Ultrasound diagnosis and perinatal management of fetal genito-urinary abnormalities

Approximately 50% of fetal abdominal masses originate in the urinary system and those recognizable ultrasonically include renal dysplasia, renal agenesis and obstruction of the lower excretory channels. Fetal renal anomalies may be discovered co-incidentally during the course of sonographic evaluation of uterine size-dates discrepancy, because they are commonly associated with fetal growth retardation and/or oligohydramnios, or during a planned sonographic follow-up of pregnancies in patients who are at risk of recurrence of such anomalies. The sonographic demonstration of renal anomalies under these circumstances may allow for elective termination of pregnancy, may modify the obstetric management and/or facilitate pediatric and surgical care of the newborn. In the collaboration study at three ultrasonic centers there were 81 cases of genito-urinary tract anomalies detected antenatally in a five years period. Among the detected anomalies there were 30 hydronephrotic fetuses, 12 with multicystic disease, 15 with Potter's syndrome, 10 with polycystic kidney, 9 with Prune Belly syndrome, 4 with isolated renal cysts and 1 with an ovarian cyst. Perinatal management of the fetus with urinary tract abnormalities greatly depends on the accuracy of the diagnosis. It would be justifiable to suggest that an inexperienced observer should not make the final diagnosis. He could be of great help, if one kept a high index of suspicion in patients with a significant family history of oligohydramnios and of unexplained abnormal cystic structures in the fetal abdomen and seek the help of a special referral center where experience in related cases is concentrated. Once an accurate diagnosis is made, various alternatives are open to the obstetrician. This is primarily dependent upon the type and degree of the abnormality. Unilateral multicystic kidney and hydronephrosis due to obstruction above the level of the urethra appear to be compatible with extrauterine life and should be approached accordingly. If there is massive enlargement of the fetal abdomen, elective cesarean delivery should be considered to prevent the dystocia which may occur with vaginal delivery and to prevent further damage of these vital organs. If bilateral renal agenesis, bilateral multicystic kidneys, or bilateral infantile polycystic kidneys are demonstrated early in gestation, the obstetrician and parents may choose to terminate the pregnancy because these conditions are not compatible with extrauterine life.(ABSTRACT TRUNCATED AT 400 WORDS)