Successful treatment of fetal megavesica in the first half of pregnancy.
OBJECTIVE
Our goal was to assess fetal kidney function in fetuses with megavesica diagnosed during the first half of pregnancy before treatment.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Wisser
J
J
Department of Obstetrics, University Hospital Zurich, Switzerland.
Kurmanavicius
J
J
Lauper
U
U
Zimmermann
R
R
Huch
R
R
Huch
A
A
D000009:Abdominal Muscles / Q000002:abnormalities; D000649:Amniocentesis; D015415:Biomarkers / Q000652:urine; D002869:Chromosome Aberrations / Q000175:diagnosis / Q000453:epidemiology; D025063:Chromosome Disorders; D003456:Cryptorchidism / Q000175:diagnosis / Q000453:epidemiology; D004573:Electrolytes / Q000652:urine; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000628:therapy* / Q000652:urine; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000196:embryology / Q000378:metabolism / Q000502:physiology; D008297:Male; D009994:Osmolar Concentration; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011379:Prognosis; D011446:Prospective Studies; D013577:Syndrome; D016216:Ultrasonography, Prenatal / Q000379:methods; D014524:Urethral Obstruction / Q000175:diagnosis / Q000628:therapy* / Q000652:urine; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000196:embryology* / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000175:diagnosis / Q000628:therapy* / Q000652:urine; D001613:beta 2-Microglobulin / Q000652:urine
D015415:Biomarkers; D004573:Electrolytes; D001613:beta 2-Microglobulin