COMPLICATIONS OF INTRAUTERINE PLACEMENT OF A VESICOAMNIOTIC SHUNT

Background: Fetal obstructive uropathies complicated by severe oligohy dramnios can cause neonatal death due to renal dysplasia and pulmonary hypoplasia. Case: A 31-year-old multigravida was referred at 19.6 wee ks with sonographic evidence of fetal megacystis and bilateral hydrour eteronephrosis, and severe oligohydramnios. A vesicoamniotic shunt was placed for urinary diversion. Complications included shunt migration, intestinal evisceration, amniorrhexis, preterm labor, and preterm del ivery. Bowel characteristics were assessed by measuring the intestinal lumen diameter for evidence of obstruction. The lumen diameter remain ed stable at 3-5 mm, and the luminal wall remained stable at 2.5 mm. A fter birth at 31 weeks, the infant underwent exploratory laparotomy an d extraction of malpositioned shunts, vesicostomy, and closure of abdo minal wall defect. He was discharged at 61 days of life after resoluti on of neonatal pulmonary and infectious complications. Conclusion: Ope rative management of complete fetal obstructive uropathy is beneficial despite potential complications. (C) 1998 by The American College of Obstetricians and Gynecologists.