Variations in Management of Mild Prenatal Hydronephrosis Among Maternal-Fetal Medicine Obstetricians, and Pediatric Urologists and Radiologists

Purpose: There are no current guidelines for diagnosing and managing mild prenatal hydronephrosis. Variations in physician approach make it difficult to analyze outcomes and establish optimal management. We determined the variability of diagnostic approach and management regarding prenatal hydronephrosis among maternal-fetal medicine obstetricians, pediatric urologists and pediatric radiologists. Materials and Methods: Online surveys were sent to mailing lists for national societies for each specialty. Participants were surveyed regarding criteria for diagnosing mild prenatal hydronephrosis and recommendations for postnatal management, including use of antibiotic prophylaxis, followup scheduling and type of followup imaging. Results: A total of 308 maternal-fetal medicine obstetricians, 126 pediatric urologists and 112 pediatric radiologists responded. Pediatric urologists and radiologists were divided between Society for Fetal Urology criteria and use of anteroposterior pelvic diameter for diagnosis, while maternal-fetal medicine obstetricians preferred using the latter. For postnatal evaluation radiologists preferred using personal criteria, while urologists preferred using anteroposterior pelvic diameter or Society for Fetal Urology grading system. There was wide variation in the use of antibiotic prophylaxis among pediatric urologists. Regarding the use of voiding cystourethrography/radionuclide cystography in patients with prenatal hydronephrosis, neither urologists nor radiologists were consistent in their recommendations. Finally, there was no agreement on length of followup for mild prenatal hydronephrosis. Conclusions: We observed a lack of uniformity regarding grading criteria in diagnosing hydronephrosis prenatally and postnatally among maternal-fetal medicine obstetricians, pediatric urologists and pediatric radiologists. There was also a lack of agreement on the management of mild intermittent prenatal hydronephrosis, resulting in these cases being managed inconsistently. A unified set of guidelines for diagnosis, evaluation and management of mild intermittent prenatal hydronephrosis would allow more effective evaluation of outcomes.

On the use of 10-minute point counts and 10-species lists for surveying birds in lowland Atlantic Forests in southeastern Brazil

Due to rapid and continuous deforestation, recent bird surveys in the Atlantic Forest are following rapid assessment programs to accumulate significant amounts of data during short periods of time. During this study, two surveying methods were used to evaluate which technique rapidly accumulated most species (> 90% of the estimated empirical value) at lowland Atlantic Forests in the state of São Paulo, southeastern Brazil. Birds were counted during the 2008-2010 breeding seasons using 10-minute point counts and 10-species lists. Overall, point counting detected as many species as lists (79 vs. 83, respectively), and 88 points (14.7 h) detected 90% of the estimated species richness. Forty-one lists were insufficient to detect 90% of all species. However, lists accumulated species faster in a shorter time period, probably due to the nature of the point count method in which species detected while moving between points are not considered. Rapid assessment programs in these forests will rapidly detect more species using 10-species lists. Both methods shared 63% of all forest species, but this may be due to spatial and temporal mismatch between samplings of each method.