title: Limb constriction as a complication of intra-uterine vesico-amniotic shunt: fetoscopic release.
abstract: Complete fetal bladder outlet obstruction was first diagnosed in a fetus at 13.5 weeks. After sequential vesicocentesis had shown good renal function, a vesico-amniotic shunt was inserted at 17 weeks with a Rodeck catheter. The procedure was successful and amniotic fluid volume re-accumulated to normal levels. A detailed scan at 20 weeks showed that the distal free end of the catheter was wound round the left fetal thigh. As the fetus grew, there was progressive constriction of the fetal thigh by the catheter. By 29 weeks, Doppler blood flow changes to the left leg were apparent. Fetoscopic surgery was performed at 30 weeks to release the constriction. The catheter was divided successfully, but the divided end of the shunt subsequently retracted into the fetal abdomen, producing urinary ascites, bilateral hydroureter and hydronephrosis. The baby was delivered at 31.5 weeks in good condition. Endoscopic resection of anterior and posterior urethral valves was performed at 6 months of age. At 2 years, the child has normal renal function, growth parameters and developmental milestones. Mild indentation of the left thigh was still apparent, although there was no functional impairment.
authors.affiliation: Mater Centre for Maternal Fetal Medicine, Mater Mother's Hospital, University of Queensland, Brisbane, Qld., Australia. fchan@mater.org.au
authors.forename: Fung Yee
authors.initials: FY
authors.lastname: Chan
authors.forename: Peter
authors.initials: P
authors.lastname: Borzi
authors.forename: Robert
authors.initials: R
authors.lastname: Cincotta
authors.forename: John
authors.initials: J
authors.lastname: Burke
authors.forename: David
authors.initials: D
authors.lastname: Tudehope
mesh_terms: D000653:Amniotic Fluid; D002408:Catheters, Indwelling / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000209:etiology / Q000601:surgery; D005260:Female; D005332:Fetoscopy; D006801:Humans; D007866:Leg / Q000473:pathology*; D011247:Pregnancy; D016216:Ultrasonography, Prenatal; D001743:Urinary Bladder; D001748:Urinary Bladder Neck Obstruction / Q000628:therapy*