11/22. Failure to detect fetal obstructive uropathy by second trimester ultrasound.The prenatal diagnosis, management and outcome of an hereditary obstructive uropathy is presented. Serial ultrasonic assessment of the fetal urinary tract was carried out from the early second trimester onward. Slight bilateral hydronephrosis as a first sign of obstructive uropathy was only established as late as 30 weeks of gestation. On the basis of weekly ultrasound scans, a conservative approach was adopted. In view of fetal maturity, labour was induced at 36 weeks resulting in the vaginal delivery of a male infant with moderate bilateral hydronephrosis. Neonatally, anuria developed due to bilateral obstruction of the ureters as a result of increasing bladder wall hypertrophy due to urethral valves. A bilateral uretero-cutaneostomy was carried out. The infant so far develops normally, and renal function is normal for age. women at risk for fetal obstructive uropathy should have ultrasonic monitoring throughout pregnancy.- - - - - - - - - - ranking = 1keywords = gestation, pregnancy (Clic here for more details about this article) |
12/22. Antenatal diagnosis of renal anomalies with ultrasound. I. Obstructive uropathy.During a 5-year period, a diagnosis of obstructive uropathy was made in 25 fetuses. Eight of them had unilateral obstruction and 17 were affected bilaterally. The most common condition encountered was urethral obstruction by posterior valves. The site and nature of the obstruction were correctly identified in 22 of the 25 fetuses. Among the 17 who had bilateral obstruction, only three survived. In contrast, only one infant with unilateral obstruction died (of unrelated causes). oligohydramnios in low-level (urethral) obstruction was a uniformly lethal finding. Relief of urethral obstruction in two fetuses after 20 weeks of gestation did not result in survival of the infant, whereas shunting prior to 20 weeks in one fetus seemed to have a beneficial effect. On the basis of this experience, we suggest that unilateral obstruction would be treated best by conservative management, while in bilateral obstruction invasive treatment may be effective if initiated early in gestation, before significant oligohydramnios occurs.- - - - - - - - - - ranking = 1.9378751683169keywords = gestation (Clic here for more details about this article) |
13/22. Fetal posterior urethral valves and renal dysplasia at 15 weeks gestational age.An enlarged bladder secondary to posterior urethral valves was detected by ultrasound in a 15-week-old fetus. autopsy at 18 weeks of gestation revealed severe renal dysplasia. Intervention, even at this early gestational age, would be unlikely to reverse these pathologic changes.- - - - - - - - - - ranking = 5.8136255049507keywords = gestation (Clic here for more details about this article) |
14/22. The prenatal ultrasonic diagnosis of urethral obstruction and diverticulum of the urinary bladder.In a 28 year old gravida 2 para 1 an ultrasonogram at 35 weeks of gestation revealed a huge cystic abdominal tumor in fetus. Postpartum ultrasound, excretory urography and micturating cystourethrography showed a trabeculated bladder with a large diverticulum and hydronephrosis due to a posterior urethral valve. The prenatal diagnosis of this anomaly and immediate surgical intervention prevented additional severe damage in the newborn.- - - - - - - - - - ranking = 0.96893758415845keywords = gestation (Clic here for more details about this article) |
15/22. Intermittent urinary retention in first trimester of pregnancy.Gynecologic diseases are a rare but easily detectable cause of complete urinary retention. Herein we describe a case of intermittent but complete urinary retention secondary to uterine fibroids and prolapse during the first trimester of pregnancy.- - - - - - - - - - ranking = 0.15531207920777keywords = pregnancy (Clic here for more details about this article) |
16/22. Neonatal perirenal urinary extravasation with posterior urethral valves.Renal dysplasia and atrophy are associated with congenital urinary tract obstruction, such as posterior urethral valves, and are thought to result from the increased pressure in the developing obstructed urinary system. This increased pressure is likely to be alleviated by perirenal urinary extravasation and urinary ascites. Whether this relief of pressure in the obstructed developing kidney results in a lessened degree of renal abnormality is likely to depend on the time during the period of gestation when the urinary leak occurs and the degree of renal dysplasia and atrophy at the time of the urinary leak.- - - - - - - - - - ranking = 0.96893758415845keywords = gestation (Clic here for more details about this article) |
17/22. Antenatal ultrasonic diagnosis of complete urethral obstruction in the fetus.A case of ante-natal diagnosis of complete obstruction of the urethra is reported. By repeated ultrasonic B-scans a distended bladder filling the abdominal cavity could be seen, and a hydroureter was demonstrated. By early diagnosis of this condition, which is incompatible with life, a decision to terminate pregnancy can be made.- - - - - - - - - - ranking = 0.031062415841555keywords = pregnancy (Clic here for more details about this article) |
18/22. Severe urethral obstruction diagnosed at 14 weeks' gestation: variability of outcome with and without drainage.We present 3 case reports to illustrate the variability of outcome of severe fetal posterior urethral obstruction. Two of the described cases support the view that early in-utero decompression of an obstructed fetal urinary system into the amniotic cavity, in the selected patient, will allow adequate lung development and will prevent the development of severe renal dysplasia. It will not prevent the abdominal wall deformity of the prune belly syndrome. The evidence suggests that to allow maximum time for lung development and to prevent increasing renal dysplasia, drainage should be performed before 18 weeks of gestation. To obtain maximum effect, this drainage should continue until at least 32-33 weeks' gestation, so that the possible respiratory problems of prematurity would not be severe enough to compound the degree of lung hypoplasia which might be present. Case 3 supports our view that an endoscopic approach to in-utero drainage of the urinary tract has the advantage of achieving drainage with minimal risk to both mother and fetus.- - - - - - - - - - ranking = 5.8136255049507keywords = gestation (Clic here for more details about this article) |
19/22. urethral obstruction sequence and lower limb deficiency: evidence for the vascular disruption hypothesis.We reviewed five unreported examples and 23 previously reported cases of urethral obstruction sequence with associated lower limb deficiency. There was no evidence of amniotic bands or exposure to vasoactive drugs during pregnancy in any case. In three infants a gangrenous lesion at the distal part of the affected leg was found; in another three infants, necrotic tissue was noted in the stump of the affected leg. This type of lesion can be explained only on a vascular ischemic basis. In five cases, signs of compression of the external iliac artery by the grossly distended bladder, by grossly distended ureters, or both were found. A vascular disruption in the territory of the external iliac artery caused by compression by the distended urinary tract is the proposed mechanism for the associated limb deficiency.- - - - - - - - - - ranking = 0.031062415841555keywords = pregnancy (Clic here for more details about this article) |
20/22. Hydrometrocolpos following prenatal dexamethasone treatment for congenital adrenal hyperplasia (21-hydroxylase deficiency).A female with congenital adrenal hyperplasia (21-hydroxylase deficiency) received prenatal dexamethasone treatment. Suppression of the fetal adrenal was initially inadequate but adequate in later pregnancy. The baby showed masculinisation without clitoral enlargement and a narrow urogenital sinus with resulting hydrometrocolpos. It is possible that dexamethasone treatment which is initially inadequate increases the risk of this latter complication.- - - - - - - - - - ranking = 0.031062415841555keywords = pregnancy (Clic here for more details about this article) |
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