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”.
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 80% of them it may represent transient changes in form of slight swelling which goes away by itself either before or after birth. These anomalies are diagnosed before the baby is born and referred for an opinion of an expert pediatric urologist even before 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.
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 possible evaluation & surgery during infancy and childhood by an expert pediatric urologist.
Possible causes of antenatal hydronephrosis include:
It is best to consult a pediatric urologist surgeon once the baby is diagnosed to have fetal hydronephrosis for good treatment after birth and plan it well in advance.
Several studies may need to be performed to evaluate the kidneys:
See cases of antental hydronephrosis here:
Case 4: Child with posterior urethral valve
Case 8: Child with antenatal hydronephrosis and PUJ Obstruction
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