Antenatal Diagnosis of Urological Abnormalities

Abstract

The use of ultrasound to scan women during the second trimester of pregnancy to determine gestational age of the fetus and during the third trimester to assess fetal growth and placental site has become routine in many centres. Not infrequently these scans lead to the detection of fetal abnormalities affecting the heart, central nervous system, abdominal wall, chest or urogenital tract. There is no doubt that the early diagnosis of severe congenital anomalies such as anencephaly offers an obvious advantage: pregnancy can be terminated at an early stage. In many other instances, however, the abnormality detected may be compatible with normal life with or without surgery, and it may even transpire that the baby is normal and the scan misleading. In these circumstances the mother goes through pregnancy with the knowledge that the fetus is abnormal and suffers all the associated anxieties instead of the normal joys of pregnancy (Griffiths and Gough 1985). This chapter will confine itself to the antenatal diagnosis and management of urological abnormalities, but it is in this group of patients that major controversy concerning management exists. The antenatal diagnosis of a urological abnormality leads to certain possible courses of action, which are described below.