Dilemmas associated with antenatally detected urinary tract abnormalities.

Abstract

SUMMARY Over a five year period 55 fetuses had abnormalities of the urinary tract detected by antenatal ultrasound scan. The incidence was 1:935 total births during a one year prospective study. Intrauterine intervention was undertaken in five for suspected obstructive uropathy, which was confirmed in only two. Of 51 live born infants, five died (two with renal failure), and only 18 (35%) had a clinically detectable abnormality at birth. Twenty seven patients underwent postnatal operations, the remainder being treated conservatively.Antenatal counselling was seldom undertaken by those responsible for the postnatal care. There were many instances of prospective parents receiving little or inappropriate information. Greater cooperation is required between all the staff concerned particularly as the natural history and appropriate postnatal management of some urinary tract abnormalities are still not known. diagnoses.Problems of diagnostic accuracy are combined with uncertainty about both the prognosis of many of the abnormalities and of the role of prenatal surgery.7 8 Urinary tract abnormalities occur in about 1:1200 pregnancies9 and hence the individual members of the obstetric and paediatric staff Care likely to have only limited experience with these lesions. Poor communication among staff in different specialities will only add to the difficulties of counselling the parents both antenatally and postnatally. We report our experience to illustrate some of the diagnostic and therapeutic dilemmas that arise when urinary tract abnormalities are detected antenatally. We emphasise the need for good communication and exchange of information among staff in the departments of obstetrics, radiology, and paediatrics. Patients and methodsBetween January 1982 and December 1986, 55 cases of antenatally diagnosed urinary tract abnormalities came to our attention either by referral for postnatal management, notification by the perinatal pathologist, or (latterly) referral for antenatal counselling.The number of cases increased from five in 19,82 to 21 in 1986. The data were collected prospectively during 1986 and included fetal urinary tract abnormalities that resulted in termination of pregnancy or intrauterine fetal death.It is the policy in all the referring centres to perform a routine ultrasound scan between 16 and 20 weeks' gestation. Further ultrasound examinations were for obstetric reasons except in one Nottingham centre where serial ultrasound scans were routinely carried out between 28 and 34 weeks as part of a research project into fetal growth. The ultrasound scans were performed by trained radiographers who called in a radiologist for more detailed scanning if an abnormality was detected or strongly suspectedfor example, if oligohydramnios was seen.Five mothers were referred to a specialist centre where antenatal bladder drainage procedures were 719 copyright.

Clinical Follow-Up of Fetal Urinary Tract Anomalies Diagnosed Prenatally by Ultrasound

“…Diagnostic accuracy in this study is com parable to others reported in the literature with rates varying between 65 and 100% depending on the pathological diagnosis [4,6,9,11,[16][17][18][19][20][21][22], Rizzo [22] showed a diag nosing accuracy of 88, 100 and 66%, with bilateral renal agenesis, polycystic kidneys and unilateral obstructive uropathies, re spectively.…”

“…This is the exact group that needs to be followed prospectively to see whether there is any ongoing or developing renal abnormalities in the pediatric age group. This lack of appre ciation of the importance of follow-up for this cases has been expressed by other au thors [16] and the need for greater inter change of information between the attending physicians and family practice, obstetrics, ultrasound (radiology), pediatrics and clini cal genetics.…”

“…These cases emphasize the necessity for re peat serial prenatal ultrasound scans prefera bly at an institution with experience in this area. Watson et al [16] comment that tran sient dilatation is not uncommon in the first half of pregnancy but its recognition later in pregnancy raises the dilemma of how to in vestigate postnatally if follow-up ultrasound scan is normal. Serial follow-up identified vesicoureteral reflux in 2 infants with mild prenatal hydronephrosis and normal postna tal (neonatal) scans [23].…”

Chronic Renal Failure in Children in Saudi Arabia

“…Examination of the fetal urinary system during antenatal ultrasonography can help diagnose many renal abnormalities, particularly the obstructive type. 5 This should give the physician enough time to educate and prepare the parents and to organize referral of the baby to the appropriate center after birth. Similarly, the importance of diagnosing urinary tract infection in children, particularly the younger ones, cannot be over emphasized.…”

Antenatally detected urinary tract abnormalities: changing incidence and management

“…Initially such abnormalities were mainly detected on scans performed late in pregnancy for obstetric reasons. Since the natural history of many of these urinary tract abnormalities was unde®ned, their detection posed many problems in terms of antenatal counselling and postnatal management [20,21].…”