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Determining the Uncertainty of Fetal Urine Production Rate Estimations

  • Original Article
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Journal of Fetal Medicine

Abstract

The fetal urinary bladder can be observed by ultrasound and the increasing bladder volume during a filling phase is assumed to reveal the urine production. Volumes, estimated at different time points within the filling phase, allow the hourly fetal urine production rate (HFUPR) to be estimated. HFUPR estimations may add to the knowledge of fetal reactions during obstetrical complications. However, it is essential to know the degree of measurement uncertainty. Otherwise, small deviations may be overrated when repeating HFUPR estimations. The purpose of the current paper was to introduce an interactive program for calculation of HFUPR and the related standard deviation (SD). Furthermore the aim was to evaluate factors which may influence the SD of HFUPR estimations. Using the office software Excel, an interactive program was created and the application was illustrated by the filling phases of 16 fetuses. This material also enabled different realistic sets of estimation data to be simulated. Thus, SDs were calculated based on various numbers of documented bladder images and investigation times. When three instead of two bladder images were used for HFUPR estimation, the mean of SD was reduced from 22.4 to 8.1 mL/h (p < 0.0001). When the time from the first to the last measurement expanded from 10 to 30 min and four bladder images were used, the mean of SD was reduced from 7.5 to 2.4 mL/h. (p < 0.0001). An interactive program for calculation of HFUPR and the related SD was provided. Reductions in the SD with increasing number of bladder measurements and time span between measurements were demonstrated.

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References

  1. Lim KI, Butt K, Naud K, Smithies M. Amniotic fluid: technical update on physiology and measurement. J Obstet Gynaecol Can. 2017;39:52–8.

    Article  Google Scholar 

  2. Rabie N, Magann E, Steelman S, Ounpraseuth S. Oligohydramnios in complicated and uncomplicated pregnancy: a systematic review and meta-analysis. Ultrasound Obstet Gynecol: Off J Int Soc Ultrasound Obstet Gynecol. 2017;49:442–9.

    Article  CAS  Google Scholar 

  3. Sandlin AT, Chauhan SP, Magann EF. Clinical relevance of sonographically estimated amniotic fluid volume: polyhydramnios. J Ultrasound Med: Off J Am Inst Ultrasound Med. 2013;32:851–63.

    Google Scholar 

  4. Khan S, Donnelly J. Outcome of pregnancy in women diagnosed with idiopathic polyhydramnios. Aust N Z J Obstet Gynaecol. 2017;57:57–62.

    Article  Google Scholar 

  5. Jacobsson B, Mattsby-Baltzer I, Andersch B, Bokstrom H, Holst RM, Nikolaitchouk N, Wennerholm UB, Hagberg H. Microbial invasion and cytokine response in amniotic fluid in a Swedish population of women with preterm prelabor rupture of membranes. Acta Obsteticia et Gynecologica Scandinavica. 2003;82:423–31.

    Article  Google Scholar 

  6. Linder N, Hiersch L, Fridman E, Klinger G, Lubin D, Kouadio F, Melamed N. Post-term pregnancy is an independent risk factor for neonatal morbidity even in low-risk singleton pregnancies. Arch Dis Child Fetal Neonatal Ed. 2017;102:F286–90.

    Article  Google Scholar 

  7. Marks Kazatsker M, Sammour R, Sagi S. Isolated oligohydramnios - the dilemma of proper management. Harefuah. 2019;158:728–31.

    PubMed  Google Scholar 

  8. Lee SM, Jun JK, Kim SA, Lee EJ, Kim BJ, Park CW, Park JS. Usefulness of fetal urine production measurement for prediction of perinatal outcomes in uteroplacental insufficiency. J Ultrasound Med: Off J American Inst Ultrasound Med. 2014;33:2165–71.

    Article  Google Scholar 

  9. Rabinowitz R, Peters MT, Vyas S, Campbell S, Nicolaides KH. Measurement of fetal urine production in normal pregnancy by real-time ultrasonography. Am J Obstet Gynecol. 1989;161:1264–6.

    Article  CAS  Google Scholar 

  10. Fagerquist MA, Sethi V, Skytteren E, Oden A. Intra-observer repeatability when assessing the foetal urinary bladder volume by the Virtual Organ Computer-aided AnaLysis and SUM-OF-CYLINDERS methods: A pilot study. Ultrasound. 2017;25:156–65.

    Article  Google Scholar 

  11. Lee SM, Park SK, Shim SS, Jun JK, Park JS, Syn HC. Measurement of fetal urine production by three-dimensional ultrasonography in normal pregnancy. Ultrasound Obstet Gynecol: Off J Int Soc Ultrasound Obstet Gynecol. 2007;30:281–6.

    Article  CAS  Google Scholar 

  12. Lee SM, Jun JK, Lee EJ, Lee JH, Park CW, Park JS, Syn HC. Measurement of fetal urine production to differentiate causes of increased amniotic fluid volume. Ultrasound Obstet Gynecol: Off J Intl Soc Ultrasound Obstet Gynecol. 2010;36:191–5.

    Article  CAS  Google Scholar 

  13. Peixoto-Filho FM, de Sa RA, Velarde LG, de Castro MC, Lopes LM, Ville Y. Normal range for fetal urine production rate customized by biometry. Arch Gynecol Obstet. 2013;287:31–5.

    Article  Google Scholar 

  14. Fagerquist M, Fagerquist U, Oden A, Blomberg SG. Estimation of fetal urinary bladder volume using the sum-of-cylinders method vs. the ellipsoid formula. Ultrasound Obstet Gynecol: Off J Int Soc Ultrasound Obstet Gynecol. 2003;22:67–73.

    Article  CAS  Google Scholar 

  15. R Development Core Team: R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2017.

  16. Fagerquist M, Sillen U, Blomberg SG. Postnatal vesico-ureteral reflux in a boy with urinary bladder dysfunction as the only prenatal sonographic sign. Ultrasound Obstet Gynecol Offic J Int Soc Ultrasound Obstet Gynecol. 1997;9:64–6.

    Article  CAS  Google Scholar 

  17. Touboul C, Boulvain M, Picone O, Levaillant JM, Frydman R, Senat MV. Normal fetal urine production rate estimated with 3-dimensional ultrasonography using the rotational technique (virtual organ computer-aided analysis). Am J Obstet Gynecol. 2008;199(57):e51-55.

    Google Scholar 

  18. Peixoto-Filho FM, de Sa RA, Velarde LG, Lopes LM, Ville Y. Normal range for fetal urine production rate by 3-D ultrasound in Brazilian population. Arch Gynecol Obstet. 2011;283:497–500.

    Article  Google Scholar 

  19. Fagerquist MA, Fagerquist UO, Oden A, Blomberg SG, Mattsson LA. Derivations that enable the testing of fetal urine production as a method of fetal surveillance. Arch Gynecol Obstet. 2010;282:481–6.

    Article  Google Scholar 

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Acknowledgement

The authors would like to thank Barbara Foran, Monika Erkelens and Rosa Moa Brynnel for assistance in the discussion and proof-reading of this paper. Also, thank you Yoni Haimovich for your support in designing the figures.

Funding

This study was supported by grants from (all Swedish): The North Elfsborg Foundation for Medical Development and Research. The Gothenburg Medical Society, The Eriksson Brother´s Foundation, The Foundation for Medical Development and The Research Foundation of Dept. of Obstetrics and Gynaecology, North Elfsborg County Hospital

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, North Elfsborg County Hospital, Trollhattan, Sweden

    Mats Fagerquist

  2. Software Engineering, Chalmers University of Technology, Gothenburg, Sweden

    Andreas Carlsson

  3. Department of Mathematical Sciences, Chalmers and University of Technology and the University of Gothenburg, Gothenburg, Sweden

    Henrik Imberg

  4. Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden

    Hans Bokstrom

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  1. Mats Fagerquist
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  2. Andreas Carlsson
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  3. Henrik Imberg
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  4. Hans Bokstrom
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Correspondence to Mats Fagerquist.

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Fagerquist, M., Carlsson, A., Imberg, H. et al. Determining the Uncertainty of Fetal Urine Production Rate Estimations. J. Fetal Med. 8, 135–140 (2021). https://doi.org/10.1007/s40556-021-00298-3

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  • DOI: https://doi.org/10.1007/s40556-021-00298-3

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