Wisser J, Kurmanavicius J, Lauper U, Zimmermann R, Huch R, Huch A
Department of Obstetrics, University Hospital Zurich, Switzerland.
Am J Obstet Gynecol. 1997 Sep;177(3):685-9. doi: 10.1016/s0002-9378(97)70165-0.
Our goal was to assess fetal kidney function in fetuses with megavesica diagnosed during the first half of pregnancy before treatment.
In a prospective interventional study 9 fetuses with megavesica diagnosed during the first half of pregnancy underwent vesicocentesis. Fetal urine biochemical markers (urine electrolytes, osmolarity, and beta 2-microglobulins) were determined after diagnostic vesicocentesis of the fetal megavesica.
Surprisingly, in four fetuses who underwent sampling at 13 to 18 postmenstrual weeks, vesicocentesis proved both diagnostic and therapeutic. Pregnancy proceeded with normal amniotic fluid volume, a normal-sized urinary bladder with normal dynamics, and normal postnatal renal function. A fifth fetus had trisomy 18. In three of the remaining four fetuses in whom sampling was performed at 16 to 20 postmenstrual weeks, biochemical markers indicated a poor prognosis. In the remaining fetus marginal results of biochemical studies prompted intrauterine treatment, but death from respiratory problems ensued after premature delivery at 31 weeks.
Fetal megavesica in the first half of pregnancy is an indication for an immediate diagnostic vesicocentesis. This is the first report emphasizing early diagnosis of fetal megavesica with subsequent fetal vesicocentesis and demonstrating that this minimally invasive procedure can be life-saving if performed in early pregnancy.
我们的目标是评估妊娠前半期诊断为巨大膀胱的胎儿的肾功能，且在治疗前进行评估。
在一项前瞻性干预性研究中，9例妊娠前半期诊断为巨大膀胱的胎儿接受了膀胱穿刺术。在对胎儿巨大膀胱进行诊断性膀胱穿刺术后，测定胎儿尿液生化标志物（尿电解质、渗透压和β2-微球蛋白）。
令人惊讶的是，在4例月经周期后13至18周接受采样的胎儿中，膀胱穿刺术证明既具有诊断性又具有治疗性。妊娠过程中羊水体积正常，膀胱大小正常且动态正常，出生后肾功能正常。第5例胎儿患有18三体综合征。在其余4例月经周期后16至20周接受采样的胎儿中，有3例的生化标志物提示预后不良。在其余1例胎儿中，生化研究结果临界，促使进行宫内治疗，但在31周早产之后因呼吸问题死亡。
妊娠前半期的胎儿巨大膀胱是立即进行诊断性膀胱穿刺术的指征。这是第一份强调早期诊断胎儿巨大膀胱并随后进行胎儿膀胱穿刺术的报告，并证明如果在妊娠早期进行这种微创手术可能挽救生命。
