Szaflik K, Kozarzewski M, Adamczewski D
Department of Ultrasonography in Obstetrics and Gynecology, Institute Polish Mother's Memorial Hospital, Lódź.
Fetal Diagn Ther. 1998 May-Jun;13(3):133-5. doi: 10.1159/000020823.
Fetal obstructive uropathy is simple to diagnose before the 24th week of life. Drainage of the pathologically enlarged fetal bladder avoids development of hydronephrosis and destruction of kidneys and, obviously, prevents development of secondary oligohydramnios and pulmonary hypoplasia. The aim of our study was to evaluate the usefulness of a fetal bladder shunt in cases of obstructive uropathy before the 24th week of gestation.
From January 1997 we diagnosed 6 cases of fetal obstructive uropathy before the 24th week of gestation. In all cases oligohydramnios or ahydramnios was also observed. After evaluation of the renal function on the basis of fetal urine samples, we shunted 5 fetuses. After routine preparation of the operative field, a special puncture needle was inserted through the abdominal wall of mother and fetus into the fetal bladder. Through the needle a fetal bladder catheter was inserted between the fetal bladder and the amniotic sac. After shunt placement, fetal urine fills the amniotic sac and the fetal bladder is decompressed. After the procedure, the patients were hospitalized and serial sonographic examinations were performed to evaluate shunt function. Bladder size, presence and size of hydronephrosis, and volume of amniotic fluid were evaluated.
The Rocket Medical catheters have an excellent 'shape memory'. All but 1 newborns had a good perinatal outcome. Mean Apgar score was 8 at 1 min, weight at delivery was between 1,700 and 3,100 g. No pulmonary hypoplasia was observed. All deliveries were after the 33rd week of gestation (range 33-38 weeks). The minimum drainage time was 11 weeks, maximum 18 weeks. In 2 cases premature delivery occurred because of premature rupture of the membranes. One newborn died of respiratory distress syndrome.
Early bladder drainage (before the 24th week of gestation) enables delivery of newborns with a good perinatal outcome, without pulmonary hypoplasia. This method of therapy limits renal damage and allows time for normal development of the fetal lungs.
胎儿梗阻性尿路病在孕24周前易于诊断。对病理性增大的胎儿膀胱进行引流可避免肾积水的发展以及肾脏的破坏，并且显然可防止继发性羊水过少和肺发育不全的发生。我们研究的目的是评估胎儿膀胱分流术在妊娠24周前梗阻性尿路病病例中的效用。
自1997年1月起，我们诊断出6例妊娠24周前的胎儿梗阻性尿路病病例。所有病例均观察到羊水过少或无羊水。在根据胎儿尿液样本评估肾功能后，我们对5例胎儿进行了分流术。在对手术区域进行常规准备后，将一根特殊的穿刺针经母亲和胎儿的腹壁插入胎儿膀胱。通过该针将一根胎儿膀胱导管插入胎儿膀胱与羊膜囊之间。分流管放置后，胎儿尿液充满羊膜囊，胎儿膀胱减压。术后，患者住院并进行系列超声检查以评估分流功能。评估膀胱大小、肾积水的存在及大小以及羊水量。
Rocket Medical导管具有出色的“形状记忆”功能。除1例新生儿外，其他所有新生儿围产期结局良好。1分钟时阿氏评分平均为8分，分娩时体重在1700至3100克之间。未观察到肺发育不全。所有分娩均发生在妊娠33周后（范围为33 - 38周）。最短引流时间为11周，最长为18周。2例因胎膜早破发生早产。1例新生儿死于呼吸窘迫综合征。
早期膀胱引流（妊娠24周前）可使新生儿获得良好的围产期结局，且无肺发育不全。这种治疗方法可限制肾脏损害，并为胎儿肺的正常发育留出时间。
