们对羊水量的价值达成了共识(结论:关于胎儿 LUTO 的诊断、预后和管理以及核心结果集的国际共识应为临床护理和研究提供依据,以优化围产期预后。本文受版权保护。保留所有权利。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Fetal lower urinary tract obstruction: international Delphi consensus on management and core outcome set.

Objectives: To reach an international expert consensus on the diagnosis, prognosis and management of fetal lower urinary tract obstruction (LUTO) by means of a Delphi procedure, and to use this to define a core outcome set (COS).

Methods: A three-round Delphi procedure was conducted among an international panel of experts in fetal LUTO. The panel was provided with a list of literature-based parameters to consider for the diagnosis, prognosis, management and outcomes of LUTO. A parallel procedure was conducted with patient groups during the development of the COS.

Results: A total of 168 experts were approached, of whom 99 completed the first round and 80/99 (80.8%) completed all three rounds of the study questionnaires. Consensus was reached that, in the first trimester, an objective measurement of longitudinal bladder diameter of ≥ 7 mm should be used to suspect LUTO. In the second trimester, imaging parameters suggestive of LUTO could include enlarged bladder, keyhole sign, bladder wall thickening, bilateral hydronephrosis, bilateral hydroureteronephrosis and male sex. There was 79% agreement that the current prognostic scoring systems in the literature should not be used clinically. However, experts agreed on the value of amniotic fluid volume (at < 24 weeks) to predict survival and that the value of fetal intervention is to improve the chance of neonatal survival. Experts endorsed sonographic parameters suggestive of renal dysplasia, at least one vesicocentesis, and renal biochemistry for prognosis and counseling, but these items did not reach a consensus for determining candidacy for fetal intervention. On the other hand, imaging parameters suggestive of LUTO, absence of life-limiting structural or genetic anomalies, gestational age of ≥ 16 weeks and oligohydramnios (defined as deepest vertical pocket < 2 cm) should be used as candidacy criteria for fetal intervention based on expert consensus. If bladder refill was evaluated, it should be assessed subjectively. Vesicoamniotic shunt should be the first line of fetal intervention. In the presence of suspected fetal renal failure, serial amnioinfusion should be offered only as an experimental procedure under research protocols. A COS for future LUTO studies was agreed upon.

Conclusion: International consensus on the diagnosis, prognosis and management of fetal LUTO, as well as the COS, should inform clinical care and research to optimize perinatal outcomes. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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来源期刊
CiteScore
12.30
自引率
14.10%
发文量
891
审稿时长
1 months
期刊介绍: Ultrasound in Obstetrics & Gynecology (UOG) is the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) and is considered the foremost international peer-reviewed journal in the field. It publishes cutting-edge research that is highly relevant to clinical practice, which includes guidelines, expert commentaries, consensus statements, original articles, and systematic reviews. UOG is widely recognized and included in prominent abstract and indexing databases such as Index Medicus and Current Contents.
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