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Detecting Urological Conditions

in the Womb

12/12/2008 

Pregnancy can be a busy time for expecting mothers. Filled with doctor’s appointments, baby showers and decorating the nursery, nine months seems to fly by.

Among the many things on an expectant mother’s to-do list is having one or more ultrasounds. The obstetrician will order this test to see how a baby is doing before birth. You can find out whether it’s a boy or a girl and with the new 3-D and 4-D technology, get a glimpse of what your baby actually looks like. The ultrasound can also alert your doctor to potential medical problems. A common problem can be hydronephrosis, or swelling of the kidneys.

Children’s Hospital Central California is a one-stop-shop for prenatal diagnostic care. Expecting mothers can have their first, second and third trimester screenings performed in the Prenatal Diagnostic Center. If hydronephrosis is caught by an ultrasound, you may be referred to our Urology Practice. Our two board certified pediatric urologists are available to meet with expecting mothers and their loved ones to discuss the diagnosis and to assuage any fears they may have.

Typically during these appointments, Drs. Devonna Kaji or Irene McAleer will explain that there generally is nothing the mom did or didn’t do during the pregnancy to cause hydronephrosis, which happens when urine builds up in the baby’s kidney drainage system. For some reason, the urine may pool in the kidneys or is unable to make it to the bladder once it leaves the kidneys. Up to 50 percent of all fetal abnormalities picked up by ultrasounds are due to hydronephrosis. They will look at the ultrasound, discuss the diagnosis, determine whether an early delivery is recommended and explain what to expect once the child is born. The pediatric urologist will develop a personalized treatment plan, which may include:

  • additional ultrasounds during the first 2 weeks of life
  • voiding cystourethrogram (VCUG): an x-ray that helps identify bladder problems and urinary reflux
  • nuclear renal scan to measure kidney function and drainage
  • antibiotics to prevent infection in case there is an anatomic problem causing the hydronephrosis

The pediatric urologist shares her findings during with the referring obstetrician or perinatologist and the baby’s pediatrician, if the parents have selected one.

Often this treatment plan can be carried out on an outpatient basis. If hospitalization is required after the baby is born, parents can be confident knowing their child is in the Central Valley’s only Regional Level III Neonatal Intensive Care Unit (NICU), with more than 140 pediatric subspecialists on site. This helps newborns with medical problems in our NICU access a much wider array of specialty care than they can get in a general hospital. In this case, the pediatric urologists’ offices are just one floor down from the NICU.

Almost half of all hydronephrosis cases identified prior to delivery are solved by the time the child is born or within their first year. Only 1 in 500 babies with hydronephrosis found before birth will have a significant urological problem after they are born. Our pediatric urologists closely monitor their patients to ensure the condition has been resolved, but the importance of prenatal diagnosis cannot be overstated.