Monday, November 25, 2013


A 32-week prenatal sonogram of a male fetus followed for hydronephrosis reveals increasing bilateral hydronephrosis, a dilated bladder, and new-onset marked oligohydramnios. What is your recommendation?

Posterior urethral valves leading to bilateral hydronephrosis with oligohydramnios is the most likely etiology, and this situation potentially represents a rare urologic indication for induction of labor or fetal intervention.

1- Fetal lung maturity should be evaluated with a lecithin/sphingomyelin amniotic fluid ratio prior to a final recommendation.

2- If fetal surgical intervention is considered, fetal renal function should be estimated by the urinary sodium chloride, osmolality, and Beta 2 microglobulin obtained by fetal bladder aspiration.

3- A high-grade obstruction of a single system also requires a similarly rapid response. The outcomes for fetal intervention with respect to improvement of renal function are mixed.



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