الفهرس 
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Abstract
Oligohydramnios is defined as less than 5th percentile of amniotic fluid volume expected for gestational age. It complicates 0.5:8% of pregnancies and early detection of Oligohydramnios is very important. Fetal causes of Oligohydramnios include renal agenesis, autosomal dominant polycystic kidney, bilateral multi cystic kidney, hydronephrotic changes of fetal kidneys, posterior urethral valve obstruction if complicated by renal hydro nephritic changes, obstructive cystic dysplasia, impaired feto-maternal circulation with reduced umbilical blood flow and Meckel Gruber syndrome.
The use of 3 D and 4 D US had made a dramatic improvement in the evaluation of fetal anomalies. Detailed fetal ultrasound examination is important for the detection of renal and extra renal causes of Oligohydramnios, fetal renal scan as well as duplex evaluation in associate with 3D as well as 4D plays important role in the evaluation of the causes of Oligohydramnios for rapid assessment if available and to early discover lethal causes without let the mother carries useless burdens.
This is an observational study that was carried out at Kasr El-Aini and Beni-suef University Hospitals during the period of 9 months (from March to December 2019) after the approval of the clinical research ethics committee of faculty of medicine, Beni-Suef University. The study included a total of 100 pregnant women with oligohydraminos who were attending the mentioned hospitals during the study period. The objective of this study was to compare between 2D and 4D Ultrasound in the detection of causes of Oligohydramnios
The obtained results are summarized as follows:
The results showed that the mean age of participants was 26.3 ± 5.2 ranged between 18:40 years and the majority of them (87.0%) were > 20-35 years, 59 cases (59.0%) were from rural areas and 31 cases had positive consanguinity. Regarding parity, 42 cases (42.0%) were primigravida and 58 cases (42.0%) were multigravida.
The results showed that 6 cases ”of the total 100 included cases” had positive TORCH infection.
The examined fetuses were normal in 64 cases (64.0%) and it was abnormal in 36 cases (36.0%).
The results showed that no cause was detected for oligohydraminos in 63 cases (63.0%) however, there were causes in the rest of 37 cases (37.0%).
Of the 37 cases, the most common cause of oligohydraminos in our study 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 ultrasound compared to 2D ultrasound (2.8 ± 1.1 vs. 2.2 ± 1.8 minutes, P≤ 0.01). Thermal index was slightly ”non significant” lower in 4D procedure while in contrary, mechanical index was significantly higher in 4D compared to 2 D (1.16 ± 0.26 vs. 0.78± 0.24, P≤ 0.01).
The 4D ultrasound detected 36 cases (97.3%) of the total of 37 cases with fetal cause for oligohydraminos while, the 2D ultrasound detected 35 cases (94.6%) and this difference was not significant (p=0.56). In cases with autosomal recessive polycystic kidney (n=13), both 2D and 4D ultrasound detected 12 cases (92.3%) of them. While, in cases with bilateral renal agenesis (n=3), the 4D ultrasound detected all of them while the 2D ultrasound only detected 2 cases of them.
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%.
Both 2D and 4D US are equally effective in detecting causes of oligohydramnios and the difference between the two procedures was not statistically significant.