SUMMARY Over a five year period 55 fetuses had abnormalities of the urinary tract detected by antenatal ultrasound scan. The incidence was 1:935 total births during a one year prospective study. Intrauterine intervention was undertaken in five for suspected obstructive uropathy, which was confirmed in only two. Of 51 live born infants, five died (two with renal failure), and only 18 (35%) had a clinically detectable abnormality at birth. Twenty seven patients underwent postnatal operations, the remainder being treated conservatively.Antenatal counselling was seldom undertaken by those responsible for the postnatal care. There were many instances of prospective parents receiving little or inappropriate information. Greater cooperation is required between all the staff concerned particularly as the natural history and appropriate postnatal management of some urinary tract abnormalities are still not known. diagnoses.Problems of diagnostic accuracy are combined with uncertainty about both the prognosis of many of the abnormalities and of the role of prenatal surgery.7 8 Urinary tract abnormalities occur in about 1:1200 pregnancies9 and hence the individual members of the obstetric and paediatric staff Care likely to have only limited experience with these lesions. Poor communication among staff in different specialities will only add to the difficulties of counselling the parents both antenatally and postnatally. We report our experience to illustrate some of the diagnostic and therapeutic dilemmas that arise when urinary tract abnormalities are detected antenatally. We emphasise the need for good communication and exchange of information among staff in the departments of obstetrics, radiology, and paediatrics. Patients and methodsBetween January 1982 and December 1986, 55 cases of antenatally diagnosed urinary tract abnormalities came to our attention either by referral for postnatal management, notification by the perinatal pathologist, or (latterly) referral for antenatal counselling.The number of cases increased from five in 19,82 to 21 in 1986. The data were collected prospectively during 1986 and included fetal urinary tract abnormalities that resulted in termination of pregnancy or intrauterine fetal death.It is the policy in all the referring centres to perform a routine ultrasound scan between 16 and 20 weeks' gestation. Further ultrasound examinations were for obstetric reasons except in one Nottingham centre where serial ultrasound scans were routinely carried out between 28 and 34 weeks as part of a research project into fetal growth. The ultrasound scans were performed by trained radiographers who called in a radiologist for more detailed scanning if an abnormality was detected or strongly suspectedfor example, if oligohydramnios was seen.Five mothers were referred to a specialist centre where antenatal bladder drainage procedures were 719 copyright.

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INTRODUCTION: Between 1999 and 2013, the prevalence of neonatal abstinence syndrome (NAS) in the United States increased almost 300%. Regional differences in the NAS prevalence highlight the need for comprehensive prevention strategies for opioid use disorder (OUD) in pregnancy. Our objective was to assess the presence of legislation requiring reporting of OUD in pregnancy, as well as available treatment resources. METHODS: We surveyed each state for existing laws or pending legislation requiring reporting of OUD in pregnancy by searching state government websites for keywords/phrases and contacted state officials directly to confirm the presence or absence of pertinent legislation. Information treatment resources offered and priority access to pregnant women was also collected. RESULTS: Fifteen states have active legislation for reporting OUD in pregnancy. Eighteen states treat OUD in pregnancy as child abuse. Twenty-five states provide priority access to pregnant women with OUD. The states not requiring reporting of OUD in pregnancy had a higher prevalence of NAS. CONCLUSION: Less than half of states have active legislation requiring OUD in pregnancy reporting. The rising prevalence and healthcare costs associated with NAS continue to confirm the need for legislation and comprehensive guidelines for opioid prescribing in each state, as well as the establishment of treatment resources for our pregnant patient population.