Management of the Fetus With Congenital Hydronephrosis II: Prognostic Criteria and Selection for Treatment

Treacher Collins syndrome: etiology, pathogenesis and prevention

“…Taking this one step further, one could even envision the therapeutic application of stem cells in utero to treat some of the debilitating malformations associated with TCS. Fetal surgery became technically feasible during the 1980s 38 and intrauterine repair of cleft palate, for example, is possible both in theory and practice. 39,40 However, at present, there is no universal recommendation for the in utero correction of prenatally diagnosed craniofacial anomalies and the decision to pursue fetal surgical intervention carries with it the potential for dual mortality (mother and fetus).…”

Prenatal diagnosis from fetal urine in bladder outlet obstruction: Success rates for traditional cytogenetic evaluation and interphase fluorescence in situ hybridization

“…Left untreated, neonatal death due to pulmonary hypoplasia and renal dysplasia commonly occur, especially in those pregnancies in which oligohydramnios and prenatally diagnosed hyperechogenic renal parenchyma or subcortical cysts are identified. 1 The most important advance in the treatment of fetuses with this condition involves intervention in the form of in utero vesicoamniotic shunting for carefully selected fetuses. Criteria for selection of candidates for fetal bladder shunting include those with favorable prognostic signs based on a thorough ultrasound examination evaluating the appearance of the fetal kidneys and ruling out other congenital malformations, sequential fetal urine electrolyte analysis, ␤ 2 -microglobulin concentration, and chromosome analysis.…”

Prenatal intervention for urinary obstruction and myelomeningocele

“…More physiologic measurements of glomerular function, while possible, are not routinely performed (38). Clearance of iothalamate has been done and shown to be nonpredictive of renal outcome (10). Retrospective analysis of individual urine constituents have shown that a sodium of less than 100 mEq/L, osmolality less than 210 mOsm/L and chloride less than 90 mEq/L, if accompanied by lack of ultrasonographic evidence of dysplasia, are helpful in predicting residual fetal renal function.…”

“…Primitive renal function begins between week 7 and 9, and by week 20, about 1/3 of the total number of nephrons are present. Nephrogenesis is complete by the 32nd week of fetal life, after which no demonstrable increase in the number of glomeruli is noted (8)(9)(10).…”