Does a non-reassuring fetal heart rate pattern impair renal function in newborns prenatally diagnosed with congenital anomalies of the kidneys and urinary tract (CAKUT)?

Yael Borovitz, Ayelet Alon, Miriam Lopian, Yinon Gilboa, Sharon Perlman*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To determine the effect of non-reassuring fetal heart rate (NRFHR) patterns in labor on the postnatal renal function of neonates with a prenatal diagnosis of Congenital Anomalies of the Kidney and Urinary Tract (CAKUT). Study design: A retrospective cohort study was conducted in a single tertiary referral center between 2012 and 2020. All cases with a prenatal diagnosis of CAKUT were extracted, and their fetal, maternal, obstetrical, and neonatal characteristics were analyzed. Cases of multiple gestations, preterm delivery, small for gestational age, major associated malformations or genetic aberrations, and pre-labor acute obstetrical events were excluded from the analysis. The study group was comprised of patients who experienced NRFHR during labor. The control groups included (1) patients who had a trial of labor with a normal fetal heart rate pattern and (2) patients who delivered by elective cesarean section (CS). The primary outcome was abnormal serum creatinine levels in the perinatal period. For statistical purposes, the CAKUT cases were classified into a low and high estimated risk for an abnormal postnatal renal outcome. A subgroup analysis of the results was performed accordingly. Results: 256 fetuses were diagnosed prenatally with CAKUT during the study period. Of them, 214 (83%) women underwent a trial of labor, and forty-two patients (17%) underwent an elective Cesarean Section. Of the patients who underwent a trial of labor, 21/214 (9.8%) experienced NRFHR during labor. No statistically significant between-group differences were found in maternal and fetal characteristics. NRFHR patterns were not associated with a deterioration in neonatal serum creatinine compared to those with normal fetal monitoring or those born by an elective CS. Conclusion: NRFHR patterns during labor and delivery did not impair neonatal renal function status in fetuses diagnosed prenatally with low and high-risk CAKUT. Delivery can be managed according to standard obstetrical guidelines.

Original languageEnglish
JournalAmerican Journal of Perinatology
DOIs
StateAccepted/In press - 2023

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