Question:
A 22-year-old primigravida attends the ANC OPD at 20 weeks of gestation. On examination the uterine height corresponds to a 16-week size. USG shows reduced liquor. What is the most likely diagnosis?
A 22-year-old primigravida attends the ANC OPD at 20 weeks of gestation. On examination the uterine height corresponds to a 16-week size. USG shows reduced liquor. What is the most likely diagnosis?
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No fetal kidneys means no fetal urine, and after 16 weeks urine is the liquor.
Updated On: Jun 23, 2026
- Renal agenesis
- Fetal anemia
- Bartter syndrome
- Liddle syndrome
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The Correct Option is A
Solution and Explanation
Step 1: Reduced liquor at 20 weeks means oligohydramnios (amniotic fluid index of 5 cm or less). The uterus measuring smaller than dates fits this.
Step 2: After the first trimester, amniotic fluid is mainly fetal urine. Anything that stops urine production or its passage causes severe oligohydramnios.
Step 3: Bilateral renal agenesis means no fetal urine at all, giving profound oligohydramnios early in the second trimester (the Potter sequence). This is the classic cause here.
Step 4: Fetal anemia causes hydrops with polyhydramnios, the opposite. Bartter and Liddle syndromes are tubular disorders linked with polyhydramnios, not oligohydramnios. So the answer is renal agenesis.
Ref: Williams Obstetrics, 24th ed, p. 237.
Step 2: After the first trimester, amniotic fluid is mainly fetal urine. Anything that stops urine production or its passage causes severe oligohydramnios.
Step 3: Bilateral renal agenesis means no fetal urine at all, giving profound oligohydramnios early in the second trimester (the Potter sequence). This is the classic cause here.
Step 4: Fetal anemia causes hydrops with polyhydramnios, the opposite. Bartter and Liddle syndromes are tubular disorders linked with polyhydramnios, not oligohydramnios. So the answer is renal agenesis.
Ref: Williams Obstetrics, 24th ed, p. 237.
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