The incidence of prenatal and intrapartum complications was examined among
33 pregnancies complicated by lethal fetal renal abnormalities (cases) and
compared to 200 contemporaneous control pregnancies (controls) by retrospec
tive record review. Cases experienced higher rates of antepartum bleeding (
2946 vs. 6%, p<0.0001) stillbirth (15% vs. 0%, p<0.0001), preterm birth (34
.3+/-4.1 vs. 39.7+/-1.8, p<0.0001) and breech presentation (48% vs. 4%, p<0
.0001). Twenty-six of 33 cases had lung weights less than or equal to first
centile. Primary cesarean section occurred more frequently in cases than i
n controls (48% vs. 9%, p<0.0001). Knowledge of poor fetal prognosis alone
did not appear to influence obstetrical management. We conclude that timely
consultation with sonologist and neonatologist and patient counseling may
avoid unnecessary obstetrical intervention when pregnancy complications occ
ur. Pregnancies complicated by lethal fetal renal abnormalities have higher
rates of ante- and intrapartum complications leading to frequent abdominal
delivery. This suggests that accurate predictive markers for lethal fetal
renal disease may reduce ineffective obstetric intervention. (C) 2000 Elsev
ier Science Ireland Ltd. All rights reserved.