OBSTRUCTIVE UROPATHY
Obstructive uropathy lends itself to early detection with ultrasonography. Posterior urethral valves or bladder outlet obstructions are the most common of these disorders, but the obstruction may be at any level of the urinary tract.
In all cases of obstructive uropathy, the rationale behind treatment is that the obstruction itself will lead to permanent renal damage in the developing fetus. Obstruction of the urinary tract will lead to oligohydramnios and pulmonary hypoplasia, which is usually the cause of death in these neonates. Thus, the rationale for invasive therapy is that it will prevent a potentially fatal sequence of events and, if successful, will lead to a favorable long-term prognosis. Ideal candidates for the procedure are fetuses with isolated anomalies who are found in the second or very early third trimester with progressive oligohydramnios but good remaining renal function.
DIAPHRAGMATIC HERNIA
Diaphragmatic hernia is a serious fetal anomaly with a high perinatal mortality rate. Although it may be associated with other fetal anomalies, more frequently it is isolated. Death of neonates from pulmonary hypoplasia is believed to be due to compression of the normal lung in utero by herniated abdominal contents. Various methods of in utero repair have been proposed, including open fetal surgery. In this procedure, a hysterotomy is performed and the exteriorized fetus undergoes surgery to repair the defect and allow normal lung development.
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