The fetus with severe bilateral
hydronephrosis and associated
oligohydramnios in the second trimester is doomed at birth by ongoing pulmonary and renal damage. Since
decompression with percutaneously placed
catheters anesthetic, surgical, and
tocolytic techniques for open fetal
anesthetic, surgical, and
tocolytic techniques for open fetal urinary tract
decompression in animals, and have now applied those techniques to a small group of five patients. One had bilateral
ureterostomies and the subsequent four had marsupialization of the bladder. All pregnancies proceeded to cesarean delivery at 32 to 35 weeks' gestation. There was no long-term maternal morbidity, and two mothers have since experienced normal pregnancies. Three fetuses had return of normal amniotic fluid dynamics, and all three had adequate pulmonary function at birth, suggesting that fatal pulmonary hypoplasia associated with early severe
oligohydramnios had been reversed. Two neonates died at birth with pulmonary hypoplasia. One had no amniotic fluid even after
decompression, and the other had some amniotic fluid after
decompression but a tiny chest cavity due to the long period of severe
oligohydramnios before
decompression. Of the three surviving infants, one had normal renal function when she died of unrelated causes at 9 months of age. One has normal renal function at 23 months and the third had failing renal function at 2 1/2 years and has grown and developed normally, but will require
renal transplantation. We have now developed selection criteria that would exclude from treatment the two fetuses who died of pulmonary hypoplasia and the one who developed
renal failure.(ABSTRACT TRUNCATED AT 250 WORDS)