Acta Medica Medianae (Jan 2008)
PRENATAL AND PERINATAL OUTCOME OF CONGENITAL FETAL OBSTRUCTIVE UROPATHY
Abstract
Abnormalities of the urinary tract account for less than 25% of any detectedcongenital anomaly during pregnancy, and approximately 60% of them are obstructiveuropathies. After the diagnosis of obstructive uropathy is made, there is a need for makinga decision whether or not to terminate a pregnancy and to determine further diagnosticprocedures and best management before and after birth. Making the decision includesmultidisciplinary approach, and we have to know the outcome of anomalies. The aim ofthis study was to determine the outcome of antenatally detected obstructive uropathies inorder to optimize counseling of the parents, and to give the right direction to the physicianfor managing that particular pregnancy. This study included all patients presented to theConsilium for fetal anomalies of Institute for Gynecology and Obstetrics of Clinical Centerof Serbia and University Children Hospital, during the three-year-period. Antenataldiagnoses were compared with the results of autopsy, if the pregnancy was determined, orwith the information obtained from the parents and clinical and operative findings if thepregnancy was continued. Of 111 antenatally detected urinary tract anomalies, 60 patientswere diagnosed with fetal obstructive uropathy. Six pregnancies were terminated, andfrom 54 surviving infants, 5 had impaired renal function. Most of the children needed twoto three surgical interventions on average. The overall conclusion for obstructiveuropathies that can be drawn from this series is that the prognosis for renal function isexcellent when oligohydramnios is absent before birth and when proper urological care isgiven postnatally. Almost all renal failures were in the group with progressiveoligohydramnios in which labor was induced preterm. Poor outcome of fetuses withbilateral urinary tract obstruction combined with prolonged periods of olygohydramnios hasbeen repeatedly described.
