Antenatal diagnosis (also called Prenatal Diagnosis) refers to diagnosis of congenital disorders while the baby is still in mother’s womb. This is the cutting edge of medical science. The once opaque womb has become accessible and transparent due to advent of high resolution ultrasound. Till some years back, pediatricians and pediatric surgeons used to feel helpless when they used to see a newborn with a severe congenital defect. In the present era, a large number of these anomalies are diagnosed even before the birth of the baby.
Ultrasound can diagnose structural abnormalities in the fetus after 16 weeks once the miniature organs are in place. As expected the specificity increases as the baby grows bigger. This is a whole new group of diseases - “Antenatally diagnosed disorders” or we call them “Unborn Patients”
The major types of defects seen in unborn babies are kidney abnormalities (swelling, absent kidney), hydrocephalus (excessive brain fluid leading to pressure damage on brain), cardiac anomalies, neural tube defects, certain chromosomal disorders, lung anomalies, tumors and cysts in belly.
Kidney abnormalities are one of the most common antenatally diagnosed disorders, found in approximately 1% of all fetuses but the good part is that in up to 80% of them it may be a very mild transient swelling which resolves either before or after birth.
Definition of Antenatal Hydronephrosis
Antenatal hydronephrosis refers to fluid-filled swelling of the kidney detected before birth in the fetus by ultrasound studies. Hydronephrosis can be diagnosed as early as the 15 weeks of pregnancy. In most instances this diagnosis does not change obstetric care, but will require careful follow-up and possible evaluation & surgery after birth during infancy and childhood.
Possible causes of antenatal hydronephrosis include:
UPJ obstruction: block at the left ureteropelvic junction or UPJ or PUJ (where ureter joins to the kidney) |
Posterior urethral valves: block at the outlet of the bladder |
Vesicoureteral reflux on the left: flow of urine back up ureter causing dilated ureter and kidney |
Multicystic kidney on the left: kidney may be large due to multiple cysts, leading to detection on ultrasound |
Duplication of ureters on both sides with ureterocele (seen where ureter joins bladder) on left causing blockage |
Management of Antenatal Hydronephrosis
Most cases of antenatal hydronephrosis diagnosed during pregnancy are just followed monthly with ultrasound, monitoring the growth of the fetus and the swelling of the kidneys. In these cases, a normal delivery can be performed. Rarely, in a fetus with severe obstruction involving both the kidneys and insufficient amniotic fluid, drainage of the kidneys or bladder by a catheter tube or operation may need to be done. In these babies, however, the kidneys are often very abnormal and do not function properly in upto 50% regardless of treatment.
Post birth Evaluation
Several studies may need to be performed to evaluate the kidneys:
Treatment
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