Prenatal and Perinatal Outcome of Congenital Fetal Obstructive Uropathy

Abnormalities of the urinary tract account for less than 25% of any detected congenital anomaly during pregnancy, and approximately 60% of them are obstructive uropathies. After the diagnosis of obstructive uropathy is made, there is a need for making a decision whether or not to terminate a pregnancy and to determine further diagnostic procedures and best management before and after birth. Making the decision includes multidisciplinary approach, and we have to know the outcome of anomalies. The aim of this study was to determine the outcome of antenatally detected obstructive uropathies in order to optimize counseling of the parents, and to give the right direction to the physician for managing that particular pregnancy. This study included all patients presented to the Consilium for fetal anomalies of Institute for Gynecology and Obstetrics of Clinical Center of Serbia and University Children Hospital, during the three-year-period. Antenatal diagnoses were compared with the results of autopsy, if the pregnancy was determined, or with the information obtained from the parents and clinical and operative findings if the pregnancy was continued. Of 111 antenatally detected urinary tract anomalies, 60 patients were diagnosed with fetal obstructive uropathy. Six pregnancies were terminated, and from 54 surviving infants, 5 had impaired renal function. Most of the children needed two to three surgical interventions on average. The overall conclusion for obstructive uropathies that can be drawn from this series is that the prognosis for renal function is excellent when oligohydramnios is absent before birth and when proper urological care is given postnatally. Almost all renal failures were in the group with progressive oligohydramnios in which labor was induced preterm. Poor outcome of fetuses with bilateral urinary tract obstruction combined with prolonged periods of olygohydramnios has been repeatedly described. Acta Medica Medianae 2008;47(1):47-51.