Many urological conditions can be picked up early on maternal ultrasound scans. 1 in 600 fetal ultrasound scan pick up uropathy. Commonly a majority of these conditions are managed conservatively and do not require an operation. However the follow up of these fetuses and babies both before and after birth is important.
I have an experience in prenatal counselling along with my fetal medicine consultant for over 15 years. My experience as a paediatric urology consultant gives me the added advantage to counsel prenatally and follow up these babies after birth and keep a close watch on their urological condition as well as operate on them when it is deemed necessary. Once a diagnosis is suspected it can cause distress to parents and this is not proportional to the severity of the condition. Simply knowing that their baby has a specific condition can cause severe anxiety in parents and having the experience and skills to take parents through this difficult time is a valuable asset.
I have the full support and the facility of good paediatric radiologists for the tests required for these babies after birth like kidney ultrasound and isotope imaging to evaluate the function in their kidneys in order to make sound management plans.
The primary imaging after birth, renal tract ultrasound scan, isotope scans Mag3 and DMSA in select cases dependent on the diagnosis a voiding cystourethrogram or Magnetic resonance imaging of renal tract MRU scan can also be arranged. The timing of these scans is different for each of the scans. Commonly the US scan is done at the end of the first week of life and 6 weeks. Isotope scans are done once baby is 3 months of age. The voiding cystogram is done in the first few weeks of life. The MRU is usually done after the isotope scans.
Parents are kept well informed during consultation regarding these investigations their indication and results discussed in appropriate details with them too.
An important fact to keep in mind is that prenatally the condition can only be suspected this has to be confirmed after birth. Prenatally the fetal physiology is rapidly changing with gestational age and is dynamic. Sometimes we need to resort to a fetal MRU to better define renal tract anatomy in a select few.
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