Intervention for Fetal Obstructive Uropathy: Has It Been Effective?

Elder, J; Duckett, J W; Snyder, HowardM.

doi:10.1016/s0140-6736(87)92567-0

Cited by 151 publications

(42 citation statements)

References 36 publications

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“…There was a 4.6% procedure-related fetal mortality rate and the overall survival was only 41%. In an additional review of reported cases from the literature, Elder et al [19] noted a 44% complication rate. This led to an inevitable backlash against the procedure, with many advocating against its use [20].…”

Section: Clinical Experiencementioning

confidence: 99%

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Fetal therapy for obstructive uropathy: past, present.....future?

Freedman

Johnson

González

2000

Pediatric Nephrology

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Antenatal treatment of obstructive uropathy, although widely performed, remains controversial. An overview of prenatal therapy for obstructive uropathy, the limitations of the early published experience, advances of recent years, and future directions for treatment are reviewed. The clinical approach and outcomes of the Fetal Treatment Program of Hutzel Hospital and Wayne State University are presented. Patient selection for antenatal treatment is based on the existence of a significant threat of neonatal death due to pulmonary hypoplasia, pending exclusion criteria such as anatomical structural anomalies and chromosomal defects. Ultrasonography, karyotyping, and sequential urinary electrolyte analysis are essential. Current treatment involves the placement under ultrasonic guidance of a Rodeck vesicoamniotic shunt. Recent technical advances include the use of amnioinfusion for fetal visualization, temporary fetal paralysis, routine antibiotics, and more-precise catheter placement. The establishment of standardized short- and long-term outcome measures and the documentation of fetal and maternal complications are in progress. Procedural refinement, development of fetoscopic techniques and equipment, identification of urinary markers to aid patient selection, and the collection of multicenter outcome data will assist the future management of prenatally detected obstructive uropathy.

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Section: Clinical Experiencementioning

confidence: 99%

“…Unfortunately there has been little formal investigation of complications. Elder et al [19] reported a 44% complication rate in 57 cases of prenatal intervention from the literature reported before 1987. However, placement of a vesicoamniotic shunt was the intervention reported in only 37% of the cases.…”

Section: Complicationsmentioning

confidence: 99%

Fetal therapy for obstructive uropathy: past, present.....future?

Freedman

Johnson

González

2000

Pediatric Nephrology

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“…Incomplete diagnoses, shunt complications and shunt migration, failure to restore AFV, and poor antenatal criteria to predict long-term outcomes make counseling difficult because the intervention may not produce the desired outcome [1,2,3,4]. Highly selected populations undergoing fetal intervention have fetal mortality rates of 38-43% [5,6].…”

Section: Introductionmentioning

confidence: 99%

Use of an Amnioport to Maintain Amniotic Fluid Volume in Fetuses with Oligohydramnios Secondary to Lower Urinary Tract Obstruction or Fetal Renal Anomalies

Polzin¹,

Lim²,

Habli

et al. 2016

Fetal Diagn Ther

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Objective: We describe a technique to maintain amniotic fluid in fetuses with severe oligo-/anhydramnios secondary to lower urinary tract obstruction or fetal renal disease when urine production is inadequate to maintain a normal amniotic fluid volume (AFV). Methods: An amnioport was inserted into the amniotic space. The catheter was secured to prevent dislodgment and tunneled to a subcutaneous reservoir. The reservoir was accessed as necessary, infusing normal saline to maintain AFV. Pregnancy continued until term or indicated delivery. Results: Since 2010, 15 patients in this category were considered for an amnioport. Six chose comfort care and one elected percutaneous amnioinfusions. Nine amnioport procedures were performed in eight patients. There were no fetal deaths. All eight had successful restoration and maintenance of amniotic fluid. Delivery ranged from 9 to 96 days after placement (mean 63.7 days). One died due to unrecognized laryngeal web and another one died of pulmonary hypoplasia after preterm premature rupture of membranes. None of the remaining six had pulmonary hypoplasia. Three remain alive. Discussion: Severe oligo-/anhydramnios in the second trimester secondary to fetal anomalies is almost uniformly lethal due to pulmonary hypoplasia without restoration of amniotic fluid. The amnioport procedure may allow pulmonary survival but commits families to postnatal care decisions regarding pulmonary and renal complications.

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“…Antenatal intervention in fetuses with obstruction of the urinary tract is still controversial. It may not be possible to de®ne the cause of the obstructive uropathy precisely, biochemical indices on bladder urine may not re¯ect damage to both kidneys and percutaneous vesicoamniotic shunts have a complication rate of 25% [8].…”

Section: Discussionmentioning

confidence: 99%