F64Intrauterine therapy of fetal obstructive uropathy

Background The aim of our study was the evaluation of the usefulness of fetal bladder drainage in cases of obstructive uropathy before the 24th week of gestation. Methods Since January 1997 we have diagnosed 9 cases of fetal obstructive uropathy before the 24th week of gestation. In all cases, oligohydramnios or ahydramnios was also diagnosed. After evaluation of kidneys function on the basis of fetal urine samples, obtained from punctures of fetal bladder (three times in each fetus) we selected 7 fetuses for in-utero shunting. 2 fetuses presented features of renal cystic dysplasia and its renal function prognostic factors were poor. Those fetuses were not offered intrauterine decompression. Results All the newborns in which intrauterine decompression of the obstructive uropathy was made have had a good perinatal outcome. The mean apgar score was 8 (7–10 points). The weight at delivery was between 1700 and 3300 g. No pulmonary hypoplasia was observed. All the deliveries took place after the 33rd week of gestation (33–38 hbd). The minimum time of drainage was 11 weeks, the maximum 18 weeks. Conclusions Early bladder drainage enables delivery of newborns without pulmonary hypoplasia. Drains with a good ‘shape memory’ enable good results, because they are not prone to migration. Shunting should be performed only in selected cases which would not be better managed by early delivery, but who have not yet developed renal dysplasia.