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Observational Study
. 2021 Sep 7;16(9):e0255890.
doi: 10.1371/journal.pone.0255890. eCollection 2021.

Megacystis in the first trimester of pregnancy: Prognostic factors and perinatal outcomes

Emmanuelle Lesieur  1 , Mathilde Barrois  1 , Mathilde Bourdon  2   3   4 , Julie Blanc  5   6 , Laurence Loeuillet  7 , Clémence Delteil  8   9 , Julia Torrents  10 , Florence Bretelle  5   11 , Gilles Grangé  1 , Vassilis Tsatsaris  1   12 , Olivia Anselem  1
Affiliations
Observational Study

Megacystis in the first trimester of pregnancy: Prognostic factors and perinatal outcomes

Emmanuelle Lesieur et al. PLoS One. .

Abstract

Objective: To determine whether bladder size is associated with an unfavorable neonatal outcome, in the case of first-trimester megacystis.

Materials and methods: This was a retrospective observational study between 2009 and 2019 in two prenatal diagnosis centers. The inclusion criterion was an enlarged bladder (> 7 mm) diagnosed at the first ultrasound exam between 11 and 13+6 weeks of gestation. The main study endpoint was neonatal outcome based on bladder size. An adverse outcome was defined by the completion of a medical termination of pregnancy, the occurrence of in utero fetal death, or a neonatal death. Neonatal survival was considered as a favorable outcome and was defined by a live birth, with or without normal renal function, and with a normal karyotype.

Results: Among 75 cases of first-trimester megacystis referred to prenatal diagnosis centers and included, there were 63 (84%) adverse outcomes and 12 (16%) live births. Fetuses with a bladder diameter of less than 12.5 mm may have a favorable outcome, with or without urological problems, with a high sensitivity (83.3%) and specificity (87.3%), area under the ROC curve = 0.93, 95% CI (0.86-0.99), p< 0.001. Fetal autopsy was performed in 52 (82.5%) cases of adverse outcome. In the 12 cases of favorable outcome, pediatric follow-up was normal and non-pathological in 8 (66.7%).

Conclusion: Bladder diameter appears to be a predictive marker for neonatal outcome. Fetuses with smaller megacystis (7-10 mm) have a significantly higher chance of progressing to a favorable outcome. Urethral stenosis and atresia are the main diagnoses made when first-trimester megacystis is observed. Karyotyping is important regardless of bladder diameter.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow chart.
Fig 2
Fig 2. Prediction of neonatal outcome: Performance of bladder diameter in the prediction of favorable or adverse outcome of megacystis in the first trimester.
Fig 3
Fig 3. Decision analysis and prenatal counseling according to the bladder size “cut-off” determined by the area under the ROC curve.
(TOP: termination of pregnancy; IUFD: in utero fetal death; ND: neonatal death).
See this image and copyright information in PMC

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