SUCCESSFUL TREATMENT OF FETAL MEGAVESICA IN THE FIRST-HALF OF PREGNANCY

OBJECTIVE: Our goal was to assess fetal kidney function in fetuses wit h megavesica diagnosed during the first half of pregnancy before treat ment. STUDY DESIGN: In a prospective interventional study 9 fetuses wi th megavesica diagnosed during the first half of pregnancy underwent v esicocentesis. Fetal urine biochemical markers (urine electrolytes, os molarity, and beta(2)-microglobulins) were determined after diagnostic vesicocentesis of the fetal megavesica. RESULTS: Surprisingly, in fou r fetuses who underwent sampling at 13 to 18 postmenstrual weeks, vesi cocentesis proved both diagnostic and therapeutic. Pregnancy proceeded with normal amniotic fluid volume, a normal-sized urinary bladder wit h normal dynamics, and normal postnatal renal function. A fifth fetus had trisomy 18. In three of the remaining four fetuses in whom samplin g was performed at 16 to 20 postmenstrual weeks, biochemical markers i ndicated a poor prognosis. In the remaining fetus marginal results of biochemical studies prompted intrauterine treatment, but death from re spiratory problems ensued after premature delivery at 31 weeks. CONCLU SIONS: Fetal megavesica in the first half of pregnancy is an indicatio n 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 procedu re can be lifesaving if performed in early pregnancy.