Question

Foetal hydronephrosis is diagnosed in the mother at 34 weeks of gestation. The amniotic fluid is normal. Which of the following is the most appropriate management?

• A. Fetal intervention to decompress hydronephrotic kidney
• B. Premature termination of pregnancy followed by pyeloplasty
• C. Delivery at term followed by radiological examination
• D. Delivery at term followed by pyeloplasty

Hint:

Normal amniotic fluid means the kidneys are still functioning; no need for early delivery or fetal intervention.

Answer 1

The Correct Option is C

Step 1: Understand what fetal hydronephrosis with normal amniotic fluid means.
Fetal hydronephrosis is swelling of the kidney's collecting system, usually picked up on a routine antenatal ultrasound. Amniotic fluid volume mainly depends on fetal urine output, so a normal amniotic fluid volume at 34 weeks tells us that the fetal kidneys, taken together, are still making enough urine and are not in a state of severe or bilateral obstruction that threatens fetal well being.

Step 2: Decide whether urgent action is needed before birth.
Fetal intervention, such as placing a shunt to decompress the kidney before birth, is reserved for severe cases with bilateral disease and oligohydramnios (low amniotic fluid), where ongoing pregnancy risks permanent kidney and lung damage. Since fluid is normal here, there is no indication for an invasive fetal procedure, and no reason to deliver the baby early either.

Step 3: Decide the correct sequence of care.
The safest course is to let the pregnancy continue to term, since prematurity carries its own risks and the normal amniotic fluid shows the kidneys are coping well. After birth, the baby should have a proper radiological work-up, typically an ultrasound in the first days of life, sometimes repeated after the first week since neonatal dehydration can under-read the swelling early on, followed by further tests like a micturating cystourethrogram or a diuretic renogram if needed, to find the cause and decide if surgery such as pyeloplasty is actually required.

Step 4: Rule out the other options.

(A) Fetal intervention: Not needed, since this invasive step is reserved for severe bilateral obstruction with reduced amniotic fluid, which is not the case here.

(B) Premature termination followed by pyeloplasty: Unnecessarily exposes the baby to the risks of prematurity for a condition that is not causing fetal compromise, and surgery cannot even be planned properly before postnatal imaging confirms true obstruction.

(D) Delivery at term followed by pyeloplasty: Jumps straight to surgery without first confirming, through postnatal imaging, whether the hydronephrosis is even due to a surgical (obstructive) cause, since many antenatally detected cases turn out to be mild or resolve without surgery.

Step 5: Final Answer.
With normal amniotic fluid, the right plan is to deliver at term and then work up the kidney with radiological studies before deciding on any surgery.
\[ \boxed{\text{Delivery at term followed by radiological examination}} \]