Fetal Obstructive Uropathy

[HisTreasure, BSN, RN]

Just found out my brother's girlfriend pregnancy is threatened. Her baby has fetal obstructive uropathy. She's eighteen weeks along. The bladder is distended and larger than his whole abdomen and part of his femur. Sonographers can't even get a good measure on him because of the enlarged bladder. Sister in law, as I refer to her, must get three amniocentesis procedures and one shunt procedure. My understanding is that the shunt is actually a procedure on the fetus that allows the bladder to empty into the amniotic sac. She must be put under general anesthesia and the baby may not survive. However, the baby won't survive at all if the shunt isn't placed. D/t the urine not emptying, the amniotic fluid levels are low:o. Has anyone dealt with this abnormality? Why does she need three amnios if this is a fairly "routine" abnormality as her OB says? If this is a threatened miscarriage and the baby may not make it either way, why even go through it at all?

[LilPeanut, MSN, RN, NP]

Because she wants the opportunity to see if the baby will make it?

She has the choice whether or not to do the procedures, but if she wants to, there is no reason why she shouldn't be given the opportunity to save the fetus. I don't know specifically what the amnios are for, but they aren't that bad. I had one when I was in labor with my son to test for lung maturity.

Well....technically I had four that day, because my fluid was so low, they had to make 4 attempts *LOL*

[HisTreasure, BSN, RN]

Because she wants the opportunity to see if the baby will make it?

She has the choice whether or not to do the procedures, but if she wants to, there is no reason why she shouldn't be given the opportunity to save the fetus. I don't know specifically what the amnios are for, but they aren't that bad. I had one when I was in labor with my son to test for lung maturity.

Well....technically I had four that day, because my fluid was so low, they had to make 4 attempts *LOL*

No, I'm not implying why SHE would go through with the procedure. That is understandable. My pregnancy has been threatened and high risk from the beginning, but I was willing to do whatever I had to do to carry a healthy baby. I TOTALLY understand why she would allow the procedure. My question, and I guess I didn't phrase it correctly, is why would the doctors put her and the baby through it if they aren't harboring much hope...which they aren't. It was more of a rhetorical question. In any event, my post was meant as a way of reaching out to my fellow nurses and see if anyone has had any experiences, good or bad with this particular problem. I had never heard of it before yesterday. We do fear about the low fluid but you offered some positive hope. Thanks.

[imenid37]

Here's a link which you may find helpful. I don't have any personal knowledge of this disorder really, other than that I have heard of it in passing before. I am not sure if this is anything helpful in the case you refer to, but will simply give more info. http://www.chop.edu/consumer/jsp/division/generic.jsp?id=81170

I hope for the best for you all.

[NurseNora, BSN, RN]

In the 90's, when I worked at a Level 3 big city hospital I saw this situation. I don't know why she needs multiple amnios before the procedure. I would imagine at least one would be for genetic testing to be sure that the baby doesn't have any lethal anomalies. If he did, there would be no reason to put him and his mother through any other procedures. But if as is usually the case, his only problem is a urethral obstruction, the surgery is worth the risk.

A small spiral tube (we called it "a pig's tail) is placed suprapubicaly into the baby's bladder. The pressure in the bladder is higher than in the surrounding amniotic fluid, so the urine flows out of the bladder into the fluid. It drains continously until birth. As I remember, delivery is done by a scheduled C/S.

Since a major part of the amniotic fluid volume is fetal urine, the procedure pretty much takes care of the oligohydramnios and the associated potential problems of muscle contractures and lack of development of the fetal lungs due to lack of fluid.

I've seen this done a few times, some only at second hand, and remember good outcomes. Hope things work out well for your nephew.

[prmenrs, RN]

I agree w/NurseNora. The baby needs amniotic fluid so his lungs can develop--he inhales the amniotic fluid, that's how he gets the chemicals/enzymes, etc.

I also agree that they need to do the genetic testing--very imp't. They may need to do other measurements over a period of time. They might want to see if the condition will correct itself. The only way for her to find out is to ASK the doc.

Best wishes to your family.