Dr. A.K. Singal MBBS (Gold Medalist), DNB, MNAMS
M.CH (AIIMS, Gold Medalist)
Stecker Scholar Pediatric Urology (USA)

Antenatal Counseling and Planning

At our Pediatric Urology services, Dr Singal helps parents understand about kidney diseases in their yet to be born kids and helps them plan out the arrival of the little one in a fully prepared way. This is done via detailed sessions of Antenatal Counseling.

It can be a very stressful and trying time for the parents when they learn that their unborn child has a Kidney abnormality. Though, a lot of these anomalies may be clinically insignificant requiring nothing more than observation after birth, some of the anomalies are indeed serious mandating a regular checkup before birth and immediate intervention after birth.

A proper counseling session ensures that everybody is on the same page and is motivated as a part of the team to tackle any issues that might arise. A detailed individualized plan is drawn up for each baby and given to the families and communicated to the Gynecologist/ Obstetrician involved. A pediatrician for post natal care for general well being of the baby is also informed about the condition.

Clear, expeditious and precise communication is the key for the little one to get best result possible after birth.

  • What does Antenatal Diagnosis mean?
  • Definition of Antenatal Hydronephrosis
  • What causes antenatal hydronephrosis?
  • How is antenatal hydronephrosis managed?
  • What is done to evaluate the hydronephrosis after the baby is born?
  • What can be done to treat the hydronephrosis?

What does Antenatal Diagnosis mean?

Antenatal diagnosis or diagnosis of disorders while the baby is still in mother’s womb is the cutting edge of medical science. The once opaque womb has been rendered transparent due to free availability of high resolution ultrasound. Two decades back pediatricians and pediatric surgeons used to get frustrated when they used to see a baby with a severe congenital malformation. They used to feel that “I wish I was there earlier”. But now a large number of these anomalies are diagnosed before the baby is born.

Ultrasound typically can pick up structural abnormalities in the developing babies especially after 16 weeks once the miniature organs are in place. As expected, the specificity is more as the baby grows bigger. This has generated a whole new group of diseases- “Antenatally diagnosed disorders” or we call them "Unborn Patients"

Kidney abnormalities are one of the most common antenatal disorders, found in approximately 1% of all fetuses but the good part is that in up to 70% of them it may represent transient changes in form of slight swelling which goes away by itself either before or after birth.

The major groups of anomalies 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.

Definition of Antenatal Hydronephrosis

Antenatal hydronephrosis refers to fluid-filled enlargement of the kidney detected before birth in the fetus by ultrasound studies. Hydronephrosis can be detected as early as the 15 weeks of pregnancy. In most instances this diagnosis will not change obstetric care, but will require careful follow-up and evaluation after birth and in some cases surgery during infancy and childhood.

What causes antenatal hydronephrosis?

Possible causes of antenatal hydronephrosis include:

  • Blockage: this may occur at the kidney in the Pelvi-ureteric junction (PUJ), (VUJ obstruction), or in the urethra (posterior urethral valve- PUV)
  • Reflux: Vesicoureteral reflux occurs when the valve between the bladder and the ureter does not fuction properly, permitting urine to flow back up to the kidney when the bladder fills or empties. Most children (90%) outgrow this during childhood but need daily antibiotic prophylaxis to try to prevent urine infections and resultant kidney damage before they outgrow the reflux. Only 10% of the children require anti-reflux or reimplantation surgery or deflux injection.
  • Duplications: Normal person has one tube or ureter draining the urine from te kidney but 1/200 people or 0.5% of people have two collecting tubes from a kidney. This is called Duplex system. Normally, this does not cause any issues unless one of the tubes is opening at a wrong location or has a swelling. These may show up on fetal ultrasound. Occasionally patients with duplication have a ureterocele, which is a balloon-like obstruction at the end of one of the duplex tubes. In girls one of the ureters can open into the vagina leading to incontinence (ectopic ureter)
  • Multicystic kidney (MCKD): This is a nonfunctional cystic kidney, where the kidney looks like a bunch of grapes and does not have function at all. Most of these multicystic kidneys disappear gradually after birth in the first five years of life and hence need no treatment except a regular USG and followup with a Pediatric Urologist.
  • Transient Hydronephrosis. Almost 50 % of the fetal hydronephrosis may be of this type where due to high urine production before birth the kidney looks swollen. After birth this hydronephrosis gradually goes away by itself. Regardless of grade of hydronephrosis best approach is to consult a pediatric urologist in the first month of age of the baby and confirm that the swelling has indeed gone away.

PUJ obstruction: blockage at the left ureteropelvic junction (where ureter joins to the kidney)
Posterior urethral valves: blockage at the outlet of the bladder
Vesicoureteral reflux on the left: flow of urine back up ureter causing dilated ureter and kidney
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